Risk factors for increased variability in dialysis delivery in haemodialysis patients

BACKGROUND: Numerous events may occur during a haemodialysis session, leading to variation in the quantity of dialysis received. The purpose of this study was to identify risk factors for variability in haemodialysis delivery. METHODS: Variability in dialysis delivery was expressed by the coefficient of variation (CV%) and calculated for the volume of blood processed (VBP) for all treatments and the monthly urea reduction ratio (URR) in each patient over an 8 month period. The univariate and multivariate relationships between various predictor variables and the URR and VBP CV% were determined. RESULTS: Eighty-nine patients were identified who met study criteria. The mean VBP and URR CV% were 10.3 +/- 4.7 and 5.4 +/- 3.8%, respectively. Patients with tunnelled catheters and total nursing-care patients had higher VBP and URR CV%, as evaluated by multivariate analysis. Patients with inadequate dialysis (mean URR <65%) had a higher VBP CV% than those patients with mean URR values > or =65% (14.8 +/- 5.4 vs 9.7 +/- 4.5%; P = 0.01). An accurate determination of the URR in 90% of patients required 14 measurements in patients with catheters vs three and two measurements in arteriovenous fistulae and polytetrafluoroethylene grafts, respectively. CONCLUSIONS: This study demonstrated that the use of a venous tunnelled catheter and dialysis in a total nursing-care unit were the only factors independently associated with greater variability in both VBP and URR. Attention to individual dialysis sessions in patients with tunnelled catheters or in a total nursing-care unit is prudent, particularly when identifying reasons for under-dialysis.