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Survival on four compared with three times per week haemodialysis in high ultrafiltration patients: an observational study

BACKGROUND: The harm caused by the long interdialytic interval in three-times-per-week haemodialysis regimens (3×WHD) may relate to fluid accumulation and associated high ultrafiltration rate (UFR). Four-times-per-week haemodialysis (4×WHD) may offer a solution, but its impact on mortality, hospital...

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Autores principales: Fotheringham, James, Latimer, Nicholas, Froissart, Marc, Kronenberg, Florian, Stenvinkel, Peter, Floege, Jürgen, Eckardt, Kai-Uwe, Wheeler, David C
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886573/
https://www.ncbi.nlm.nih.gov/pubmed/33623692
http://dx.doi.org/10.1093/ckj/sfaa250
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author Fotheringham, James
Latimer, Nicholas
Froissart, Marc
Kronenberg, Florian
Stenvinkel, Peter
Floege, Jürgen
Eckardt, Kai-Uwe
Wheeler, David C
author_facet Fotheringham, James
Latimer, Nicholas
Froissart, Marc
Kronenberg, Florian
Stenvinkel, Peter
Floege, Jürgen
Eckardt, Kai-Uwe
Wheeler, David C
author_sort Fotheringham, James
collection PubMed
description BACKGROUND: The harm caused by the long interdialytic interval in three-times-per-week haemodialysis regimens (3×WHD) may relate to fluid accumulation and associated high ultrafiltration rate (UFR). Four-times-per-week haemodialysis (4×WHD) may offer a solution, but its impact on mortality, hospitalization and vascular access complications is unknown. METHODS: From the AROii cohort of incident in-centre haemodialysis patients, 3×WHD patients with a UFR >10 mL/kg/h were identified. The hazard for the outcomes of mortality, hospitalization and vascular access complications in those who switched to 4×WHD compared with staying on 3×WHD was estimated using a marginal structural Cox proportional hazards model. Adjustment included baseline patient and treatment characteristics with inverse probability weighting used to adjust for time-varying UFR and cardiovascular comorbidities. RESULTS: From 10 637 European 3×WHD patients, 3842 (36%) exceeded a UFR >10 mL/kg/h. Of these, 288 (7.5%) started 4×WHD and at baseline were more comorbid. Event rates while receiving 4×WHD compared with 3×WHD were 12.6 compared with 10.8 per 100 patient years for mortality, 0.96 compared with 0.65 per year for hospitalization and 14.7 compared with 8.0 per 100 patient years for vascular access complications. Compared with 3×WHD, the unadjusted hazard ratio (HR) for mortality on 4×WHD was 1.05 [95% confidence interval (CI) 0.78–1.42]. Following adjustment for baseline demographics, time-varying treatment probability and censoring risks, this HR was 0.73 (95% CI 0.50–1.05; P = 0.095). Despite these adjustments on 4×WHD, the HR for hospitalization remained elevated and vascular access complications were similar to 3×WHD. CONCLUSIONS: This observational study was not able to demonstrate a mortality benefit in patients switched to 4×WHD. To demonstrate the true benefits of 4×WHD requires a large, well-designed clinical trial. Our data may help in the design of such a study.
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spelling pubmed-78865732021-02-22 Survival on four compared with three times per week haemodialysis in high ultrafiltration patients: an observational study Fotheringham, James Latimer, Nicholas Froissart, Marc Kronenberg, Florian Stenvinkel, Peter Floege, Jürgen Eckardt, Kai-Uwe Wheeler, David C Clin Kidney J Original Articles BACKGROUND: The harm caused by the long interdialytic interval in three-times-per-week haemodialysis regimens (3×WHD) may relate to fluid accumulation and associated high ultrafiltration rate (UFR). Four-times-per-week haemodialysis (4×WHD) may offer a solution, but its impact on mortality, hospitalization and vascular access complications is unknown. METHODS: From the AROii cohort of incident in-centre haemodialysis patients, 3×WHD patients with a UFR >10 mL/kg/h were identified. The hazard for the outcomes of mortality, hospitalization and vascular access complications in those who switched to 4×WHD compared with staying on 3×WHD was estimated using a marginal structural Cox proportional hazards model. Adjustment included baseline patient and treatment characteristics with inverse probability weighting used to adjust for time-varying UFR and cardiovascular comorbidities. RESULTS: From 10 637 European 3×WHD patients, 3842 (36%) exceeded a UFR >10 mL/kg/h. Of these, 288 (7.5%) started 4×WHD and at baseline were more comorbid. Event rates while receiving 4×WHD compared with 3×WHD were 12.6 compared with 10.8 per 100 patient years for mortality, 0.96 compared with 0.65 per year for hospitalization and 14.7 compared with 8.0 per 100 patient years for vascular access complications. Compared with 3×WHD, the unadjusted hazard ratio (HR) for mortality on 4×WHD was 1.05 [95% confidence interval (CI) 0.78–1.42]. Following adjustment for baseline demographics, time-varying treatment probability and censoring risks, this HR was 0.73 (95% CI 0.50–1.05; P = 0.095). Despite these adjustments on 4×WHD, the HR for hospitalization remained elevated and vascular access complications were similar to 3×WHD. CONCLUSIONS: This observational study was not able to demonstrate a mortality benefit in patients switched to 4×WHD. To demonstrate the true benefits of 4×WHD requires a large, well-designed clinical trial. Our data may help in the design of such a study. Oxford University Press 2020-12-28 /pmc/articles/PMC7886573/ /pubmed/33623692 http://dx.doi.org/10.1093/ckj/sfaa250 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Articles
Fotheringham, James
Latimer, Nicholas
Froissart, Marc
Kronenberg, Florian
Stenvinkel, Peter
Floege, Jürgen
Eckardt, Kai-Uwe
Wheeler, David C
Survival on four compared with three times per week haemodialysis in high ultrafiltration patients: an observational study
title Survival on four compared with three times per week haemodialysis in high ultrafiltration patients: an observational study
title_full Survival on four compared with three times per week haemodialysis in high ultrafiltration patients: an observational study
title_fullStr Survival on four compared with three times per week haemodialysis in high ultrafiltration patients: an observational study
title_full_unstemmed Survival on four compared with three times per week haemodialysis in high ultrafiltration patients: an observational study
title_short Survival on four compared with three times per week haemodialysis in high ultrafiltration patients: an observational study
title_sort survival on four compared with three times per week haemodialysis in high ultrafiltration patients: an observational study
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886573/
https://www.ncbi.nlm.nih.gov/pubmed/33623692
http://dx.doi.org/10.1093/ckj/sfaa250
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