Outcomes of extended-hours hemodialysis performed predominantly at home

Min Jun, Meg Jardine, Nicholas Gray, Rosemary Masterson, Peter Kerr, John Agar, Carmel Hawley, Carolyn Van Eps, Alan Cass, Martin Gallagher, Vlado Perkovic

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Background: Recent evidence suggests that increased frequency and/or duration of dialysis are associated with improved outcomes. We aimed to describe the outcomes associated with patients starting extended-hours hemodialysis and assess for risk factors for these outcomes.
    Study Design: 
    Case series.
    Setting & Participants: 
    Patients were from 6 Australian centers offering extended-hours hemodialysis. Cases were patients who started treatment for 24 hours per week or longer at any time.
    Outcomes: All-cause mortality, technique failure (withdrawal from extended-hours hemodialysis therapy), and access-related events.
    Measurements:  Baseline patient characteristics (sex, primary cause of end-stage kidney disease, age, ethnicity, diabetes, and cannulation technique), presence of a vascular access–related event, and dialysis frequency.
    Results: 286 patients receiving extended-hours hemodialysis were identified, most of whom performed home (96%) or nocturnal (77%) hemodialysis. Most patients performed alternate-daily dialysis (52%). Patient survival rates using an intention-to-treat approach at 1, 3, and 5 years were 98%, 92%, and 83%, respectively. Of 24 deaths overall, cardiac death (n = 7) and sepsis (n = 5) were the leading causes. Technique survival rates at 1, 3, and 5 years were 90%, 77%, and 68%, respectively. Access event–free rates at the same times were 80%, 68%, and 61%, respectively. Access events significantly predicted death (HR, 2.85; 95% CI, 1.14-7.15) and technique failure (HR, 3.76; 95% CI, 1.93-7.35). Patients with glomerulonephritis had a reduced risk of technique failure (HR, 0.31; 95% CI, 0.14-0.69). Higher dialysis frequency was associated with elevated risk of developing an access event (HR per dialysis session, 1.56; 95% CI, 1.03-2.36).
    Limitations: Selection bias, lack of a comparator group.
    Conclusions: Extended-hours hemodialysis is associated with excellent survival rates and is an effective treatment option for a select group of patients. The major treatment-associated adverse events were related to complications of vascular access, particularly infection. The risk of developing vascular access complications may be increased in extended-hours hemodialysis, which may negatively affect long-term outcomes.
    Original languageEnglish
    Pages (from-to)247-253
    Number of pages7
    JournalAmerican Journal of Kidney Diseases
    Volume61
    Issue number2
    DOIs
    Publication statusPublished - 2013

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