Abstract: SA-PO911
Clinical Impact of CMS’ Ultrafiltration Limit on Hemodialysis Patients
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
- Silberzweig, Jeffrey I., The Rogosin Institute, New York, New York, United States
- Levine, Daniel, The Rogosin Institute, New York, New York, United States
- Parker, Thomas, The Rogosin Institute, New York, New York, United States
- Morris, Diane, The Rogosin Institute, New York, New York, United States
Group or Team Name
- The Governing Body of The Rogosin Institute
Background
In January 2018, CMS instituted a reporting requirement: dialysis facilities must report the percentage of treatments during which patients removed less than 13 cc/kg/hr of fluid based on data demonstrating a relationship between higher ultrafiltration (UF) rates and adverse cardiac effects including myocardial stunning. Many dialysis patients demonstrate adverse effects from volume overload both acutely and chronically including hospitalizations for related complications and poorly controlled hypertension. We sought to evaluate the effect of the new CMS requirement on the clinical status of our maintenance hemodialysis (HD) patients.
Methods
As part of the QAPI program at The Rogosin Institute, we began monitoring the percentage of patients meeting CMS' UF requirement in January 2018. After three months living with this limit, we asked facilities to report on the proportion of patients demonstrating evidence of fluid overload and methods for managing patients not thriving in the face of the UF limit. We analyzed the data using descriptive statistics to look for relationships between the measured variables.
Results
More than 90% of the 1,197 patients dialyzed in our seven facilities met CMS' UF requirement each month. Problems living with the fluid restriction and problems reaching target weight with the UF requirement were reported by 283 (24%) and 143 (12%) of our patients, respectively. Despite 27 patients (2%) receiving more than three treatments weekly, 50 (4%) patients were hospitalized during a three month period for symptoms related to volume overload. In our population, 299 patients (25%) had inadequate blood pressure control and 262 (22%) required more than three medications to control blood pressure.
Conclusion
Despite the documented benefits of limiting UF rates for patients treated by maintenance HD, the restriction has adverse effects: more than 4% of our population was hospitalized during the first three months of the restriction and more than 25% of our population has inadeaquate blood pressure control despite standard interventions. We are developing best practices for managing fluid overload and attempting to improve the clinical outcomes for patients struggling to live with the new CMS UF limit.