Could Targeting Dry Weight on Hemodialysis Patients Before Kidney Transplantation Leave Them Too Dry?
Bibliographic record
Abstract
Background: Delayed graft function (DGF) after kidney transplantation is associated with inferior kidney and patient outcomes. Studies suggest that avoidance of hypovolemia peri-kidney transplantation is associated with a reduced risk of DGF. Hemodialysis (HD) patients that have HD prior to transplant targeting their usual dry weight may be volume contracted pre-transplant and at increased risk for DGF. By definition the dry weight is the state of near maximal volume contraction for most HD patients. The objective of this study is to examine the proportion of HD patients who have a pre-transplant post-HD weight at or below their usual dry weight. Methods: This is a retrospective study of sequential kidney transplants in HD patients at our center from Jan 2015 to Dec 2019. The primary outcome was the proportion of patients who had an HD session before transplantation that resulted in a post-HD weight equal to or less than their prevalent set target dry weight. Data was extracted from the electronic medical record and chart review. Recipients on home therapies and pre-emptive transplants were excluded. Results: Of 68 kidney transplants done in the study period, 40 were in-center HD patients with available HD data. They were mean age 54.8±14.5 years, 12 (30%) female, and majority were Caucasian. Twenty-five (62.5%) patients had a pre-transplant post-HD weight equal to or less than their prevalent set target dry weight (mean - 0.26±0.25 kg). The other 15 (37.5%) patients achieved post-HD weights higher than their usual targets (+0.72±0.41 Kg). Conclusions: The results of this study suggest that a high proportion of HD patients are at below dry weight after their dialysis and may be hypovolemic before kidney transplantation. This may represent at potentially avoidable increased risk for DGF. Further studies are planned to examine possible associations of achieved post-HD weight prior to transplant with perioperative central venous pressure, IV fluid administration, and graft function. There may be strategies to optimize volume status pre-transplantation to mitigate this risk of DGF including targeting a higher weight on HD or administration of IV fluid to raise weight above the prevalent set target dry weight before transplantation when feasible.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".