Shailender Swaminathan1, Vincent Mor2, Rajnish Mehrotra3, Amal N Trivedi2. 1. Department of Health Services, Policy and Practice, Alpert Medical School of Brown University, Providence, RI; Providence VA Medical Center, Providence, RI. Electronic address: shailender_swaminathan@brown.edu. 2. Department of Health Services, Policy and Practice, Alpert Medical School of Brown University, Providence, RI; Providence VA Medical Center, Providence, RI. 3. Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
Abstract
BACKGROUND: The association of dialysis session duration with mortality in patients undergoing maintenance hemodialysis is unclear. We compared mortality rates of patients treated in dialysis facilities that used initial session durations of either ≥ 4 versus 3 hours for all incident patients. STUDY DESIGN: Retrospective cohort study. SETTINGS & PARTICIPANTS: Patients with end-stage renal disease beginning maintenance hemodialysis therapy in January 2006 to December 2010 and followed up through December 2012, including 39,172 patients in 852 facilities who initiated treatment for ≥ 4 hours and 47,721 patients in 631 facilities who initiated treatment for 3 hours. PREDICTOR: Initial session duration of ≥ 4 hours versus 3 hours. OUTCOME: 2- and 1-year mortality rates. RESULTS: Total numbers of deaths observed within 2 years after initiating dialysis therapy were 8,945 in the ≥ 4-hour group and 15,624 in the 3-hour group. The corresponding numbers of deaths observed within 1 year were 5,492 and 10,372, respectively. The 2-year adjusted HR in the ≥ 4-hour versus 3-hour group was 0.79 (95% CI, 0.73-0.86). The corresponding 1-year adjusted HR was 0.77 (95% CI, 0.70-0.84). Results were robust when analyses were restricted to specific subgroups of patients classified by age, sex, race, and select clinical characteristics. LIMITATIONS: We did not observe hemodialysis duration in sessions subsequent to initiation. We only included patients treated in facilities with uniform session length (at initiation) for all their patients. Furthermore, we lacked information for dialysis dosage and patients' baseline residual kidney function. CONCLUSIONS: Patients in facilities routinely initiating hemodialysis therapy for ≥ 4 hours may have substantially lower mortality as compared with patients in facilities initiating for only 3 hours of treatment.
BACKGROUND: The association of dialysis session duration with mortality in patients undergoing maintenance hemodialysis is unclear. We compared mortality rates of patients treated in dialysis facilities that used initial session durations of either ≥ 4 versus 3 hours for all incident patients. STUDY DESIGN: Retrospective cohort study. SETTINGS & PARTICIPANTS: Patients with end-stage renal disease beginning maintenance hemodialysis therapy in January 2006 to December 2010 and followed up through December 2012, including 39,172 patients in 852 facilities who initiated treatment for ≥ 4 hours and 47,721 patients in 631 facilities who initiated treatment for 3 hours. PREDICTOR: Initial session duration of ≥ 4 hours versus 3 hours. OUTCOME: 2- and 1-year mortality rates. RESULTS: Total numbers of deaths observed within 2 years after initiating dialysis therapy were 8,945 in the ≥ 4-hour group and 15,624 in the 3-hour group. The corresponding numbers of deaths observed within 1 year were 5,492 and 10,372, respectively. The 2-year adjusted HR in the ≥ 4-hour versus 3-hour group was 0.79 (95% CI, 0.73-0.86). The corresponding 1-year adjusted HR was 0.77 (95% CI, 0.70-0.84). Results were robust when analyses were restricted to specific subgroups of patients classified by age, sex, race, and select clinical characteristics. LIMITATIONS: We did not observe hemodialysis duration in sessions subsequent to initiation. We only included patients treated in facilities with uniform session length (at initiation) for all their patients. Furthermore, we lacked information for dialysis dosage and patients' baseline residual kidney function. CONCLUSIONS:Patients in facilities routinely initiating hemodialysis therapy for ≥ 4 hours may have substantially lower mortality as compared with patients in facilities initiating for only 3 hours of treatment.
Authors: R Saran; J L Bragg-Gresham; N W Levin; Z J Twardowski; V Wizemann; A Saito; N Kimata; B W Gillespie; C Combe; J Bommer; T Akiba; D L Mapes; E W Young; F K Port Journal: Kidney Int Date: 2006-04 Impact factor: 10.612
Authors: Steven M Brunelli; Glenn M Chertow; Elizabeth D Ankers; Edmund G Lowrie; Ravi Thadhani Journal: Kidney Int Date: 2010-01-20 Impact factor: 10.612
Authors: Garabed Eknoyan; Gerald J Beck; Alfred K Cheung; John T Daugirdas; Tom Greene; John W Kusek; Michael Allon; James Bailey; James A Delmez; Thomas A Depner; Johanna T Dwyer; Andrew S Levey; Nathan W Levin; Edgar Milford; Daniel B Ornt; Michael V Rocco; Gerald Schulman; Steve J Schwab; Brendan P Teehan; Robert Toto Journal: N Engl J Med Date: 2002-12-19 Impact factor: 91.245
Authors: Jessica E Miller; Csaba P Kovesdy; Allen R Nissenson; Rajnish Mehrotra; Elani Streja; David Van Wyck; Sander Greenland; Kamyar Kalantar-Zadeh Journal: Am J Kidney Dis Date: 2009-10-22 Impact factor: 8.860