Interdialytic weight gain and ultrafiltration rate in hemodialysis: Lessons about fluid adherence from a national registry of clinical practice

Excessive interdialytic weight gain (IWG) and ultrafiltration rates (UFR) above 10 mL/h/kg body weight imply higher morbidity and mortality. This study aimed to estimate the prevalence of high fluid consumers, describe UFR patterns, and describe patient characteristics associated with IWG and UFR. The Swedish Dialysis DataBase and The Swedish Renal Registry of Active Treatment of Uremia were used as data sources. Data were analyzed from patients aged >= 18 on regular treatment with hemodialysis (HD) and registered during 2002 to 2006. Interdialytic weight gain and dialytic UFR were examined in annual cohorts and the records were based on 9693 HD sessions in 4498 patients. Differences in proportions were analyzed with the chi-square test and differences in means were tested using the ANOVA or the t test. About 30% of the patients had IWG that exceed 3.5% of dry body weight and 5% had IWG >= 5.7%. The volume removed during HD was > 10 mL/h/kg for 15% to 23% of the patients, and this rate increased during the first dialytic year. Patient characteristics associated with fluid overload were younger age, lower body mass index, longer dialytic vintage, and high blood pressure. By studying IWG and dialytic UFR as quality indicators, it is shown that there is a potential for continuing improvement in the care of patients in HD settings, i.e., to enhanced adherence to fluid restriction or alternatively to extend the frequency of dialysis for all patients, e.g., by providing daily treatment.