Target weight achievement and ultrafiltration rate thresholds: potential patient implications

Area of Science:

• Nephrology
• Dialysis
• Patient Outcomes

Background:

• Higher ultrafiltration (UF) rates and extracellular fluid imbalances are linked to adverse outcomes in maintenance hemodialysis patients.
• The Centers for Medicare and Medicaid Services considered UF rate and target weight achievement measures for quality incentive programs.
• These measures aimed to balance aggressive and conservative fluid removal strategies.

Purpose of the Study:

• To examine the proposed target weight measure for hemodialysis.
• To quantify potential weight gain if UF rate thresholds were applied without concurrent treatment time (TT) extension or interdialytic weight gain (IDWG) reduction.

Main Methods:

• Analysis of 2012 data from a large dialysis organization, including 152,196 United States hemodialysis patients.
• Description of monthly patient and dialysis facility target weight achievement patterns.
• Computation of theoretical 1-month fluid-related weight gain under a capped UF rate (13 mL/h/kg) without TT extension or IDWG reduction.

Main Results:

• Target weight achievement varied across patient subgroups, with younger, black patients on catheter dialysis and those with shorter dialysis vintage being less likely to achieve target weight.
• Facilities in the Midwest and South, and those with higher proportions of black, Hispanic, or shorter TT patients, showed less favorable target weight measure scores.
• Without TT extension or IDWG reduction, implementing a 13 mL/h/kg UF rate threshold theoretically resulted in an average 1-month fluid-related weight gain of 1.4 ± 3.0 kg.

Conclusions:

• Hemodialysis target weight achievement patterns differ significantly across patient clinical subgroups.
• Implementing maximum UF rate thresholds without considering extracellular volume status may inadvertently lead to increased fluid-related weight gain.