Abstract: SA-PO409
Assessing the Role of Cooling on Hemodynamics of Patients on Dialysis in Inpatient Settings
Session Information
- Hemodialysis and Frequent Dialysis - 2
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Xue, Hui, Kaiser Permanente Southern California, San Diego, California, United States
- Liu, In-Lu Amy, Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, California, United States
- Chen, Aiyu, Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, California, United States
- Lin, Edward, Southern California Permanente Medical Group, Pasadena, California, United States
- Creekmur, Beth, Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, California, United States
- Abcar, Antoine C., Kaiser Permanente Southern California, Los Angeles, California, United States
- Chiu, Josephine J., Southern California Permanente Medical Group, Pasadena, California, United States
- Cho, Paula S., Southern California Permanente Medical Group, Pasadena, California, United States
- Fong, Patrick, Southern California Permanente Medical Group, Pasadena, California, United States
- Sim, John J., Kaiser Permanente Southern California, Los Angeles, California, United States
- Suh, Annie, Southern California Permanente Medical Group, Pasadena, California, United States
- Ali, Behzad, Southern California Permanente Medical Group, Pasadena, California, United States
Background
The effect of cooling dialysate to reduce intradialytic hypotension (IDH) in the inpatient setting is unknown.
Methods
Retrospective Cohort: Session Level: 2019 inpatient (IP) HD sessions (n=17357) were evaluated at Kaiser Permanente Southern California (KPSC). Using multivariable repeated measure models; covariates included age, gender, race, IP utilization, IP duration, HD sessions, HD temp, blood pressure (Bp), fluid removed, BMI, and Elixhauser index (EI). Patient Level: 3243 patients received IP HD. Multivariable analysis (Fine and Gray, Cox proportional hazards, Robust Poisson, multiple regression) examined 30-day and 12-month outcomes: re-admissions (re-IP), total IP/day, 30-day-alive-at-home, hospice referral and death. Covariates included age, sex, race, index IP characteristics, prior utilization and comorbidity.
Prospective cross-over design cohort: Session: Examined Cooled dialysate <36.5°C (CD) on IDH in 6 KPSC hospitals over 6-months in 2022. Each hospital served as its own control and was assigned to either 37.0°C or 35.5°C for the first 3 months, then switched in the 2nd 3 months. 6698 IP HD sessions were evaluated using a nested multivariable repeated measure model. Covariates included assigned temp (AT) and retrospective variables listed above. Patient: 1159 patients were followed for 12-months using models, covariates and outcomes similar to retrospective patient analyses with the addition of AT.
Results
Retrospective Cohort: Session: IDH risk factors were CD, older age, prior IP, lower ultrafiltration, under-weight, service area and higher EI. Higher Bp significantly reduce risk. Patient: IDH significantly increased risk of death, total IP/day and increased re-IP in 30-day.
Prospective cross-over design cohort: Session: Lower AT (35.5 °C) and higher Bp could significantly reduce IDH risk. Patient: Lower AT tended to reduce outcomes for patients with less comorbidities (EI < 11) in 30-day. Due to small sample size, no risk reductions were significant.
Comparison: Session: Prospective cross-over design reduced the effect of unmeasured confounders and shows AT (35.5 °C) could significantly reduce IDH risk (0.83 (0.71-0.97)).
Conclusion
CD reduced the risks of IP IDH, healthier patients had the greatest short-term benefits. Larger sample size needed for future work.