대한신장학회

논문분류	춘계학술대회 초록집
제목	Blood Flow Rate and Mortality in Chronic Hemodialysis Patients
저자	Kyung Yoon Chang1, Su-Hyun Kim2, Hyung Wook Kim1, Young Ok Kim1, Dong Chan Jin1,Ho Chul Song1, Euy Jin Choi1, Yong-Lim Kim3, Yon-Su Kim4,Shin-Wook Kang5, Nam-Ho Kim6, Chul Woo Yang1, Yong Kyun Kim1
출판정보	2014; 2014(1):
키워드	사망률, 혈액 투석, 혈류속도
초록	Background: Inadequacy of dialysis is associated with morbidity and mortality in chronic hemodialysis (HD) patients. Blood flow rate (BFR) is one of the important determinants of increasing dialysis dose. However, the optimal BFR is unclear. In this study, we investigated the impact of the BFR on mortality in chronic HD patients. Methods: Prevalent HD patients were selected from Clinical Research Center registry for End Stage Renal Disease cohort in Korea. Patients were categorized into two groups by BFR <250 ml/min and BFR ≥250 ml/min. The primary outcome was all-cause mortality. Vascular access was major potential confounder of BFR and mortality. Therefore, we also performed subgroup analysis according to the vascular access. Cox regression analysis was used to calculate the adjusted hazard ratio (HR) of mortality. Results: A total of 1,669 prevalent HD patients were included. The median follow-up period was 30 months. Kaplan- Meier analysis showed that the mortality rate was significantly higher in patients with BFR <250 ml/min than those with BFR ≥250 ml/min (p=0.024, Log-rank). The multivariate Cox proportional hazard model showed that patients with BFR <250 ml/min tended to exhibit higher mortality than those with BFR ≥250 ml/min but statistically not significant (HR 1.43, 95% CI, 0.98-2.08, p=0.062). In subgroup analysis according to the vascular access, patients with BFR <250 ml/min had significantly higher mortality than those with BFR ≥250 ml/min after adjustment for clinical variables in subgroup with arteriovenous fistula (HR 1.81, 95% CI, 1.15-2.84, p=0.010), while mortality was not significant different between patient with BFR <250 ml/min and BFR ≥250 ml/min in subgroup with arteriovenous graft (HR 0.70, 95% CI, 0.26-1.84, p=0.466) or subgroup with catheter (HR 1.32, 95% CI, 0.48-3.66, p=0.595). Conclusions: Our data showed that elevated BFR < 250 ml/min is associated with increased mortality in chronic HD patients, especially in patients with AVF.
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