Survival and hospitalization among patients using nocturnal and short daily compared to conventional hemodialysis: a USRDS study

• Authors: Kirsten L. Johansen, University of California San Francisco; Rebecca Zhang, Emory University; Yijian Huang, Emory University; Shu-Cheng Chen, USRDS Coordinating Center; Christopher R. Blagg, Northwest Kidney Centers; Alexander S. Goldfarb-Rumyantzev, Harvard University; Christopher D. Hoy, Rubin Dialysis Center; Robert S. Lockridge, Lynchburg Nephrology Dialysis, Inc.; Brent W. Miller, Washington University; Paul Eggers, National Institute of Diabetes and Digestive and Kidney Diseases; Nancy Kutner, Emory University
• Journal Title: Kidney International Supplements
• Volume: Volume 76, Number 9
• Publisher: Nature Publishing Group | 2009-11-01, Pages 984-990
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1038/ki.2009.291
• Subjects: Health Sciences, Rehabilitation and Therapy; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Urology & Nephrology; daily hemodialysis; hospitalization; survival; USRDS; LEFT-VENTRICULAR HYPERTROPHY; QUALITY-OF-LIFE; IN-CENTER HEMODIALYSIS; VASCULAR ACCESS; HOME HEMODIALYSIS; DAILY DIALYSIS; LONG-TERM; COST; MORTALITY; TRIAL

Abstract

We estimated the survival and hospitalization among frequent hemodialysis users in comparison to those patients undergoing thrice-weekly conventional hemodialysis. All patients had similar characteristics and medical histories. In this cohort study of frequent hemodialysis users and propensity score-matched controls, the collaborating clinicians identified 94 patients who used nocturnal hermodialysis (NHD) and 43 patients who used short-duration daily hemodialysis (SDHD) for a minimum of 60 days. Ten propensity score-matched control patients for each NHD and SDHD patient were identified from the United States Renal Data System database. Primary outcomes were risk for all-cause mortality and risk for the composite outcome of mortality or major morbid event (acute myocardial infarction or stroke) estimated using Cox proportional hazards models. Risks for all-cause, cardiovascular-related, infection-related, and vascular access-related hospital admissions were also studied. Nocturnal hemodialysis was associated with significant reductions in mortality risk and risk for mortality or major morbid event when compared to conventional hemodialysis. There was a reduced but non-significant risk of death for patients using SDHD compared to controls. All-cause and specific hospitalizations did not differ significantly between NHD and SDHD patients and their matched control cohorts. Our study suggests that NHD may improve patient survival.