title: Superior patient and technique survival with very high standard Kt/V in quotidian home hemodialysis.
abstract: We studied the association of patient and dialysis factors with patient and technique survival in a cohort of all of our 191 of patients surviving >3 months on quotidian home hemodialysis (QHHD). Eighty-one patients were on nocturnal QHHD and 110 on short -daily QHHD. Weekly dialysis time was 7.5-48 hours, single pool Kt/V was 0.38-4.5 per treatment, and weekly standardKt/V was 2.1-7.5. The association of 18 patient and dialysis variables with patient and technique survival was analyzed by Kaplan-Meier and Cox analyses. Ninety-nine patients (52%) remained on QHHD, 34 (18%) were transplanted, 31 (16%) returned to 3/week HD, and 27 (14%) died. The 5-year patient survival was 71% ± 6% (night: 79% ± 7%, day: 69% ± 9%, P = 0.002). The 5-year technique survival was 80% ± 4% (night: 93% ± 3%, day: 46% ± 17%, P = 0.001). In Cox analyses, patient survival was independently associated with standard Kt/V (hazard ratio [HR] = 0.29, P < 0.0001), graduating from high school (HS) (HR = 0.11, P = 0.0002), and use of graft/fistula (HR = 0.22, P = 0.007). Technique survival was independently associated with standard Kt/V (HR = 0.50, P = 0.0003) and start of QHHD after 2003 (HR = 0.18, P = 0.007). Every increase in standard Kt/V was associated with improved survival. The highest survival occurred when standard Kt/V exceeded 5.1, only possible when weekly dialysis hours exceed 35 hours. In QHHD, higher standard Kt/V, education, and subcutaneous access are associated with better patient survival and higher standard Kt/V and longer experience of center with better technique survival. There was no upper limit of standard Kt/V, where survival plateaus. The amount of minimally "adequate" dialysis should be much increased.
authors.affiliation: Division of Nephrology, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Lockridge
authors.forename: George
authors.initials: G
authors.lastname: Ting
authors.forename: Carl M
authors.initials: CM
authors.lastname: Kjellstrand
mesh_terms: D015331:Cohort Studies; D015314:Dialysis Solutions; D005260:Female; D006437:Hemodialysis, Home / Q000379:methods* / Q000592:standards; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods* / Q000592:standards; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D015314:Dialysis Solutions