Abstract
The association of survival with characteristics of thrice-weekly hemodialysis (HD) treatment, including dose or duration of treatment, has not been completely elucidated, especially in different race and sex categories. We examined associations of time-averaged and quarterly varying (time-dependent) delivered HD dose and treatment time and 5-year (July 2001-June 2006) survival. 88,153 thrice-weekly-treated HD patients from DaVita dialysis clinics. HD treatment dose (single-pool Kt/V) and treatment time. 5-Year mortality. Thrice-weekly treatment time < 3 hours (but > or = 2.5 hours) per HD session compared with > or = 3.5 hours (but < 5 hours) was associated with increased death risk independent of Kt/V dose. The greatest survival gain of higher HD dose was associated with a Kt/V approaching the 1.6-1.8 range, beyond which survival gain was minimal, nonexistent, or even tended to reverse in African American men and those with 4-5 hours of HD treatment. In non-Hispanic white women, Kt/V > 1.8 continued to show survival advantage trends, especially in time-dependent models. Our results may incorporate uncontrolled confounding. Achieved Kt/V may have different associations than targeted Kt/V. HD treatment dose and time appear to have different associations with survival in different sex or race groups. Randomized controlled trials may be warranted to examine these associations across different racial and demographic groups.
Highlights
Over 90% of the 350,000 Americans with dialysis-dependent chronic kidney disease (CKD) undergo thrice-weekly hemodialysis (HD) treatment, usually between 3 to 4 hrs per treatment session in one of the 5,000 dialysis clinics in the United States.[1]
Even though it was once believed that longer or higher doses of hemodialysis treatment would improve survival, a recent randomized controlled trial known as the HEMO Study [3] did not detect survival advantage for higher dialysis dose or the use of higher flux dialysis membranes
Subgroup analyses of the HEMO Study data, suggested that certain groups of HD patients such as women may benefit from higher hemodialysis doses.[3]
Summary
Over 90% of the 350,000 Americans with dialysis-dependent chronic kidney disease (CKD) undergo thrice-weekly hemodialysis (HD) treatment, usually between 3 to 4 hrs per treatment session in one of the 5,000 dialysis clinics in the United States.[1]. Higher Kt/V values can be the result of longer hemodialysis treatment sessions or higher flux membranes as well as smaller body sizes, i.e., smaller V. It is not clear whether longer hemodialysis sessions is independently associated with greater survival, irrespective of the magnitude of the Kt/V[8,9] or vice versa. The cumulative effect of the dialysis dose over time on long-term survival is unclear It is not known whether higher combined dose of Kt/V over time is associated with greater survival across different sex or racial subgroups of CKD patients, especially when African Americans are compared to other patients. In non-Hispanic white women, a Kt/V above 1.8 continued to exhibit survival advantage trends esp. in time-dependent models
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