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Survival of patients treated with extended-hours haemodialysis in Europe: an analysis of the ERA-EDTA Registry

Abstract Background Previous US studies have indicated that haemodialysis with ≥6-h sessions [extended-hours haemodialysis (EHD)] may improve patient survival. However, patient characteristics and treatment practices vary between the USA and Europe. We therefore investigated the effect of EHD three...

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Published in:Nephrology, dialysis, transplantation dialysis, transplantation, 2020-03, Vol.35 (3), p.488-495
Main Authors: Jansz, Thijs T, Noordzij, Marlies, Kramer, Anneke, Laruelle, Eric, Couchoud, Cécile, Collart, Frederic, Cases, Aleix, Arici, Mustafa, Helve, Jaako, Waldum-Grevbo, Bård, Rydell, Helena, Traynor, Jamie P, Zoccali, Carmine, Massy, Ziad A, Jager, Kitty J, van Jaarsveld, Brigit C
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cited_by cdi_FETCH-LOGICAL-c530t-cc57f6f90b41f46829232cabfc9392a000b26c149a4263c33bda7e013aef464b3
cites cdi_FETCH-LOGICAL-c530t-cc57f6f90b41f46829232cabfc9392a000b26c149a4263c33bda7e013aef464b3
container_end_page 495
container_issue 3
container_start_page 488
container_title Nephrology, dialysis, transplantation
container_volume 35
creator Jansz, Thijs T
Noordzij, Marlies
Kramer, Anneke
Laruelle, Eric
Couchoud, Cécile
Collart, Frederic
Cases, Aleix
Arici, Mustafa
Helve, Jaako
Waldum-Grevbo, Bård
Rydell, Helena
Traynor, Jamie P
Zoccali, Carmine
Massy, Ziad A
Jager, Kitty J
van Jaarsveld, Brigit C
description Abstract Background Previous US studies have indicated that haemodialysis with ≥6-h sessions [extended-hours haemodialysis (EHD)] may improve patient survival. However, patient characteristics and treatment practices vary between the USA and Europe. We therefore investigated the effect of EHD three times weekly on survival compared with conventional haemodialysis (CHD) among European patients. Methods We included patients who were treated with haemodialysis between 2010 and 2017 from eight countries providing data to the European Renal Association–European Dialysis and Transplant Association Registry. Haemodialysis session duration and frequency were recorded once every year or at every change of haemodialysis prescription and were categorized into three groups: CHD (three times weekly, 3.5–4 h/treatment), EHD (three times weekly, ≥6 h/treatment) or other. In the primary analyses we attributed death to the treatment at the time of death and in secondary analyses to EHD if ever initiated. We compared mortality risk for EHD to CHD with causal inference from marginal structural models, using Cox proportional hazards models weighted for the inverse probability of treatment and censoring and adjusted for potential confounders. Results From a total of 142 460 patients, 1338 patients were ever treated with EHD (three times, 7.1 ± 0.8 h/week) and 89 819 patients were treated exclusively with CHD (three times, 3.9 ± 0.2 h/week). Crude mortality rates were 6.0 and 13.5/100 person-years. In the primary analyses, patients treated with EHD had an adjusted hazard ratio (HR) of 0.73 [95% confidence interval (CI) 0.62–0.85] compared with patients treated with CHD. When we attributed all deaths to EHD after initiation, the HR for EHD was comparable to the primary analyses [HR 0.80 (95% CI 0.71–0.90)]. Conclusions EHD is associated with better survival in European patients treated with haemodialysis three times weekly.
doi_str_mv 10.1093/ndt/gfz208
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However, patient characteristics and treatment practices vary between the USA and Europe. We therefore investigated the effect of EHD three times weekly on survival compared with conventional haemodialysis (CHD) among European patients. Methods We included patients who were treated with haemodialysis between 2010 and 2017 from eight countries providing data to the European Renal Association–European Dialysis and Transplant Association Registry. Haemodialysis session duration and frequency were recorded once every year or at every change of haemodialysis prescription and were categorized into three groups: CHD (three times weekly, 3.5–4 h/treatment), EHD (three times weekly, ≥6 h/treatment) or other. In the primary analyses we attributed death to the treatment at the time of death and in secondary analyses to EHD if ever initiated. We compared mortality risk for EHD to CHD with causal inference from marginal structural models, using Cox proportional hazards models weighted for the inverse probability of treatment and censoring and adjusted for potential confounders. Results From a total of 142 460 patients, 1338 patients were ever treated with EHD (three times, 7.1 ± 0.8 h/week) and 89 819 patients were treated exclusively with CHD (three times, 3.9 ± 0.2 h/week). Crude mortality rates were 6.0 and 13.5/100 person-years. In the primary analyses, patients treated with EHD had an adjusted hazard ratio (HR) of 0.73 [95% confidence interval (CI) 0.62–0.85] compared with patients treated with CHD. When we attributed all deaths to EHD after initiation, the HR for EHD was comparable to the primary analyses [HR 0.80 (95% CI 0.71–0.90)]. Conclusions EHD is associated with better survival in European patients treated with haemodialysis three times weekly.</description><identifier>ISSN: 0931-0509</identifier><identifier>ISSN: 1460-2385</identifier><identifier>EISSN: 1460-2385</identifier><identifier>DOI: 10.1093/ndt/gfz208</identifier><identifier>PMID: 31740955</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Human health and pathology ; Life Sciences ; Medicin och hälsovetenskap ; Original ; Santé publique et épidémiologie ; Urology and Nephrology</subject><ispartof>Nephrology, dialysis, transplantation, 2020-03, Vol.35 (3), p.488-495</ispartof><rights>The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. 2019</rights><rights>The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c530t-cc57f6f90b41f46829232cabfc9392a000b26c149a4263c33bda7e013aef464b3</citedby><cites>FETCH-LOGICAL-c530t-cc57f6f90b41f46829232cabfc9392a000b26c149a4263c33bda7e013aef464b3</cites><orcidid>0000-0002-5686-5033 ; 0000-0002-6962-8184 ; 0000-0001-5771-5996 ; 0000-0003-0444-8569 ; 0000-0002-6616-1996</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31740955$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-03228151$$DView record in HAL$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:143133094$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Jansz, Thijs T</creatorcontrib><creatorcontrib>Noordzij, Marlies</creatorcontrib><creatorcontrib>Kramer, Anneke</creatorcontrib><creatorcontrib>Laruelle, Eric</creatorcontrib><creatorcontrib>Couchoud, Cécile</creatorcontrib><creatorcontrib>Collart, Frederic</creatorcontrib><creatorcontrib>Cases, Aleix</creatorcontrib><creatorcontrib>Arici, Mustafa</creatorcontrib><creatorcontrib>Helve, Jaako</creatorcontrib><creatorcontrib>Waldum-Grevbo, Bård</creatorcontrib><creatorcontrib>Rydell, Helena</creatorcontrib><creatorcontrib>Traynor, Jamie P</creatorcontrib><creatorcontrib>Zoccali, Carmine</creatorcontrib><creatorcontrib>Massy, Ziad A</creatorcontrib><creatorcontrib>Jager, Kitty J</creatorcontrib><creatorcontrib>van Jaarsveld, Brigit C</creatorcontrib><title>Survival of patients treated with extended-hours haemodialysis in Europe: an analysis of the ERA-EDTA Registry</title><title>Nephrology, dialysis, transplantation</title><addtitle>Nephrol Dial Transplant</addtitle><description>Abstract Background Previous US studies have indicated that haemodialysis with ≥6-h sessions [extended-hours haemodialysis (EHD)] may improve patient survival. However, patient characteristics and treatment practices vary between the USA and Europe. We therefore investigated the effect of EHD three times weekly on survival compared with conventional haemodialysis (CHD) among European patients. Methods We included patients who were treated with haemodialysis between 2010 and 2017 from eight countries providing data to the European Renal Association–European Dialysis and Transplant Association Registry. Haemodialysis session duration and frequency were recorded once every year or at every change of haemodialysis prescription and were categorized into three groups: CHD (three times weekly, 3.5–4 h/treatment), EHD (three times weekly, ≥6 h/treatment) or other. In the primary analyses we attributed death to the treatment at the time of death and in secondary analyses to EHD if ever initiated. We compared mortality risk for EHD to CHD with causal inference from marginal structural models, using Cox proportional hazards models weighted for the inverse probability of treatment and censoring and adjusted for potential confounders. Results From a total of 142 460 patients, 1338 patients were ever treated with EHD (three times, 7.1 ± 0.8 h/week) and 89 819 patients were treated exclusively with CHD (three times, 3.9 ± 0.2 h/week). Crude mortality rates were 6.0 and 13.5/100 person-years. In the primary analyses, patients treated with EHD had an adjusted hazard ratio (HR) of 0.73 [95% confidence interval (CI) 0.62–0.85] compared with patients treated with CHD. When we attributed all deaths to EHD after initiation, the HR for EHD was comparable to the primary analyses [HR 0.80 (95% CI 0.71–0.90)]. Conclusions EHD is associated with better survival in European patients treated with haemodialysis three times weekly.</description><subject>Human health and pathology</subject><subject>Life Sciences</subject><subject>Medicin och hälsovetenskap</subject><subject>Original</subject><subject>Santé publique et épidémiologie</subject><subject>Urology and Nephrology</subject><issn>0931-0509</issn><issn>1460-2385</issn><issn>1460-2385</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><recordid>eNp9kl-L1DAUxYMo7rj64geQvAgq1M2fpm18EIZ1dIUBYV2fQ5reTqOdpibprOOnN0NnV1dQCCTc-zsnueEg9JSS15RIfjY08WzT_mSkuocWNC9Ixngl7qNFatKMCCJP0KMQvhJCJCvLh-iE0zInUogFGj5Pfmd3useuxaOOFoYYcPSgIzT42sYOw48IQwNN1rnJB9xp2LrG6n4fbMB2wKvJuxHeYD2kdSwns9gBXl0us9W7qyW-hI0N0e8fowet7gM8Oe6n6Mv71dX5Rbb-9OHj-XKdGcFJzIwRZVu0ktQ5bfOiYpJxZnTdGskl02mQmhWG5lLnrOCG87rRJRDKNSQ8r_kpymbfcA3jVKvR2632e-W0VcfSt3QClZdCiDLx8p_86F3zW3QjpDmnnBOZJ-3bWZuALTQm_aDX_V2LO53BdmrjdqokopCCJoOXs0H3l-xiuVaHGuGMVVTQ3YF9cbzMu-8ThKi2Nhjoez2Am4JinApZVIIe3vVqRo13IXhob70pUYfgqBQcNQcnwc_-HOIWvUlKAp7PgJvG_xn9Apbrznk</recordid><startdate>20200301</startdate><enddate>20200301</enddate><creator>Jansz, Thijs T</creator><creator>Noordzij, Marlies</creator><creator>Kramer, Anneke</creator><creator>Laruelle, Eric</creator><creator>Couchoud, Cécile</creator><creator>Collart, Frederic</creator><creator>Cases, Aleix</creator><creator>Arici, Mustafa</creator><creator>Helve, Jaako</creator><creator>Waldum-Grevbo, Bård</creator><creator>Rydell, Helena</creator><creator>Traynor, Jamie P</creator><creator>Zoccali, Carmine</creator><creator>Massy, Ziad A</creator><creator>Jager, Kitty J</creator><creator>van Jaarsveld, Brigit C</creator><general>Oxford University Press</general><scope>TOX</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>1XC</scope><scope>VOOES</scope><scope>5PM</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0002-5686-5033</orcidid><orcidid>https://orcid.org/0000-0002-6962-8184</orcidid><orcidid>https://orcid.org/0000-0001-5771-5996</orcidid><orcidid>https://orcid.org/0000-0003-0444-8569</orcidid><orcidid>https://orcid.org/0000-0002-6616-1996</orcidid></search><sort><creationdate>20200301</creationdate><title>Survival of patients treated with extended-hours haemodialysis in Europe: an analysis of the ERA-EDTA Registry</title><author>Jansz, Thijs T ; 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However, patient characteristics and treatment practices vary between the USA and Europe. We therefore investigated the effect of EHD three times weekly on survival compared with conventional haemodialysis (CHD) among European patients. Methods We included patients who were treated with haemodialysis between 2010 and 2017 from eight countries providing data to the European Renal Association–European Dialysis and Transplant Association Registry. Haemodialysis session duration and frequency were recorded once every year or at every change of haemodialysis prescription and were categorized into three groups: CHD (three times weekly, 3.5–4 h/treatment), EHD (three times weekly, ≥6 h/treatment) or other. In the primary analyses we attributed death to the treatment at the time of death and in secondary analyses to EHD if ever initiated. We compared mortality risk for EHD to CHD with causal inference from marginal structural models, using Cox proportional hazards models weighted for the inverse probability of treatment and censoring and adjusted for potential confounders. Results From a total of 142 460 patients, 1338 patients were ever treated with EHD (three times, 7.1 ± 0.8 h/week) and 89 819 patients were treated exclusively with CHD (three times, 3.9 ± 0.2 h/week). Crude mortality rates were 6.0 and 13.5/100 person-years. In the primary analyses, patients treated with EHD had an adjusted hazard ratio (HR) of 0.73 [95% confidence interval (CI) 0.62–0.85] compared with patients treated with CHD. When we attributed all deaths to EHD after initiation, the HR for EHD was comparable to the primary analyses [HR 0.80 (95% CI 0.71–0.90)]. Conclusions EHD is associated with better survival in European patients treated with haemodialysis three times weekly.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>31740955</pmid><doi>10.1093/ndt/gfz208</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-5686-5033</orcidid><orcidid>https://orcid.org/0000-0002-6962-8184</orcidid><orcidid>https://orcid.org/0000-0001-5771-5996</orcidid><orcidid>https://orcid.org/0000-0003-0444-8569</orcidid><orcidid>https://orcid.org/0000-0002-6616-1996</orcidid><oa>free_for_read</oa></addata></record>
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subjects Human health and pathology
Life Sciences
Medicin och hälsovetenskap
Original
Santé publique et épidémiologie
Urology and Nephrology
title Survival of patients treated with extended-hours haemodialysis in Europe: an analysis of the ERA-EDTA Registry
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