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Changing hemodialysis thresholds for optimal survival.

L A Szczech1, E G Lowrie, Z Li

  • 1Duke Institute for Renal Outcomes Research and Health Policy, Duke University Medical Center, Durham, North Carolina 27710, USA. szcze001@mc.duke.edu

Kidney International
|February 13, 2001
PubMed
Summary

The urea reduction ratio (URR) threshold for optimal hemodialysis survival increased from 1994 to 1997. Current minimum URR recommendations may be too low for current patient populations and dialysis practices.

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Area of Science:

  • Nephrology
  • Clinical Epidemiology
  • Dialysis Efficacy

Background:

  • The urea reduction ratio (URR) quantifies solute removal during hemodialysis and is a key measure of dialysis dose in the U.S.
  • A prior recommendation suggested a minimum URR of 65% for optimal survival, based on older patient data.
  • Contemporary hemodialysis technologies and patient demographics necessitate re-evaluation of URR's relationship with mortality.

Purpose of the Study:

  • To examine the relationship between hemodialysis dose (URR) and mortality in current patient cohorts.
  • To determine the URR threshold for optimal mortality benefit in contemporary hemodialysis practice.
  • To assess if the previously recommended minimum URR of 65% remains adequate.

Main Methods:

  • Retrospective cohort study of over 15,000 hemodialysis patients annually from 1994-1997.

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  • Averaged patient URR over three months preceding each year for analysis.
  • Utilized spline functions in logistic regression to identify URR thresholds for mortality benefit, adjusting for case mix.

    • Main Results:

    • Median URR increased from 63.2% in 1994 to 68.1% in 1997.
    • The URR threshold for mortality benefit also rose, from 61.1% in 1994 to 71.0% in 1997.
    • The ratio of median URR to the mortality benefit threshold decreased, indicating a potential gap between achieved and optimal URR.

    Conclusions:

    • Both median URR and the URR threshold for mortality benefit increased between 1994 and 1997.
    • Observed increases in URR may be due to procedural changes rather than increased dialysis dose.
    • The current recommended minimum URR of 65% appears insufficient for optimal mortality benefit in contemporary hemodialysis.