Impact of haemodialysis hours on outcomes in older patients

Abstract

Aim Previous studies report an association between longer haemodialysis treatment sessions and improved survival. Worldwide, there is a trend to increasing age among prevalent patients receiving haemodialysis. This analysis aimed to determine whether the mortality benefit of longer haemodialysis treatment sessions diminishes with increasing age. Methods This was a retrospective cohort study of people who first commenced thrice‐weekly haemodialysis aged ≥65 years, reported to the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry from 2005 to 2015, included from 90 days after dialysis start. The primary outcome was all‐cause mortality. Cox regression analysis was performed with haemodialysis session duration the exposure of interest. Results Of 8224 people who commenced haemodialysis as their first treatment for kidney failure aged ≥65 years during this period, 4727 patients died. Longer dialysis hours per session was associated with a decreased risk of death in unadjusted analyses [hazard ratio, HR, for ≥5 h versus 4 to <4.5 h: 0.81 (0.75–0.88, p < .001)]. Patients having longer dialysis sessions were younger but had greater co‐morbidity. In an adjusted model including age and other variables, the survival benefit of longer hours was only partially attenuated [HR for previous comparison: 0.75 (0.69–0.82, p < .001)], and no interaction between age and hours was demonstrated (p = .89). Conclusion The apparent survival benefit associated with longer haemodialysis session length appears to be preserved in patients 65 years or older. In practice, the benefit of longer dialysis hours should be carefully weighed against other factors in this patient group.

Questioning one-size-fits-all dialysis prescription: balancing dialysis prescription and residual kidney function

“…De plus, Lin et al ont découvert que les patients transférés de dialyse trihebdomadaire à une hémodialyse bihebdomadaire présentaient un déclin moins rapide de la FRR que le groupe de patients restés en dialyse trihebdomadaire, cette supériorité s'associait également à une diminution des épisodes d'hospitalisation [24]. De façon discordante, une étude de cohorte récente portant sur 8000 patients a montré un bénéfice de survie associé à des séances d'hémodialyse plus longues chez les patients âgés de 65 ans ou plus [35].…”