Blood Volume Monitoring in Hospitalized Patients with ESKD and Heart Failure

Background: Heart failure (HF) is the leading cause of hospitalization in people with end-stage kidney disease (ESKD). The co-occurrence of ESKD and HF increases this likelihood. This study assesses the association between blood volume monitoring (BVM) guided hemodialysis (HD) and clinical outcomes in ESKD patients with HF admitted for HF exacerbation. Methods: This multicenter retrospective cohort study, conducted between January 2017 and January 2020, included 278 hospitalized HD-dependent individuals with HF admitted for HF exacerbation. BVM was either applied or not according to the admitting hospital’s protocols. BVM use was confirmed based on manual patient chart review. Data for demographics, comorbidities, and clinical parameters were extracted from the electronic health records. Results: 278 patients were hospitalized between 2017 and 2020 (mean age: 70 years, 58% males, 62% white) with an average index hospitalization of 7 days [(interquartile range) IQR: 4.00, 11.75]. 168 patients (58%) were dialyzed with BVM while 118 (42%) were dialyzed without BVM during hospitalization. Multivariable adjusted analyses showed that BVM-guided HD was associated with a shorter length of stay (difference of -2.00 days, 95% confidence interval (CI) -3.90 to -0.13), reduced number of readmissions within 90- (adjusted Beta Coefficient= -0.27, 95% CI: -0.48, -0.06) and 180-days post-discharge (adjusted Beta Coefficient= -0.47, 95% CI: -0.48, -0.06) compared to assignment to without BVM guidance. During 2015 and 2017, BVM was not utilized at MGH and BWH, 100 patients dialyzed independent of BVM showed no difference in all endpoints. Conclusion: BVM use was associated with shorter length of stay and lower number of readmits in patients with ESKD hospitalized for HF.