title: Initial Session Duration and Mortality Among Incident Hemodialysis Patients.
abstract: BACKGROUND
  The association of dialysis session duration with mortality in patients undergoing maintenance hemodialysis is unclear. We compared mortality rates of patients treated in dialysis facilities that used initial session durations of either ≥ 4 versus 3 hours for all incident patients.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Patients with end-stage renal disease beginning maintenance hemodialysis therapy in January 2006 to December 2010 and followed up through December 2012, including 39,172 patients in 852 facilities who initiated treatment for ≥ 4 hours and 47,721 patients in 631 facilities who initiated treatment for 3 hours.
  
  
  METHODS
  Initial session duration of ≥ 4 hours versus 3 hours.
  
  
  RESULTS
  2- and 1-year mortality rates.
  
  
  RESULTS
  Total numbers of deaths observed within 2 years after initiating dialysis therapy were 8,945 in the ≥ 4-hour group and 15,624 in the 3-hour group. The corresponding numbers of deaths observed within 1 year were 5,492 and 10,372, respectively. The 2-year adjusted HR in the ≥ 4-hour versus 3-hour group was 0.79 (95% CI, 0.73-0.86). The corresponding 1-year adjusted HR was 0.77 (95% CI, 0.70-0.84). Results were robust when analyses were restricted to specific subgroups of patients classified by age, sex, race, and select clinical characteristics.
  
  
  CONCLUSIONS
  We did not observe hemodialysis duration in sessions subsequent to initiation. We only included patients treated in facilities with uniform session length (at initiation) for all their patients. Furthermore, we lacked information for dialysis dosage and patients' baseline residual kidney function.
  
  
  CONCLUSIONS
  Patients in facilities routinely initiating hemodialysis therapy for ≥ 4 hours may have substantially lower mortality as compared with patients in facilities initiating for only 3 hours of treatment.
authors.affiliation: Department of Health Services, Policy and Practice, Alpert Medical School of Brown University, Providence, RI; Providence VA Medical Center, Providence, RI. Electronic address: shailender_swaminathan@brown.edu.
authors.forename: Shailender
authors.initials: S
authors.lastname: Swaminathan
authors.affiliation: Department of Health Services, Policy and Practice, Alpert Medical School of Brown University, Providence, RI; Providence VA Medical Center, Providence, RI.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
authors.affiliation: Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
authors.forename: Rajnish
authors.initials: R
authors.lastname: Mehrotra
authors.affiliation: Department of Health Services, Policy and Practice, Alpert Medical School of Brown University, Providence, RI; Providence VA Medical Center, Providence, RI.
authors.forename: Amal N
authors.initials: AN
authors.lastname: Trivedi
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods* / Q000401:mortality*; D012189:Retrospective Studies; D013997:Time Factors
keywords: Renal hemodialysis; death; end-stage renal disease (ESRD); facility-level analysis; mortality rate; quasi-experimental design; session length, dialysis duration, dialysis facilities; treatment time