Brendan Smyth1,2,3, Li Zuo4, Nicholas A Gray5,6, Christopher T Chan7, Janak R de Zoysa8,9, Daqing Hong10,11, Kris Rogers1,12, Jia Wang11,13, Alan Cass14, Martin Gallagher1,15, Vlado Perkovic1, Meg Jardine1,15. 1. Renal and Metabolic Division, The George Institute for Global Health and University of New South Wales, Sydney, New South Wales, Australia. 2. Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia. 3. Department of Renal Medicine, St George Hospital, Sydney, New South Wales, Australia. 4. Department of Nephrology, Peking University People's Hospital, Beijing, China. 5. Renal Department, Sunshine Coast University Hospital, Birtinya, Queensland, Australia. 6. Sunshine Coast Clinical School, University of Sunshine Coast, Sippy Downs, Queensland, Australia. 7. Department of Medicine, University Health Network, Toronto, Ontario, Canada. 8. Renal Services, North Shore Hospital, Auckland, New Zealand. 9. Department of Medicine, University of Auckland, Auckland, New Zealand. 10. Renal Department, Sichuan Provincial People's Hospital, Chengdu, China. 11. School of Medicine, University of Electronic Science and Technology of China Medical School, Chengdu, China. 12. Graduate School of Health, University of Technology, Sydney, New South Wales, Australia. 13. General Practice Department, Sichuan Provincial People's Hospital, Chengdu, China. 14. Menzies School of Health Research, Charles Darwin University, Darwin, North Territory, Australia. 15. Renal Unit, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
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.
RCT Entities:
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 participantsdied, 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.
Authors: Melissa Nataatmadja; Rathika Krishnasamy; Li Zuo; Daqing Hong; Brendan Smyth; Min Jun; Janak R de Zoysa; Kirsten Howard; Jing Wang; Chunlai Lu; Zhangsuo Liu; Christopher T Chan; Alan Cass; Vlado Perkovic; Meg Jardine; Nicholas A Gray Journal: Kidney Int Rep Date: 2021-02-01
Authors: James Fotheringham; Nicholas Latimer; Marc Froissart; Florian Kronenberg; Peter Stenvinkel; Jürgen Floege; Kai-Uwe Eckardt; David C Wheeler Journal: Clin Kidney J Date: 2020-12-28