Intensive Hemodialysis Associates with Improved Survival Compared with Conventional Hemodialysis

被引：161

作者：

Nesrallah, Gihad E. ^{[1
,2
]}

Lindsay, Robert M. ^{[1
]}

Cuerden, Meaghan S. ^{[1
]}

Garg, Amit X. ^{[1
,2
,3
]}

Port, Friedrich ^{[4
]}

Austin, Peter C. ^{[5
,6
]}

Moist, Louise M. ^{[1
,3
]}

Pierratos, Andreas ^{[7
]}

Chan, Christopher T. ^{[7
]}

Zimmerman, Deborah ^{[8
]}

Lockridge, Robert S. ^{[9
]}

Couchoud, Cecile ^{[10
]}

Chazot, Charles ^{[11
]}

Ofsthun, Norma ^{[12
]}

Levin, Adeera ^{[13
]}

Copland, Michael ^{[13
]}

Courtney, Mark ^{[14
]}

Steele, Andrew ^{[15
]}

McFarlane, Philip A. ^{[7
]}

Geary, Denis F. ^{[7
]}

Pauly, Robert P. ^{[14
]}

Komenda, Paul ^{[16
]}

Suri, Rita S. ^{[1
]}

机构：

[1] Univ Western Ontario, Div Nephrol, London, ON, Canada

[2] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada

[3] Univ Western Ontario, Dept Clin Epidemiol & Biostat, London, ON, Canada

[4] Arbor Collaborat Hlth, Ann Arbor, MI USA

[5] Inst Clin Evaluat Sci, Toronto, ON, Canada

[6] Univ Toronto, Depy Hlth Policy Management & Evaluat, Toronto, ON, Canada

[7] Univ Toronto, Div Nephrol, Toronto, ON, Canada

[8] Univ Ottawa, Div Nephrol, Ottawa, ON, Canada

[9] Univ Virginia, Div Nephrol, Lynchburg, VA USA

[10] Agence Biomed, Renal Epidemiol & Informat Network Registry, La Plaine St Denis, France

[11] NephroCare Tassin Charcot, Sainte Foy Les Lyon, France

[12] North Amer, Fresenius Med Care, Waltham, MA USA

[13] Univ British Columbia, Div Nephrol, Vancouver, BC V5Z 1M9, Canada

[14] Univ Alberta, Div Nephrol, Edmonton, AB, Canada

[15] Lakeridge Hlth Oshawa, Oshawa, ON, Canada

[16] Univ Manitoba, Div Nephrol, Winnipeg, MB, Canada

来源：

JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2012年 / 23卷 / 04期

基金：

加拿大健康研究院;

关键词：

NOCTURNAL HOME HEMODIALYSIS; UNTREATED SUBJECTS; PROPENSITY SCORE; MORTALITY; TIME; EXPERIENCE; OUTCOMES; REGISTRY;

D O I：

10.1681/ASN.2011070676

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Patients undergoing conventional maintenance hemodialysis typically receive three sessions per week, each lasting 2.5-5.5 hours. Recently, the use of more intensive hemodialysis (>5.5 hours, three to seven times per week) has increased, but the effects of these regimens on survival are uncertain. We conducted a retrospective cohort study to examine whether intensive hemodialysis associates with better survival than conventional hemodialysis. We identified 420 patients in the International Quotidian Dialysis Registry who received intensive home hemodialysis in France, the United States, and Canada between January 2000 and August 2010. We matched 338 of these patients to 1388 patients in the Dialysis Outcomes and Practice Patterns Study who received in-center conventional hemodialysis during the same time period by country, ESRD duration, and propensity score. The intensive hemodialysis group received a mean (SD) 4.8 (1.1) sessions per week with a mean treatment time of 7.4 (0.87) hours per session; the conventional group received three sessions per week with a mean treatment time of 3.9 (0.32) hours per session. During 3008 patient-years of follow-up, 45 (13%) of 338 patients receiving intensive hemodialysis died compared with 293(21%) of 1388 patients receiving conventional hemodialysis (6.1 versus 10.5 deaths per 100 person-years; hazard ratio, 0.55 [95% confidence interval, 0.34-0.87]). The strength and direction of the observed association between intensive hemodialysis and improved survival were consistent across all prespecified subgroups and sensitivity analyses. In conclusion, there is a strong association between intensive home hemodialysis and improved survival, but whether this relationship is causal remains unknown.

引用

页码：696 / 705

页数：10

共 32 条

[1] Statistics Notes - Interaction revisited: the difference between two estimates [J].

Altman, DG ;

Bland, JM .

BMJ-BRITISH MEDICAL JOURNAL, 2003, 326 (7382) :219-219

[2]

[Anonymous], INTR SAS

[3] A comparison of the ability of different propensity score models to balance measured variables between treated and untreated subjects: a Monte Carlo study [J].

Austin, Peter C. ;

Grootendorst, Paul ;

Anderson, Geoffrey M. .

STATISTICS IN MEDICINE, 2007, 26 (04) :734-753

[4] Statistical Criteria for Selecting the Optimal Number of Untreated Subjects Matched to Each Treated Subject When Using Many-to-One Matching on the Propensity Score [J].

Austin, Peter C. .

AMERICAN JOURNAL OF EPIDEMIOLOGY, 2010, 172 (09) :1092-1097

[5] Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples [J].

Austin, Peter C. .

STATISTICS IN MEDICINE, 2009, 28 (25) :3083-3107

[6] First use of nocturnal hemodialysis [J].

Blagg, Christopher R. .

KIDNEY INTERNATIONAL, 2009, 76 (08) :917-917

[7] The logrank test [J].

Bland, JM ;

Altman, DG .

BRITISH MEDICAL JOURNAL, 2004, 328 (7447) :1073-1073

[8] Nocturnal hemodialysis is associated with restoration of impaired endothelial progenitor cell biology in end-stage renal disease [J].

Chan, CT ;

Li, SH ;

Verma, S .

AMERICAN JOURNAL OF PHYSIOLOGY-RENAL PHYSIOLOGY, 2005, 289 (04) :F679-F684

[9] The renal epidemiology and information network (REIN): a new registry for end-stage renal disease in France [J].

Couchoud, C ;

Stengel, B ;

Landais, P ;

Aldigier, JC ;

de Cornelissen, F ;

Dabot, C ;

Maheut, H ;

Joyeux, V ;

Kessler, M ;

Labeeuw, M ;

Isnard, H ;

Jacquelinet, C .

NEPHROLOGY DIALYSIS TRANSPLANTATION, 2006, 21 (02) :411-418

[10] Effect of frequent nocturnal hemodialysis vs conventional hemodialysis on left ventricular mass and quality of life - A randomized controlled trial [J].

Culleton, Bruce F. ;

Walsh, Michael ;

Klarenbach, Scott W. ;

Mortis, Garth ;

Scott-Douglas, Narine ;

Quinn, Robert R. ;

Tonelli, Marcello ;

Donnelly, Sarah ;

Friedrich, Matthias G. ;

Kumar, Andreas ;

Mahallati, Houman ;

Hemmelgarn, Brenda R. ;

Manns, Braden J. .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2007, 298 (11) :1291-1299

← 1 2 3 4 →