Ilic LM, et al. - In this pilot study, researchers proposed a novel marker, the Interdialytic Creatinine Rise (IDCR), readily calculated as the change in serum creatinine over time (in mg/dL/h), to determine volume overload and anticipate mortality risk in hemodialysis patients. Findings revealed that IDCR was appeared to be a novel metric that reduces with fluid retention and increases after fluid removal. The study findings suggested that IDCR could assist medical practitioners in the discovery or exclusion of volume overload in hemodialysis patients and provide prognostic value in identifying those at high risk for death.

Methods

• For this investigation, researchers calculated IDCR changes with volume in a prospective cohort of 35 hospitalized hemodialysis subjects awaiting hemodialysis and 33 hospitalized patients undergoing hemodialysis every other day.
• IDCR cutoff values related to hypervolemia were determined between two treatments and compared with simultaneous volume assessments by their nephrologist in a prospective cohort of 25 outpatients.
• IDCR as a mortality predictor was studied using survival analysis in a longitudinal retrospective cohort study of 39 maintenance hemodialysis subjects followed from 2012 until death or 2017.

Results

• The study results showed that IDCR decreased by - 0.014 mg/dL/h each day (95%CI – 0.017,- 0.010; p < 0.001) without dialysis due to fluid volume gain and increased by 0.013 mg/dL/h (95%CI 0.008,0.017; p < 0.001) from before to after each successive hemodialysis due to fluid removal.
• It was observed that choosing an IDCR cutoff value of ≤0.1 had sensitivity of 82% and specificity of 79% in diagnosing volume overload with the area under the ROC curve of 0.78 (95%CI 0.59,0.97).
• Findings revealed that the hazard ratio of death for each 0.01 decrease in IDCR was 1.64 (95%CI 1.31,2.07; p < 0.001).
• According to the findings obtained, the median survival was 32 days and the odds ratio of death within 2 months was 38 (95%CI 8, 131; p < 0.001) if IDCR decreased to less than 0.05 mg/dL/h.