title: Intensive hemodialysis associates with improved survival compared with conventional hemodialysis.
abstract: Patients undergoing conventional maintenance hemodialysis typically receive three sessions per week, each lasting 2.5-5.5 hours. Recently, the use of more intensive hemodialysis (>5.5 hours, three to seven times per week) has increased, but the effects of these regimens on survival are uncertain. We conducted a retrospective cohort study to examine whether intensive hemodialysis associates with better survival than conventional hemodialysis. We identified 420 patients in the International Quotidian Dialysis Registry who received intensive home hemodialysis in France, the United States, and Canada between January 2000 and August 2010. We matched 338 of these patients to 1388 patients in the Dialysis Outcomes and Practice Patterns Study who received in-center conventional hemodialysis during the same time period by country, ESRD duration, and propensity score. The intensive hemodialysis group received a mean (SD) 4.8 (1.1) sessions per week with a mean treatment time of 7.4 (0.87) hours per session; the conventional group received three sessions per week with a mean treatment time of 3.9 (0.32) hours per session. During 3008 patient-years of follow-up, 45 (13%) of 338 patients receiving intensive hemodialysis died compared with 293 (21%) of 1388 patients receiving conventional hemodialysis (6.1 versus 10.5 deaths per 100 person-years; hazard ratio, 0.55 [95% confidence interval, 0.34-0.87]). The strength and direction of the observed association between intensive hemodialysis and improved survival were consistent across all prespecified subgroups and sensitivity analyses. In conclusion, there is a strong association between intensive home hemodialysis and improved survival, but whether this relationship is causal remains unknown.
authors.affiliation: Division of Nephrology, University of Western Ontario, London, Ontario, Canada. Gihad.Nesrallah@lawsonresearch.com
authors.forename: Gihad E
authors.initials: GE
authors.lastname: Nesrallah
authors.forename: Robert M
authors.initials: RM
authors.lastname: Lindsay
authors.forename: Meaghan S
authors.initials: MS
authors.lastname: Cuerden
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.forename: Friedrich
authors.initials: F
authors.lastname: Port
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.forename: Louise M
authors.initials: LM
authors.lastname: Moist
authors.forename: Andreas
authors.initials: A
authors.lastname: Pierratos
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chan
authors.forename: Deborah
authors.initials: D
authors.lastname: Zimmerman
authors.forename: Robert S
authors.initials: RS
authors.lastname: Lockridge
authors.forename: Cécile
authors.initials: C
authors.lastname: Couchoud
authors.forename: Charles
authors.initials: C
authors.lastname: Chazot
authors.forename: Norma
authors.initials: N
authors.lastname: Ofsthun
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
authors.forename: Michael
authors.initials: M
authors.lastname: Copland
authors.forename: Mark
authors.initials: M
authors.lastname: Courtney
authors.forename: Andrew
authors.initials: A
authors.lastname: Steele
authors.forename: Philip A
authors.initials: PA
authors.lastname: McFarlane
authors.forename: Denis F
authors.initials: DF
authors.lastname: Geary
authors.forename: Robert P
authors.initials: RP
authors.lastname: Pauly
authors.forename: Paul
authors.initials: P
authors.lastname: Komenda
authors.forename: Rita S
authors.initials: RS
authors.lastname: Suri
mesh_terms: D000328:Adult; D000368:Aged; D001774:Blood Chemical Analysis; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D003422:Critical Care / Q000379:methods; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors