From the Research
Introduction to Prognosis for Initiating Dialysis for Ultrafiltration (UF) in Patients with End-Stage Kidney Disease (ESKD)
The prognosis for patients with End-Stage Kidney Disease (ESKD) initiating dialysis for Ultrafiltration (UF) is a complex issue, influenced by various factors including the timing of dialysis initiation, the presence of comorbidities, and the patient's overall health status. According to 1, long-term prognosis in dialysis is poor compared to that in healthy control persons, with cardiovascular causes being the most common reason for morbidity in these patients.
Factors Influencing Prognosis
Several factors can influence the prognosis of patients with ESKD initiating dialysis for UF, including:
- The presence of comorbidities such as congestive heart failure, ischemic heart disease, or left ventricular dysfunction or hypertrophy 1
- The timing of dialysis initiation, with some studies suggesting that earlier initiation may not necessarily improve prognosis 2, 3
- The patient's volume status, with volume overload being a significant risk factor for mortality 2, 4
- The presence of malnutrition and low albumin levels, which can worsen prognosis 1
- The patient's hematocrit level, with anemia or high hematocrit levels potentially impairing cardiac function 1
Treatment and Management
To improve prognosis, several treatment and management strategies can be employed, including:
- Finding the right dry weight to minimize volume overload and prevent hypotension 1
- Minimizing interdialytic weight gain to reduce the risk of volume overload 1
- Optimizing the target for hemoglobin to prevent anemia and improve cardiac function 1
- Lowering dialysate calcium to reduce the risk of cardiovascular disease 1
- Using higher dialysate potassium if long dialyses are performed to prevent hypokalemia 1
Dosing and Duration
The dosing and duration of dialysis can also impact prognosis, with some studies suggesting that:
- A higher dialysis dose per week may improve survival 5
- The frequency and duration of dialysis sessions can impact the patient's volume status and overall health 5
Caveats and Differentials
It is essential to consider several caveats and differentials when initiating dialysis for UF in patients with ESKD, including:
- The risk of hypotension and hypoperfusion of vital organs if ultrafiltration goes beyond compensatory mechanisms 1
- The potential for cardiac morbidity, aspiration pneumonia, vascular access closure, or neurological complications if dialysis is not managed carefully 1
- The importance of individualizing treatment and management strategies to each patient's unique needs and health status 2, 5