Abstract: SA-PO890
Blood Pressure Control and Days-in-Hospital Before and After Initiating Nocturnal In-Center Hemodialysis
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
- Lea, Janice P., Emory Dialysis Centers, Atlanta, Georgia, United States
- Hoge, Courtney E., Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
- Franch, Harold A., Emory Dialysis Centers, Atlanta, Georgia, United States
- Plantinga, Laura, Emory University School of Medicine, Atlanta, Georgia, United States
- Wilk, Adam S., Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
Background
Nocturnal dialysis (ND) can support longer sessions with lower ultrafiltration (UF) rates, compared to traditional in-center hemodialysis (HD). We compared UF rates, key blood pressure (BP) measures, and days hospitalized for ND patients before and after they initiated ND treatment.
Methods
We identified ND patients at a medium-sized dialysis organization to be those HD patients for whom ≥80% of dialysis sessions were ND sessions—starting at 6:30pm or later and lasted ≥5 hours—over the 3 months after their first ND session (≥20 sessions total) during 2010-16. Outpatient dialysis session and hospitalization dates were extracted for these patients within 12 months of ND transition (pre and post). BP measures included pre- and post-session sitting SBP and DBP, and minimum intradialytic SBP and DBP. Descriptive patient-month-level analyses of all outcomes were performed for all months with ≥7 sessions (i.e., still in care). We tested effects of ND care post-transition using generalized linear models with a Gaussian distribution and random intercepts and slopes; standard errors were clustered at the patient level.
Results
We identified 64 ND patients (4.7% of 1,357 eligible patients in care), with 354 pre-transition patient-months (3,974 sessions) and 496 post-transition patient-months (5,841 sessions). Post- vs pre-transition, we observed significant declines in UF rates (5.16 vs 9.34 mL/kg/hr, p<0.01), pre-SBP (154.1 vs 157.1 mmHg, p=0.05) and DBP (85.8 vs 88.0 mmHg, p=0.02), post-SBP (138.1 vs 142.6 mmHg, p<0.01) and DBP (77.0 vs 80.2 mmHg, p<0.01), and minimum intradialytic SBP (113.6 mmHg vs. 120.6 mmHg, p<0.01) and DBP (60.4 mmHg vs. 65.0 mmHg, p<0.01). We observed no change in hospitalized days per month (0.78 vs 0.82 days, p=0.80). Regression results accounting for patient-level clustering were similar, including a decline in UF rates (-3.57 mL/kg/hr, p<0.01) and no change in hospitalized days (-0.095 days, p=0.60) post-transition.
Conclusion
While patients experienced significant improvements in BP control both inter- and intradialytically after initiating ND treatment, we observed no change in their days hospitalized.