No evidence of a legacy effect on survival following randomization to extended hours dialysis in the ACTIVE Dialysis trial

Brendan Smyth, Li Zuo, Nicholas A. Gray, Christopher T Chan, Janak de Zoysa, Daqing Hong, Kris Rogers, Jia Wang, Alan Cass, Martin Gallagher, Vlado Perkovic, Meg Jardine

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Aim: Extended hours haemodialysis is associated with superior survival to standard hours. However, residual confounding limits the interpretation of this observation. We aimed to determine the effect of a period of extended hours dialysis on long‐term survival among participants in the ACTIVE Dialysis trial.

    Methods: Two‐hundred maintenance haemodialysis recipients were randomized to extended hours dialysis (median 24 h/wk) or standard hours dialysis (median 12 h/wk) for 12 months. Further pre‐specified observational follow up occurred at 24, 36 and 60 months. Vital status and modality of renal replacement therapy were ascertained.

    Results:
    Over the 5 years, 38 participants died, 30 received a renal transplant, and 6 were lost to follow up. Total weekly dialysis hours did not differ between standard and extended groups during the follow‐up period (14.1 hours [95%CI 13.4‐14.8] vs 14.8 hours [95%CI 14.1‐15.6]; P = .16). There was no difference in all‐cause mortality (hazard ratio for extended hours 0.91 [95%CI 0.48‐1.72]; P = .77). Similar results were obtained after censoring participants at transplantation, and after adjusting for potential confounding variables. Subgroup analysis did not reveal differences in treatment effect by region, dialysis setting or vintage (P ‐interaction .51, .54, .12, respectively).

    Conclusion: Twelve months of extended hours dialysis did not improve long‐term survival nor affect dialysis hours after the intervention period. An urgent need remains to further define the optimal dialysis intensity across the broad range of dialysis recipients.
    Original languageEnglish
    Article numbere13737
    Pages (from-to)792-800
    Number of pages9
    JournalNephrology
    Volume25
    Issue number10
    Early online date5 Jun 2020
    DOIs
    Publication statusPublished - Oct 2020

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