Short daily haemodialysis: survival in 415 patients treated for 1006 patient-years

Kjellstrand, Carl M.; Buoncristiani, U; Ting, George; Traeger, J; Piccoli, G; Sibaï-Galland, Roula; Young, Bessie A.; Blagg, Christopher R.

doi:10.1093/ndt/gfn210

Cited by 163 publications

(164 citation statements)

References 27 publications

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“…Published estimates of mortality risk reductions with daily hemodialysis range from 36% to 66% in as-treated analysis (Table 4). [7][8][9][10][11] All except one of these studies used the adjustment technique of indirect standardization to derive standardized mortality ratios, with the United States in-center population as the referent. Although this statistical approach is theoretically adequate, it is not well suited for high-dimensional adjustment.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] Whether such mechanisms result in lower mortality risk is unknown, as observational studies that have reported improved survival with more frequent dialysis were relatively small and/or incompletely adjusted for selection bias. [7][8][9][10][11] The popularity of home hemodialysis has recently risen in the United States. According to the ESRD Network Organizations Program, the number of home hemodialysis patients increased from 1481 at the end of 2004 to 4836 at the end of 2009.…”

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confidence: 99%

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Survival in Daily Home Hemodialysis and Matched Thrice-Weekly In-Center Hemodialysis Patients

Weinhandl

Liu

Gilbertson

et al. 2012

Journal of the American Society of Nephrology

188

171

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Frequent hemodialysis improves cardiovascular surrogates and quality-of-life indicators, but its effect on survival remains unclear. We used a matched-cohort design to assess relative mortality in daily home hemodialysis and thrice-weekly in-center hemodialysis patients between 2005 and 2008. We matched 1873 home hemodialysis patients with 9365 in-center patients (i.e., 1:5 ratio) selected from the prevalent population in the US Renal Data System database. Matching variables included first date of follow-up, demographic characteristics, and measures of disease severity. The cumulative incidence of death was 19.2% and 21.7% in the home hemodialysis and in-center patients, respectively. In the intention-to-treat analysis, home hemodialysis associated with a 13% lower risk for all-cause mortality than in-center hemodialysis (hazard ratio [HR], 0.87; 95% confidence interval [95% CI], 0.78-0.97). Cause-specific mortality HRs were 0.92 (95% CI, 0.78-1.09) for cardiovascular disease, 1.13 (95% CI, 0.84-1.53) for infection, 0.63 (95% CI, 0.41-0.95) for cachexia/dialysis withdrawal, 1.06 (95% CI, 0.81-1.37) for other specified cause, and 0.59 (95% CI, 0.44-0.79) for unknown cause. Findings were similar using as-treated analyses. We did not detect statistically significant evidence of heterogeneity of treatment effects in subgroup analyses. In summary, these data suggest that relative to thrice-weekly in-center hemodialysis, daily home hemodialysis associates with modest improvements in survival. Continued surveillance should strengthen inference about causes of mortality and determine whether treatment effects are homogeneous throughout the dialysis population.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Survival in Daily Home Hemodialysis and Matched Thrice-Weekly In-Center Hemodialysis Patients

Weinhandl

Liu

Gilbertson

et al. 2012

Journal of the American Society of Nephrology

188

171

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“…This is a small number if compared with over 50 papers per year focused on dialysis start, and the growing attention on the importance of preserving renal function in dialysis patients, in large series and in sporadic case reports (41)(42)(43)(44)(45)(46)(47). Our review, which includes both large series and case reports, is in line with a brilliant previous review that focused on large series reporting on renal function recovery, and that suggests that this even may be encountered in the clinical practice in at least 1% of the patients who start dialysis with a chronic, life-long perspective of renal replacement therapy (Tabs.…”

Section: Discussionmentioning

confidence: 99%

Chronic Dialysis Discontinuation: A Systematic Narrative Review of the Literature in the New Millennium

et al. 2014

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Introduction and aims Renal function recovery (RFR), defined as the discontinuation of dialysis after 3 months of replacement therapy, is an uncommon occurrence. At a time when the “too early” start of dialysis is in discussion, a systematic review of the literature for cases in which patients recovered renal function after starting dialysis with chronic indications, including single cases and large series, may lead to attention being focused on this interesting issue. Methods The search strategy was built in Medline on Pubmed, in EMBASE and in the Cochrane Collaboration (August 2013) combining Mesh, Emtree and free terms: dialysis or hemodialysis, kidney function, renal function and recovery (publication date 2000-2013). The following tasks were performed in duplicate: titles and abstracts were manually screened, the data were extracted: title, author, objective, year, journal, period of study, multi-center, country, type of study. Results The systematic review retrieved 1 894 titles; 58 full papers were retrieved and the final selection included 24 papers: 11 case series or Registry data (4 from ANZdata) and 13 case reports. In spite of the high heterogeneity of the studies, overall they suggest that RFR occurs in about 1% of patients, without differences between PD and HD. RFR appears to be more frequent in elderly patients with renal vascular disease (up to 10% RFR in cholesterol emboli or scleroderma), but is reported in all types of primary and secondary kidney diseases. Conclusions RFR is a clinical event that should be looked for, particularly in elderly patients with vascular comorbidity.

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“…[1][2][3][4] Several studies have reported that use of home HD improves survival for those patients on dialysis compared with those on in-center HD, [7][8][9][10][11][12] and approaches longevity offered by deceased donor transplantation. 5,6 Home HD has also been reported to offer improved wellbeing and enhanced patient lifestyle.…”

Section: The Global Forum For Home Hemodialysis Initiativementioning

confidence: 99%

Home hemodialysis needs you!

Agar

Schatell

Walker

2015

Hemodialysis International

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This special supplement of Hemodialysis International focuses on home hemodialysis (HD). It has been compiled by a group of international experts in home HD who were brought together throughout 2013-2014 to construct a home HD "manual." Drawing upon both the literature and their own extensive expertise, these experts have helped develop this supplement that now stands as an A-to-Z guide for any who may be unfamiliar or uncertain about how to establish and maintain a successful home HD program.

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Short daily haemodialysis: survival in 415 patients treated for 1006 patient-years

Abstract: Survival of patients on short daily haemodialysis was 2-3 times better than that of matched three times weekly haemodialysis patients reported by the USRDS.

Cited by 163 publications

References 27 publications

Survival in Daily Home Hemodialysis and Matched Thrice-Weekly In-Center Hemodialysis Patients

Survival in Daily Home Hemodialysis and Matched Thrice-Weekly In-Center Hemodialysis Patients

Chronic Dialysis Discontinuation: A Systematic Narrative Review of the Literature in the New Millennium

Home hemodialysis needs you!

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