title: Association between daily haemodialysis, access to renal transplantation and patients' survival in France.
abstract: OBJECTIVE
  Daily haemodialysis improves patients' quality of life and blood purification, but its effect on survival remains controversial. The aim of this study was to analyze the association between daily haemodialysis and renal transplantation and survival in France.
  
  
  METHODS
  This was an observational cohort study based on the French REIN registry. All incident patients ≥18 years old who started daily haemodialysis in France between 2003 and 2012 were included. Using a propensity score, 575 patients on daily haemodialysis were matched with 1696 patients receiving thrice-weekly haemodialysis. Survival analysis was performed using the Cox model. Access to the renal transplant waiting list and renal transplantation were analyzed using the Fine and Gray model.
  
  
  RESULTS
  Daily haemodialysis was not independently associated with reduced access to transplant waiting list, whereas, major comorbidities remained associated with restricted waitlisting after multivariate analysis adjusted for confounding factors. After being waitlisted, the cumulative incidence of renal transplantation was lower for the daily haemodialysis than for the thrice-weekly haemodialysis group (SHR = 0.72, 95%CI: 0.56-0.91). The risk of death was significantly higher in the daily haemodialysis group (HRadjusted= 1.58, 95%CI: 1.4-1.8). Major comorbidities were associated with higher risk of death and lower likelihood of receiving a renal transplant during the follow-up period.
  
  
  CONCLUSIONS
  Our study showed that in France, the likelihood of undergoing renal transplantation after being waitlisted was lower for patients on daily haemodialysis than those on thrice-weekly haemodialysis. Moreover, daily haemodialysis was associated with higher risk of death, even after taking into account age and all major comorbidities.
authors.affiliation: High French School of Public Health (EHESP: Ecole des Hautes Etude de Sante Publique), Rennes, France.|University of Rennes 1, UMR CNRS 6290, Rennes, France.
authors.forename: Adélaïde
authors.initials: A
authors.lastname: Pladys
authors.affiliation: University of Rennes 1, UMR CNRS 6290, Rennes, France.|Service of Nephrology, Pontchaillou hospital, Rennes, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Vigneau
authors.affiliation: Service of Nephrology, Hospital of Nantes, Nantes, France.
authors.forename: Maryvonne
authors.initials: M
authors.lastname: Hourmant
authors.affiliation: Service of Nephrology, Robert Boulin hospital, Libourne, France.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Duneau
authors.affiliation: REIN (Renal Epidemiology and Information Network) registry, Biomedecine Agency, Saint Denis La Plaine, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Couchoud
authors.affiliation: High French School of Public Health (EHESP: Ecole des Hautes Etude de Sante Publique), Rennes, France.
authors.forename: Sahar
authors.initials: S
authors.lastname: Bayat
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005602:France / Q000453:epidemiology; D006297:Health Services Accessibility; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult
keywords: daily haemodialysis; end stage renal disease; registry; renal transplantation; survival