The relationship between dialysis prescription/dialysis dose and patient mortality : : Death risk among patients with different backgrounds

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A retrospective observational study was conducted to determine the relationship between the treatment time (TT)/blood flow rate (Qb)/dialysis dose (Kt urea) and patient mortality using data from the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR). The 1-year mortality (up to the end of 2003) and 5-year mortality (up to the end of 2007) risks of thrice-weekly HD patients as of the end of 2002 were assessed by performing a logistic regression analysis of HD prescription and dose data, using a cause of death other than accident or suicide as the endpoint. The patients were stratified by sex, post-dialysis body weight (PDBW), predialysis serum albumin (Alb), creatinine generation rate corrected by sex and age (%CGR), and normalized protein catabolic rate (nPCR). The results for patients on HD for 5 or more years were as follows: When a TT of ≥240min and <270min was regarded as the reference, the mortality risk was higher in the group of patients with a shorter TT and lower in patients with a longer TT regardless of subgroups. When a Qb of ≥200mL/min and <220mL/min was regarded as the reference, the mortality risk was higher in the patients with a lower Qb, and lower in the group of patients with a higher Qb, except female patients and patients aged ≥75, PDBW <40kg, Alb <3.0g/dL, %CGR <80%, and nPCR <0.7g/kg/day. When a Kt urea of ≥38.8L and <42.7L was used as the reference, the group of patients with a Kt urea smaller than this had an increased mortality risk, and patients with a larger Kt urea had a decreased mortality risk, except those with Alb <3.0g/dL, %CGR <80%, and nPCR<0.7g/kg/day. The results for patients on HD for less than 5 years were similar. These results suggest that the life prognosis of thrice-weekly HD patients may be improved by increasing the dialysis dose through a longer TT and increased Qb, except for malnourished patients.

The relationship between dialysis prescription/dialysis dose and patient mortality : : Death risk among patients with different backgrounds

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