Impact of old age on the association between in-center extended-hours hemodialysis and mortality in patients on incident hemodialysis

Abstract

With the global problem of aging, it has become more difficult to improve the prognosis of older dialysis patients. Extended-hours hemodialysis offers longer treatment time compared to conventional hemodialysis regimen and provides favorable metabolic status, hemodynamic stability, and increased dietary intake. Despite prior studies reporting that in-center extended-hours hemodialysis can reduce the mortality rate, the treatment impact on elderly patients remains unclear. Therefore, we examined the association between extended-hours hemodialysis compared to conventional hemodialysis and all-cause mortality. Survival analyses using Cox proportional hazard model with multivariable adjustments and propensityscore based method were performed to compare mortality risk between 198 consecutive patients who started in-center extended-hours hemodialysis (Extended-HD) and 1407 consecutive patients who initiated conventional hemodialysis. The median age was 67.1 years in the Extended-HD group and 70.7 years in the conventional hemodialysis group. Extended-HD was associated with lower all-cause mortality in overall patients and the subgroup >70 years (adjusted hazard ratios of 0.60 [95% CI, 0.39-0.91] and 0.35 [95% CI, 0.18-0.69], respectively). There was a significant interaction between age >70 years and Extended-HD. In conclusion, extended-hours hemodialysis was associated with a lower mortality rate, especially in elderly patients.

Extended-Hours Hemodialysis without Dietary Restrictions Is Associated with Lower Risk for Developing of Dialysis-Related Amyloidosis

“…Recently, Hishida et al (2020) and Okazaki et al (2020) had demonstrated that extended-hours HD without dietary restrictions provided body weight increase, favorable metabolic status, hemodynamic stability, increased dietary intake and better survival rate, especially in elderly maintenance HD patients (more than 70 years old). However, they did not refer to the effects of extended-hours HD without dietary restrictions on the risk for developing of DRA.…”

Extended-Hours Hemodialysis without Dietary Restrictions Increases Body Mass Index and Normalizes Hypertension: A Case Report

“…Adequate energy and protein intake and exercise reduce the prevalence of sarcopenia (Sabatino et al 2021). A decreased risk of death in patients over 70 who received extended-hours hemodialysis without dietary restrictions has been reported (Okazaki et al 2020), suggesting that extended-hours hemodialysis without dietary restrictions may be an effective treatment option for elderly dialysis patients.…”

Association of calciprotein particles with serum phosphorus among patients undergoing conventional and extended-hours haemodialysis

“…Previous studies have shown that extended-hours HD is associated with lower mortality than conventional HD (typically three times per week, 3–5 hours per treatment) [ 18–21 ]. We have reported that extended-hours HD without strict dietary restriction, which we call a liberalized diet, was associated with improved survival compared with conventional HD, and that patients whose body mass index (BMI) was maintained or increased for 1 year after the induction of extended-hours HD had a better prognosis than those whose BMI decreased [ 22 , 23 ]. Although a previous study revealed that liberalized phosphorus intake among conventional HD patients was associated with better nutritional indicators and survival [ 24 ], clinicians often have difficulty balancing concerns about vascular calcification with phosphorus intake and dietary liberalization.…”