title: Outcomes of extended-hours hemodialysis performed predominantly at home.
abstract: BACKGROUND
  Recent evidence suggests that increased frequency and/or duration of dialysis are associated with improved outcomes. We aimed to describe the outcomes associated with patients starting extended-hours hemodialysis and assess for risk factors for these outcomes.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Patients were from 6 Australian centers offering extended-hours hemodialysis. Cases were patients who started treatment for 24 hours per week or longer at any time.
  
  
  RESULTS
  All-cause mortality, technique failure (withdrawal from extended-hours hemodialysis therapy), and access-related events.
  
  
  METHODS
  Baseline patient characteristics (sex, primary cause of end-stage kidney disease, age, ethnicity, diabetes, and cannulation technique), presence of a vascular access-related event, and dialysis frequency.
  
  
  RESULTS
  286 patients receiving extended-hours hemodialysis were identified, most of whom performed home (96%) or nocturnal (77%) hemodialysis. Most patients performed alternate-daily dialysis (52%). Patient survival rates using an intention-to-treat approach at 1, 3, and 5 years were 98%, 92%, and 83%, respectively. Of 24 deaths overall, cardiac death (n = 7) and sepsis (n = 5) were the leading causes. Technique survival rates at 1, 3, and 5 years were 90%, 77%, and 68%, respectively. Access event-free rates at the same times were 80%, 68%, and 61%, respectively. Access events significantly predicted death (HR, 2.85; 95% CI, 1.14-7.15) and technique failure (HR, 3.76; 95% CI, 1.93-7.35). Patients with glomerulonephritis had a reduced risk of technique failure (HR, 0.31; 95% CI, 0.14-0.69). Higher dialysis frequency was associated with elevated risk of developing an access event (HR per dialysis session, 1.56; 95% CI, 1.03-2.36).
  
  
  CONCLUSIONS
  Selection bias, lack of a comparator group.
  
  
  CONCLUSIONS
  Extended-hours hemodialysis is associated with excellent survival rates and is an effective treatment option for a select group of patients. The major treatment-associated adverse events were related to complications of vascular access, particularly infection. The risk of developing vascular access complications may be increased in extended-hours hemodialysis, which may negatively affect long-term outcomes.
authors.affiliation: George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Min
authors.initials: M
authors.lastname: Jun
authors.forename: Meg J
authors.initials: MJ
authors.lastname: Jardine
authors.forename: Nicholas
authors.initials: N
authors.lastname: Gray
authors.forename: Rosemary
authors.initials: R
authors.lastname: Masterson
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kerr
authors.forename: John W M
authors.initials: JW
authors.lastname: Agar
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hawley
authors.forename: Carolyn
authors.initials: C
authors.lastname: van Eps
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.forename: Martin
authors.initials: M
authors.lastname: Gallagher
authors.forename: Vlado
authors.initials: V
authors.lastname: Perkovic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006437:Hemodialysis, Home / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult