Survival with Three-Times Weekly In-Center Nocturnal Versus Conventional Hemodialysis

Whether the duration of hemodialysis treatments improves outcomes remains controversial. Here, we evaluated survival and clinical changes associated with converting from conventional hemodialysis (mean=3.75 h/treatment) to in-center nocturnal hemodialysis (mean=7.85 h/treatment). All 959 consecutive...

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Bibliographic Details
Published in:Journal of the American Society of Nephrology 2012-04, Vol.23 (4), p.687-695
Main Authors: LACSON, Eduardo, JIANGLIN XU, SURI, Rita S, NESRALLAH, Gihad, LINDSAY, Robert, GARG, Amit X, LESTER, Keith, OFSTHUN, Norma, LAZARUS, Michael, HAKIM, Raymond M
Format: Article
Language:English
Subjects:
Adult
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Cause of Death
Clinical Epidemiology
Cohort Studies
Emergency and intensive care: renal failure. Dialysis management
Female
Hemodialysis Units, Hospital
Humans
Intensive care medicine
Kaplan-Meier Estimate
Kidney Failure, Chronic - diagnosis
Kidney Failure, Chronic - mortality
Kidney Failure, Chronic - therapy
Male
Medical sciences
Middle Aged
Nephrology. Urinary tract diseases
Night Care
Proportional Hazards Models
Renal Dialysis - methods
Risk Assessment
Survival Analysis
Time Factors
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Summary:Whether the duration of hemodialysis treatments improves outcomes remains controversial. Here, we evaluated survival and clinical changes associated with converting from conventional hemodialysis (mean=3.75 h/treatment) to in-center nocturnal hemodialysis (mean=7.85 h/treatment). All 959 consecutive patients who initiated nocturnal hemodialysis for the first time in 77 Fresenius Medical Care facilities during 2006 and 2007 were eligible. We used Cox models to compare risk for mortality during 2 years of follow-up in a 1:3 propensity score-matched cohort of 746 nocturnal and 2062 control patients on conventional hemodialysis. Two-year mortality was 19% among nocturnal hemodialysis patients compared with 27% among conventional patients. Nocturnal hemodialysis associated with a 25% reduction in the risk for death after adjustment for age, body mass index, and dialysis vintage (hazard ratio=0.75, 95% confidence interval=0.61-0.91, P=0.004). With respect to clinical features, interdialytic weight gain, albumin, hemoglobin, dialysis dose, and calcium increased on nocturnal therapy, whereas postdialysis weight, predialysis systolic blood pressure, ultrafiltration rate, phosphorus, and white blood cell count declined (all P
ISSN:1046-6673
1533-3450
DOI:10.1681/ASN.2011070674