Quotidian dialysis Survival in 221 patients treated by short daily hemodialysis for 315 patient years

Abstract

Daily hemodialysis greatly improves clinical and biochemical parameters and patient quality of life compared to conventional thrice weekly dialysis. However, mortality statistics are lacking as most centers providing daily dialysis have treated only a small number of relatively selected patients for relatively short observation times. To study patient survival we pooled experience from three sources: 51 French and 128 U.S. patients selected for daily home hemodialysis and 42 U.S. patients selected for short daily center hemodialysis because of many medical complications and cardiovascular instability. Results were compared to age‐matched patients from the USRDS 2003 data base. The age of the patients was 51 ± 16 (18–89) years; 29% were female; they had 3.3 ± 1.8 comorbidities (twice that of USRDS patients); 32% had diabetes or hypertension as cause of renal disease (USRDS patients 70%); blood access was 61% fistulae, 25% grafts, and 14% CV‐catheters. Mean duration of ESRD treatment at start of short daily hemodialysis was 6 ± 7 years.The observation period was 315 patient years. Patients had been on daily hemodialysis for a mean of 17 ± 18 (0–92) months and 11 patients were observed for more than 5 years. 35 of the 221 patients died (16%); deaths were 111 per 1,000 patient years (53% of expected) and 5‐year cumulative survival was 63% compared to 32% for USRDS patients. Five‐year survival was 0% in patients with >3 comorbidities, 75% in patients with <3 comorbidities (p < 0.0001), and in patients aged <53 years was 80% vs. 50% in patients aged >53 years (p = 0.0007). On Cox stepwise hazards analysis, comorbidity alone predicted survival when used with age. Comorbidity >3 HR = 6.00 (95% CI 2.2–16.3). Conclusions: It is difficult to do survival comparisons between patient groups. However, these daily dialysis patients were age‐matched with patients from the USRDS database. There were fewer diabetic and hypertensive patients but the comorbidity index was twice that of USRDS patients. Survival, both deaths per 1,000 patient years and cumulative count was approximately twice that reported by the USRDS and strongly suggests superior survival with short daily hemodialysis compared to thrice weekly conventional dialysis.