Abstract

With the global problem of aging, it has become more difficult to improve the prognosis of older dialysis patients. Extended-hours hemodialysis offers longer treatment time compared to conventional hemodialysis regimen and provides favorable metabolic status, hemodynamic stability, and increased dietary intake. Despite prior studies reporting that in-center extended-hours hemodialysis can reduce the mortality rate, the treatment impact on elderly patients remains unclear. Therefore, we examined the association between extended-hours hemodialysis compared to conventional hemodialysis and all-cause mortality. Survival analyses using Cox proportional hazard model with multivariable adjustments and propensity-score based method were performed to compare mortality risk between 198 consecutive patients who started in-center extended-hours hemodialysis (Extended-HD) and 1407 consecutive patients who initiated conventional hemodialysis. The median age was 67.1 years in the Extended-HD group and 70.7 years in the conventional hemodialysis group. Extended-HD was associated with lower all-cause mortality in overall patients and the subgroup >70 years (adjusted hazard ratios of 0.60 [95% CI, 0.39–0.91] and 0.35 [95% CI, 0.18–0.69], respectively). There was a significant interaction between age >70 years and Extended-HD. In conclusion, extended-hours hemodialysis was associated with a lower mortality rate, especially in elderly patients.

Highlights

  • As the world’s population ages, increasing numbers of elderly patients have been started on renal replacement therapy and are becoming a major part of the incident dialysis patient

  • A retrospective cohort study of 198 consecutive incident dialysis patients who had exclusively received in-center extended-hours HD (Extended-HD) after the initiation of renal replacement therapy at 3 facilities operated by a specialized longer dialysis treatment provider located in the rural area of North-Eastern Japan during October 2008 to September 2017 was performed

  • [20] This study included the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis (AICOPP), the prospective cohort representing patients on conventional HD, in which all participants basically received HD of three to five

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Summary

Objectives

The aim of the present study was to determine the association between in-center daytime extended-hours HD and survival in incident HD patients

Methods
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