Abstract
BackgroundAs patients on daily hemodialysis (DHD) have heterogeneous profiles, DHD benefit in terms of survival is still debated. The aim of this study was to compare DHD practices in France and in Australia and New Zealand.MethodsThis study was based on data from the French Renal Epidemiology and Information Network (REIN) and the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). All incident patients from both registries who underwent DHD (i.e., 5–6 sessions/week, including short daily hemodialysis and long nocturnal hemodialysis) at least once during their trajectories were included, and their characteristics and care trajectories were compared. For survival analyses, one French patient was matched to one Australian or New Zealand patient, based on age, sex and year of dialysis start. Survival was assessed using the Cox proportional hazards model, and access to renal transplantation was evaluated using the Fine & Gray model to take into account death as competing risk.ResultsBetween 2003 and 2012, 523 patients from the AZNDATA and 753 from the REIN registry started DHD. ANZDATA patients were younger (54.8 vs 64.0 years, p < 0.001) and had comorbidities more frequently than French patients. In both registries, one third of patients were on early DHD (i.e., DHD started less than one year after dialysis initiation). Long nocturnal hemodialysis was more frequent in the ANZDATA than in the REIN cohort (20.8 and 3%, respectively). Comparison of the matched subgroups showed comparable survival rates between French and Australian/New Zealand patients (HRadjusted = 1.08; 95%CI: 0.78–1.50). Access to renal transplantation also was similar between matched groups (SHRadjusted = 1.30, 95%CI: 0.86–1.97).ConclusionsOur study shows that, despite differences in terms of patients’ characteristics and DHD regimens, the mortality risk and access to renal transplantation are similar in France and Australia and New Zealand.
Highlights
As patients on daily hemodialysis (DHD) have heterogeneous profiles, DHD benefit in terms of survival is still debated
As the number of patients from New Zealand was low and they displayed characteristics similar to those of the Australian patients, patients from these two countries were grouped in a single Australia/New Zealand cohort
In France as well as in Australia and New Zealand, one third of patients were on early DHD, and the others on late DHD (Fig. 1)
Summary
As patients on daily hemodialysis (DHD) have heterogeneous profiles, DHD benefit in terms of survival is still debated. Analysis of the REIN data highlighted the clinical feature heterogeneity of patients starting DHD (i.e., 5 or 6 HD sessions/week) [15], and showed that the risk of death is higher in patients on DHD than in matched patients on HD 3 times/week [16]. This confirmed a Pladys et al BMC Nephrology (2019) 20:156 previous study by Suri et al that included patients undergoing in-center HD [17]. These contradictory results could be explained by differences in the practices associated with DHD between France and other countries [16, 17]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
