Relationship between effective blood flow rate and clinical outcomes in maintenance hemodialysis patients: a single-center study

Ren Fail. 2024 Dec;46(1):2344655. doi: 10.1080/0886022X.2024.2344655. Epub 2024 Apr 29.

Abstract

The association between blood flow rate (BFR) and clinical outcomes in patients undergoing maintenance hemodialysis (MHD) is inconclusive. This retrospective study included 175 patients undergoing MHD treatment between July 2015 and March 2022, divided into two groups based on time-averaged effective blood flow rate (eBFR) median value. We investigated arteriovenous fistula (AVF) outcomes and the association of eBFR with all-cause mortality and new major adverse cardiovascular events (MACE). Mean ± SD and median time-averaged eBFR values were 276 ± 24 and 275 mL/min, respectively. After adjusting for relevant factors including age, sex, vintage, diabetes, CVD, receiving hemodiafiltration (HDF) treatment and spKt/V, Cox models indicated a low time-averaged eBFR (≤ 275 ml/min) was associated with increased risks of all-cause mortality (hazard ratio [HR] 14.18; 95% confidence interval [CI], 3.14-64.1) and new MACE (HR 3.76; 95% CI, 1.91-7.40) in MHD patients. Continuous Cox models demonstrated each 20 ml/min increase in eBFR linked to a 63% decrease in the risk of all-cause mortality (HR: 0.37, 95% CI: 0.23-0.59) and a 38% decrease in the occurrence of new MACE (HR: 0.62, 95% CI: 0.46-0.84). There was no significant difference in AVF outcomes between the two groups. Our study noted higher eBFR (>275 mL/min) is associated with lower risks of both all-cause mortality and new MACE compared with low eBFR (≤275 mL/min). Increased eBFR is not associated with a higher risk of AVF failure.

Keywords: Hemodialysis; all-cause mortality; arteriovenous fistula; effective blood flow rate; major adverse cardiovascular events.

MeSH terms

  • Aged
  • Arteriovenous Shunt, Surgical / adverse effects
  • Blood Flow Velocity
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality
  • Female
  • Hemodiafiltration / adverse effects
  • Hemodiafiltration / methods
  • Humans
  • Kidney Failure, Chronic* / mortality
  • Kidney Failure, Chronic* / therapy
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Renal Dialysis*
  • Retrospective Studies
  • Treatment Outcome

Grants and funding

This work was supported by the Hebei Provincial Specialty Capacity Building and Specialty Leader Training Project ([2018]674), the Hebei Provincial Excellent Talents in Clinical Medicine Training Project ([2019]139), the Hebei Province Medical Technology Tracking Project (GZ2020013), the Hebei Clinical Medical Research Center Project (20577701D), the Project of the Hebei Provincial Excellent Health Talents and High-Quality Development of Public Hospitals([2022]180), and Hebei Natural Science Foundation Project (H2023206385).