B13(Th)
DIALYSIS UNIT PRACTICES AIMED AT TARGET WEIGHT ACHIEVEMENT AND PATIENT
OUTCOMES IN DOPPS
Coogan, L, Barlow, J, Saran, R, Fuller, D, Sen, A, Jacobsen, S, Vanholder, R, Tomo, T, Tentori, F
Accrington Victoria Hospital, University of Michigan, Ann Arbor, US, Arbor Research Collaboration for
Health, Ann Arbor, US, Danderyd Hospital, Stockholm, Sweden, UZ Gent, Belgium, Oita University
Hospital, Oita, Japan
BACKGROUND: Failure to achieve target weight exposes dialysis patients to long-term volume expansion and
drives increasing left ventricular mass and hypertension. This has been shown to be associated with increased
risk of cardiovascular events and death. We sought to link patient outcomes with strategies utilized by dialysis
facilities in 12 countries towards selecting and achieving target weight (TW).
METHODS: Medical Directors of DOPPS III facilities (2005-2008, n=240) reported the typical frequency of
TW assessment and rated importance of 7 IDFM practices used to assess TW at their unit: physical examination,
on-line volume monitoring, chest X-ray, orthostatic BP, intradialytic hypotension, Hb, and symptoms. Adjusted
regressions were used to predict patient-level TW achievement and mortality.
RESULTS: Wide variation was noted across countries for the 7 IDFM practices. TW achievement was
improved among patients in units which indicated higher frequency of TW assessment and higher importance of
chest X-ray to assess TW (Figure, upper half). Patients in units that rated physical examination to have low
importance in assessing TW showed significantly higher hazard of mortality (Figure, lower half) compared to
patients in facilities rating it to be very important. Patients in facilities that rated chest X-rays to be very
important in determining TW tended to have a lower HR of mortality.
CONCLUSIONS: Increased frequency of TW assessment at dialysis units and greater emphasis towards
physical examination in determining volume status was associated with improved TW achievement and lower
mortality in haemodialysis patients. Additional results regarding on-line volume monitoring suggest that reliance
on technology alone may not be the best solution in this area compared with clinical assessment.