Abstract: SA-PO909
Pre- and Post-Kidney Transplantation Body Weights: Assessing Dry Weight Levels
Session Information
- Dialysis: Cardiovascular, BP, Volume
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Chait, Yossi, University of Massachusetts, Amherst, Massachusetts, United States
- Wojciechowski, David, Massachusetts General Hospital, Boston, Massachusetts, United States
- Crisalli, Kerry, Massachusetts General Hospital, Boston, Massachusetts, United States
- Germain, Michael J., Renal and Transplant Assoc of New England, Hampden, Massachusetts, United States
- Thadhani, Ravi I., Cedars-Sinai, Los Angeles, California, United States
Background
The single most important variable in fluid management during hemodialysis (HD) is dry weight (DW). Incorrect DW values result in hypo- or hyper-volemic patients at the end of HD treatments, conditions with serious morbidity and mortality consequences. There is lack of consensus about the definition and assessment of DW; however, consensus opinion is that the optimal DW (ODW) target should be near a patient’s weight at euvolemic state. We investigated this hypothesis by comparing patient weights pre- and post-transplantation (Tx) in hemodialysis patients early post transplant with functional grafts . We assumed that patients with functioning allografts achieve euvolemia by week 2 post transplant .
Methods
DW before Tx, weights, demographics, and biomarkers, were retrospectively collected for 42 patients that underwent kidney transplantation at Massachusetts General Hospital during 2016-2017. A creatinine level Cr<1.5 mg/dL was assumed to indicate a functioning graft and a euvolemic state. The ODW target was defined as the weight at week 2 post transplant for patients with a functioning graft. Patients with DW within +1% and -3% of ODW were considered to have DW values “sufficiently close” to ODW (+0.5 to -1.5 kg in a 50kg patient). In patients with a functioning graft, we used Wilcoxon signed rank test to analyze the agreement between paired changes in weight and hemoglobin (Hb) between weeks 1 and 2 post-Tx.
Results
73% (N=31) of the 42 patients were males; 40% (N=17) received transplants from living donors; 10 patients had a functioning graft at week 1 (all living donor type) and 10 additional patients achieved that at week 2 (8 cadaver donor type). In the group with a functioning graft by week 2 (N=20) 21% had too low DW values (i.e., 3% or more below ODW), and 47% had too high DW values. Weight changes in the group with a functioning graft were significantly correlated with Hb changes between weeks 1 and 2 post-Tx r=-0.7 (p<0.001).
Conclusion
A high number (68%) of HD patients may have incorrect DW values with 21% rendered hypovolemic and 47% hypervolemic. Weight reduction in group with a functioning graft at week 2 issignificantly correlated with fluid volume reduction. It is imperative that new dry-weight assessment methods be developed that could improve cardiovascular outcomes in hemodialysis.
Funding
- NIDDK Support