Delivered dialysis dose is suboptimal in hospitalized patients

Underdialyzed patients have high hospitalization and mortality rates. It is unclear if such patients receive adequate dialysis during hospitalization. In this cross-sectional study, we evaluated single treatment delivered dia lysis dose during hospitalization and compared this to the dosage received at the free-standing outpatient clinics in the same patients. Eighty-four p atients (54% male) aged 23-63 years (means +/- SD 55.5 +/- 14.6) who have b een on dialysis for at least 3 months were evaluated. Hypertension and diab etes were the most common diagnoses, while thrombosed graft or fistula acco unted for 40% of admissions. The mean dialysis treatment time (Td) was 30 m in longer in the outpatient (OP) setting than the hospital (H): 3.6 +/- 0.3 vs. 3.1 +/- 0.2 h (p < 0.0001). Attained blood flow (QB) was 15 % greater in the OP than H: 394 +/- 40 vs. 331 +/- 54 ml/min (p < 0.0001). The Kt/V w as analyzed in 49 of 84 patients; the OP Kt/V was 20% greater than the H Kt /V: 1.38 +/- 0.2 vs. 1.11 +/- 0.1 (p < 0.0001). A further breakdown of H Kt /V according to access and membrane types showed that patients with functio nal grafts/fistula had a higher Kt/V than those with temporary accesses 1.1 4 +/- 0.1 vs. 1.07 +/- 0.1 (p = 0.01). We conclude that hospitalized patien ts receive suboptimal dialysis dose, this could have a negative impact on s urvival if hospitalization is recurrent and prolonged. Kinetic modeling sho uld be routinely performed in such patients and Td should be increased in p atients with temporary accesses.