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Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study

BACKGROUND: Globally, there is increased clinical interest and uptake of hemodiafiltration (HDF) for increased removal of uremic toxins. To date, there has been no epidemiological analysis of HDF in China. We present HDF practice patterns and associated mortality risk in Shanghai. METHODS: This is a...

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Autores principales: Zhang, Weiming, Mei, Changlin, Chen, Nan, Ding, Xiaoqiang, Ni, Zhaohui, Hao, Chuanming, Zhang, Jinghong, Zhang, Jinyuan, Wang, Niansong, Jiang, Gengru, Guo, Zhiyong, Yu, Chen, Deng, Yueyi, Li, Haiming, Yao, Qiang, Marshall, Mark R., Wolley, Martin J., Qian, Jiaqi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6359843/
https://www.ncbi.nlm.nih.gov/pubmed/30709342
http://dx.doi.org/10.1186/s12882-019-1219-z
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author Zhang, Weiming
Mei, Changlin
Chen, Nan
Ding, Xiaoqiang
Ni, Zhaohui
Hao, Chuanming
Zhang, Jinghong
Zhang, Jinyuan
Wang, Niansong
Jiang, Gengru
Guo, Zhiyong
Yu, Chen
Deng, Yueyi
Li, Haiming
Yao, Qiang
Marshall, Mark R.
Wolley, Martin J.
Qian, Jiaqi
author_facet Zhang, Weiming
Mei, Changlin
Chen, Nan
Ding, Xiaoqiang
Ni, Zhaohui
Hao, Chuanming
Zhang, Jinghong
Zhang, Jinyuan
Wang, Niansong
Jiang, Gengru
Guo, Zhiyong
Yu, Chen
Deng, Yueyi
Li, Haiming
Yao, Qiang
Marshall, Mark R.
Wolley, Martin J.
Qian, Jiaqi
author_sort Zhang, Weiming
collection PubMed
description BACKGROUND: Globally, there is increased clinical interest and uptake of hemodiafiltration (HDF) for increased removal of uremic toxins. To date, there has been no epidemiological analysis of HDF in China. We present HDF practice patterns and associated mortality risk in Shanghai. METHODS: This is an observational, prospectively collected, retrospective analysis of 9351 Chinese patients initiating hemodialysis in Shanghai from 2007 to 2014. The primary exposure was hemodialysis sub-modality at inception, classified into hemodiafiltration (HDF) and hemodialysis (HD), with adjustment for concommitant hemoperfusion. The primary outcome was patient mortality. We used Cox proportional hazards regression and Fine and Gray’s proportional subhazards regression, with multiple imputation of missing co-variates by the chained equation method, adjusting for demographic and clinical variables. RESULTS: Overall, patients in the cohort were younger, with a more males, and with a lower body mass index when compared to corresponding non-Asian cohorts. Mortality rate was low although it doubled over the period of observation. HDF utilization increased from 7% of patients in 2007 to 42% of patients in 2014. The majority of patients received HDF once a week. The adjusted hazard ratio of death (95% confidence intervals) for HDF versus HD was 0.85 (0.71–1.03), and corresponding sub-hazard ratio 0.86 (0.71–1.03). There was strong effect modification by age. In those aged 40–60 years, the hazard ratio (95% confidence intervals) was 0.65 (0.45–0.94), and sub-hazard ratio also 0.65 (0.45–0.95). CONCLUSIONS: Our study has certain limitations resulting from the limited number of co-variates available for modelling, missing data for some co-variates, and the lack of verification of data against source documentation. Notwithstanding, there is evidence of clinical benefit from HDF in China, and potential to improve patient outcomes through the greater removal of middle and larger uremic solutes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12882-019-1219-z) contains supplementary material, which is available to authorized users.
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spelling pubmed-63598432019-02-07 Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study Zhang, Weiming Mei, Changlin Chen, Nan Ding, Xiaoqiang Ni, Zhaohui Hao, Chuanming Zhang, Jinghong Zhang, Jinyuan Wang, Niansong Jiang, Gengru Guo, Zhiyong Yu, Chen Deng, Yueyi Li, Haiming Yao, Qiang Marshall, Mark R. Wolley, Martin J. Qian, Jiaqi BMC Nephrol Research Article BACKGROUND: Globally, there is increased clinical interest and uptake of hemodiafiltration (HDF) for increased removal of uremic toxins. To date, there has been no epidemiological analysis of HDF in China. We present HDF practice patterns and associated mortality risk in Shanghai. METHODS: This is an observational, prospectively collected, retrospective analysis of 9351 Chinese patients initiating hemodialysis in Shanghai from 2007 to 2014. The primary exposure was hemodialysis sub-modality at inception, classified into hemodiafiltration (HDF) and hemodialysis (HD), with adjustment for concommitant hemoperfusion. The primary outcome was patient mortality. We used Cox proportional hazards regression and Fine and Gray’s proportional subhazards regression, with multiple imputation of missing co-variates by the chained equation method, adjusting for demographic and clinical variables. RESULTS: Overall, patients in the cohort were younger, with a more males, and with a lower body mass index when compared to corresponding non-Asian cohorts. Mortality rate was low although it doubled over the period of observation. HDF utilization increased from 7% of patients in 2007 to 42% of patients in 2014. The majority of patients received HDF once a week. The adjusted hazard ratio of death (95% confidence intervals) for HDF versus HD was 0.85 (0.71–1.03), and corresponding sub-hazard ratio 0.86 (0.71–1.03). There was strong effect modification by age. In those aged 40–60 years, the hazard ratio (95% confidence intervals) was 0.65 (0.45–0.94), and sub-hazard ratio also 0.65 (0.45–0.95). CONCLUSIONS: Our study has certain limitations resulting from the limited number of co-variates available for modelling, missing data for some co-variates, and the lack of verification of data against source documentation. Notwithstanding, there is evidence of clinical benefit from HDF in China, and potential to improve patient outcomes through the greater removal of middle and larger uremic solutes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12882-019-1219-z) contains supplementary material, which is available to authorized users. BioMed Central 2019-02-01 /pmc/articles/PMC6359843/ /pubmed/30709342 http://dx.doi.org/10.1186/s12882-019-1219-z Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Zhang, Weiming
Mei, Changlin
Chen, Nan
Ding, Xiaoqiang
Ni, Zhaohui
Hao, Chuanming
Zhang, Jinghong
Zhang, Jinyuan
Wang, Niansong
Jiang, Gengru
Guo, Zhiyong
Yu, Chen
Deng, Yueyi
Li, Haiming
Yao, Qiang
Marshall, Mark R.
Wolley, Martin J.
Qian, Jiaqi
Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study
title Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study
title_full Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study
title_fullStr Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study
title_full_unstemmed Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study
title_short Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study
title_sort outcomes and practice patterns with hemodiafiltration in shanghai: a longitudinal cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6359843/
https://www.ncbi.nlm.nih.gov/pubmed/30709342
http://dx.doi.org/10.1186/s12882-019-1219-z
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