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Nephrol Dial Transplant. 2019 Nov 18. pii: gfz208. doi: 10.1093/ndt/gfz208. [Epub ahead of print]

Survival of patients treated with extended-hours haemodialysis in Europe: an analysis of the ERA-EDTA Registry.

Author information

1
Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
2
Dianet Dialysis Centres, Utrecht, The Netherlands.
3
ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
4
AUB Sante Dialyse, Rennes, France.
5
Service de Nephrologie, CHU Rennes, Rennes, France.
6
REIN Registry, Agence de la biomédecine, Saint-Denis La Plaine, France.
7
French-Belgian ESRD Registry, Brussels, Belgium.
8
Nephrology Unit, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
9
Registre de Malalts Renals de Catalunya, Barcelona, Spain.
10
Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
11
Finnish Registry for Kidney Diseases, Helsinki, Finland.
12
Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
13
Department of Nephrology, Oslo University Hospital, Ullevål, Norway.
14
Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Huddinge, Sweden.
15
Swedish Renal Registry, Department of Internal Medicine, Ryhov County Hospital, Jönköping, Sweden.
16
Scottish Renal Registry Meridian Court, Information Services Division Scotland, Glasgow, UK.
17
Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, CNR-Institute of Clinical Physiology, Reggio Calabria, Italy.
18
Division of Nephrology, Ambroise-Paré University Hospital, APHP, University of Paris Ouest-Versailles-St-Quentin-en-Yvelines, Boulogne-Billancourt/Paris, France.
19
Institut National de la Santé et de la Recherche Médicale U1018, Team 5, CESP UVSQ, University Paris Saclay, Villejuif, France.
20
Department of Nephrology and Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

Abstract

BACKGROUND:

Previous US studies have indicated that haemodialysis with ≥6-h sessions [extended-hours haemodialysis (EHD)] may improve patient survival. However, patient characteristics and treatment practices vary between the USA and Europe. We therefore investigated the effect of EHD three times weekly on survival compared with conventional haemodialysis (CHD) among European patients.

METHODS:

We included patients who were treated with haemodialysis between 2010 and 2017 from eight countries providing data to the European Renal Association-European Dialysis and Transplant Association Registry. Haemodialysis session duration and frequency were recorded once every year or at every change of haemodialysis prescription and were categorized into three groups: CHD (three times weekly, 3.5-4 h/treatment), EHD (three times weekly, ≥6 h/treatment) or other. In the primary analyses we attributed death to the treatment at the time of death and in secondary analyses to EHD if ever initiated. We compared mortality risk for EHD to CHD with causal inference from marginal structural models, using Cox proportional hazards models weighted for the inverse probability of treatment and censoring and adjusted for potential confounders.

RESULTS:

From a total of 142 460 patients, 1338 patients were ever treated with EHD (three times, 7.1 ± 0.8 h/week) and 89 819 patients were treated exclusively with CHD (three times, 3.9 ± 0.2 h/week). Crude mortality rates were 6.0 and 13.5/100 person-years. In the primary analyses, patients treated with EHD had an adjusted hazard ratio (HR) of 0.73 [95% confidence interval (CI) 0.62-0.85] compared with patients treated with CHD. When we attributed all deaths to EHD after initiation, the HR for EHD was comparable to the primary analyses [HR 0.80 (95% CI 0.71-0.90)].

CONCLUSIONS:

EHD is associated with better survival in European patients treated with haemodialysis three times weekly.

KEYWORDS:

ERA-EDTA Registry; extended-hours; haemodialysis; nocturnal haemodialysis; survival

PMID:
31740955
DOI:
10.1093/ndt/gfz208

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