Active fluid management in Tassin/France of the 21st century and outcomes

Whether active fluid management prospectively improves hemodialysis outcomes is today more unknown than ever. 1 Zoccali C. Torino C. Mallamaci F. et al. A randomized multicenter trial on a lung ultrasound-guided treatment strategy in patients on chronic hemodialysis with high cardiovascular risk. Kidney Int. 2021; 100: 1325-1333 Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar Historically, the “Centre de Rein Artificiel” in Tassin/France has been recognized for strictly “probing dry weight,” which was placed in context with blood pressure control and excellent survival. 2 Charra B. Calemard E. Ruffet M. et al. Survival as an index of adequacy of dialysis. Kidney Int. 1992; 41: 1286-1291 Abstract Full Text PDF PubMed Scopus (682) Google Scholar We aimed at providing an update on fluid management in Tassin, hypothesizing that the mortality rate of the 2000 to 2014 Tassin incident cohort would be superior to that in the Dialysis Outcomes and Practice Patterns Study (for methodology, see the Supplementary Methods). 3 Pisoni R.L. Gillespie B.W. Dickinson D.M. et al. The Dialysis Outcomes and Practice Patterns Study (DOPPS): design, data elements, and methodology. Am J Kidney Dis. 2004; 44: 7-15 Abstract Full Text Full Text PDF PubMed Scopus (259) Google Scholar The Tassin cohort comprised 648 patients of median age 73.2 years (Supplementary Table S1), who lost 4 kg body weight on average, by week 4 after hemodialysis initiation (Figure 1a ). Blood pressure decreased steadily, reaching 9 mm Hg lower by week 36 (Figure 1b). The median hemodialysis session length was 5.0 hours (Figure 1c), with 27.7% patients having “long, slow dialysis” of 3 times 8 hours at week 24. Median survival of the entire Tassin cohort was 4.6 years and was 5.3 years when restricting to patients surviving to 90 days. The latter restriction enabled a mortality comparison with the Dialysis Outcomes and Practice Patterns Study (Figure 1d–f), showing that the age-adjusted mortality rate in Tassin was close to average of the European and French facilities. In summary, the Tassin probing-dry-weight approach was no longer associated with improved survival. In consequence, we suggest managing fluid even more actively, by incorporating several objective measurements of volume status together. 4 Hecking M Madero M Port FK et al. Fluid volume management in hemodialysis: never give up! Kidney Int. https://doi.org/10.1016/j.kint.2022.09.021 Google Scholar