Outcomes of extended-hours hemodialysis performed predominantly at home

Jun, M., Jardine, Meg J., Gray, Nicholas, Masterson, Rosemary, Kerr, Peter G., Agar, John W. M., Hawley, Carmel M., van Eps, Carolyn, Cass, Alan, Gallagher, Martin and Perkovic, Vlado (2013) Outcomes of extended-hours hemodialysis performed predominantly at home. American Journal of Kidney Diseases, 61 2: 247-253. doi:10.1053/j.ajkd.2012.08.032

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Author Jun, M.
Jardine, Meg J.
Gray, Nicholas
Masterson, Rosemary
Kerr, Peter G.
Agar, John W. M.
Hawley, Carmel M.
van Eps, Carolyn
Cass, Alan
Gallagher, Martin
Perkovic, Vlado
Title Outcomes of extended-hours hemodialysis performed predominantly at home
Journal name American Journal of Kidney Diseases   Check publisher's open access policy
ISSN 0272-6386
Publication date 2013-02
Year available 2012
Sub-type Article (original research)
DOI 10.1053/j.ajkd.2012.08.032
Volume 61
Issue 2
Start page 247
End page 253
Total pages 7
Place of publication Maryland Heights, MO, U.S.A.
Publisher W.B. Saunders Co.
Collection year 2013
Language eng
Formatted abstract
Background: Recent evidence suggests that increased frequency and/or duration of dialysis are associated with improved outcomes. We aimed to describe the outcomes associated with patients starting extended-hours hemodialysis and assess for risk factors for these outcomes.

Study Design: Case series.

Setting & Participants: Patients were from 6 Australian centers offering extended-hours hemodialysis. Cases were patients who started treatment for 24 hours per week or longer at any time.

Outcomes: All-cause mortality, technique failure (withdrawal from extended-hours hemodialysis therapy), and access-related events.

Measurements: Baseline patient characteristics (sex, primary cause of end-stage kidney disease, age, ethnicity, diabetes, and cannulation technique), presence of a vascular access-related event, and dialysis frequency.

Results: 286 patients receiving extended-hours hemodialysis were identified, most of whom performed home (96%) or nocturnal (77%) hemodialysis. Most patients performed alternate-daily dialysis (52%). Patient survival rates using an intention-to-treat approach at 1, 3, and 5 years were 98%, 92%, and 83%, respectively. Of 24 deaths overall, cardiac death (n = 7) and sepsis (n = 5) were the leading causes. Technique survival rates at 1, 3, and 5 years were 90%, 77%, and 68%, respectively. Access event-free rates at the same times were 80%, 68%, and 61%, respectively. Access events significantly predicted death (HR, 2.85; 95% CI, 1.14-7.15) and technique failure (HR, 3.76; 95% CI, 1.93-7.35). Patients with glomerulonephritis had a reduced risk of technique failure (HR, 0.31; 95% CI, 0.14-0.69). Higher dialysis frequency was associated with elevated risk of developing an access event (HR per dialysis session, 1.56; 95% CI, 1.03-2.36).

Limitations: Selection bias, lack of a comparator group.

Extended-hours hemodialysis is associated with excellent survival rates and is an effective treatment option for a select group of patients. The major treatment-associated adverse events were related to complications of vascular access, particularly infection. The risk of developing vascular access complications may be increased in extended-hours hemodialysis, which may negatively affect long-term outcomes.
Keyword End-stage kidney disease
Extended-hours hemodialysis
Technique failure
Vascular access events
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online: 4 October 2012.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Public Health Publications
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 25 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 25 times in Scopus Article | Citations
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Created: Wed, 21 Nov 2012, 14:56:34 EST by Matthew Lamb on behalf of School of Medicine