Restitution volumes at the end of dialysis sessions: A potential influencing factor on patients' haemoglobin levels?
Joao Fazendeiro Matos, Ricardo Peralta, Carla Felix and 7 others
PMID 31660157WHAT IT FOUND
Thorough blood reinfusion at the end of dialysis is linked to slightly higher haemoglobin levels.
However, the effect is tiny, explaining only 0.6% of variation. Clinics using higher reinfusion volumes did not significantly reduce their use of anaemia medications.
Key findings
01Restitution volume explained only 0.6% of the variation in haemoglobin levels, meaning 99.4% of the change was due to other factors.
02Although statistically significant, the association between restitution volume and haemoglobin was weak, with an increase of 0.1318 g/dl per 100 ml of restitution volume.
03Clinics that used higher restitution volumes did not show a statistically significant reduction in the consumption of erythropoiesis-stimulating agents or iron compared to clinics using lower volumes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study is observational, so it can only show associations, not cause and effect. Many other factors influence haemoglobin levels that were not controlled for. The authors could not isolate patients who had infections or received blood transfusions, which are major drivers of anaemia and could skew the results. The statistical significance of the restitution volume effect is heavily influenced by the large sample size, masking the fact that the clinical impact is extremely small (0.6% variance).
Declared interests
The study was conducted using data from Fresenius Medical Care NephroCare Portugal, and the authors are affiliated with this company, which provides the dialysis services and machines studied.
The easy way to misread this
Do not interpret the statistical significance of the restitution volume as clinical importance. The effect on haemoglobin is so small (explaining 0.6% of variation) that increasing reinfusion volume alone will not meaningfully improve anaemia or reduce medication needs.