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Associations between hemodialysis facility practices to manage fluid volume and intradialytic hypotension and patient outcomes

Clinical Journal of the American Society of Nephrology Feb 11, 2019

Dasgupta I, et al. - Researchers investigated how hemodialysis facility practices related to fluid volume and intradialytic hypotension are correlated to patient outcomes via analyzing data from 10,250 patients in 273 facilities across 12 countries, from phase 4 of the Dialysis Outcomes and Practice Patterns Study. Of ten facility practices tested (chosen a priori), having a protocol that specifies how often to assess dry weight in most patients was noted to correlate with lower all-cause and cardiovascular mortality. Lower all-cause hospitalization and cardiovascular events were evident with routine orthostatic BP measurement to assess dry weight. Routine use of lower dialysate temperature to limit or prevent intradialytic hypotension was noted to be correlated with lower cardiovascular mortality. Higher all-cause hospitalization was noted in correlated with routine use of an online volume indicator to assess dry weight. Using sodium modeling/profiling routinely to limit or prevent intradialytic hypotension was correlated with higher all-cause mortality, cardiovascular mortality, and cardiovascular events.
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