Incremental Hemodialysis, Residual Kidney Function, and Mortality Risk in Incident Dialysis Patients: A Cohort Study
Maintenance hemodialysis is typically prescribed thrice weekly irrespective of a patient’s residual kidney function (RKF). We hypothesized that a less frequent schedule at hemodialysis therapy initiation is associated with greater preservation of RKF without compromising survival among patients with...
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Published in | American journal of kidney diseases Vol. 68; no. 2; pp. 256 - 265 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Elsevier Inc
01.08.2016
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Subjects | |
Online Access | Get full text |
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Abstract | Maintenance hemodialysis is typically prescribed thrice weekly irrespective of a patient’s residual kidney function (RKF). We hypothesized that a less frequent schedule at hemodialysis therapy initiation is associated with greater preservation of RKF without compromising survival among patients with substantial RKF.
A longitudinal cohort.
23,645 patients who initiated maintenance hemodialysis therapy in a large dialysis organization in the United States (January 2007 to December 2010), had available RKF data during the first 91 days (or quarter) of dialysis, and survived the first year.
Incremental (routine twice weekly for >6 continuous weeks during the first 91 days upon transition to dialysis) versus conventional (thrice weekly) hemodialysis regimens during the same time.
Changes in renal urea clearance and urine volume during 1 year after the first quarter and survival after the first year.
Among 23,645 included patients, 51% had substantial renal urea clearance (≥3.0mL/min/1.73m2) at baseline. Compared with 8,068 patients with conventional hemodialysis regimens matched based on baseline renal urea clearance, urine volume, age, sex, diabetes, and central venous catheter use, 351 patients with incremental regimens exhibited 16% (95% CI, 5%-28%) and 15% (95% CI, 2%-30%) more preserved renal urea clearance and urine volume at the second quarter, respectively, which persisted across the following quarters. Incremental regimens showed higher mortality risk in patients with inadequate baseline renal urea clearance (≤3.0mL/min/1.73m2; HR, 1.61; 95% CI, 1.07-2.44), but not in those with higher baseline renal urea clearance (HR, 0.99; 95% CI, 0.76-1.28). Results were similar in a subgroup defined by baseline urine volume of 600mL/d.
Potential selection bias and wide CIs.
Among incident hemodialysis patients with substantial RKF, incremental hemodialysis may be a safe treatment regimen and is associated with greater preservation of RKF, whereas higher mortality is observed after the first year of dialysis in those with the lowest RKF. Clinical trials are needed to examine the safety and effectiveness of twice-weekly hemodialysis. |
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AbstractList | Background Maintenance hemodialysis is typically prescribed thrice weekly irrespective of a patient’s residual kidney function (RKF). We hypothesized that a less frequent schedule at hemodialysis therapy initiation is associated with greater preservation of RKF without compromising survival among patients with substantial RKF. Study Design A longitudinal cohort. Setting & Participants 23,645 patients who initiated maintenance hemodialysis therapy in a large dialysis organization in the United States (January 2007 to December 2010), had available RKF data during the first 91 days (or quarter) of dialysis, and survived the first year. Predictor Incremental (routine twice weekly for >6 continuous weeks during the first 91 days upon transition to dialysis) versus conventional (thrice weekly) hemodialysis regimens during the same time. Outcomes Changes in renal urea clearance and urine volume during 1 year after the first quarter and survival after the first year. Results Among 23,645 included patients, 51% had substantial renal urea clearance (≥3.0 mL/min/1.73 m2 ) at baseline. Compared with 8,068 patients with conventional hemodialysis regimens matched based on baseline renal urea clearance, urine volume, age, sex, diabetes, and central venous catheter use, 351 patients with incremental regimens exhibited 16% (95% CI, 5%-28%) and 15% (95% CI, 2%-30%) more preserved renal urea clearance and urine volume at the second quarter, respectively, which persisted across the following quarters. Incremental regimens showed higher mortality risk in patients with inadequate baseline renal urea clearance (≤3.0 mL/min/1.73 m2 ; HR, 1.61; 95% CI, 1.07-2.44), but not in those with higher baseline renal urea clearance (HR, 0.99; 95% CI, 0.76-1.28). Results were similar in a subgroup defined by baseline urine volume of 600 mL/d. Limitations Potential selection bias and wide CIs. Conclusions Among incident hemodialysis patients with substantial RKF, incremental hemodialysis may be a safe treatment regimen and is associated with greater preservation of RKF, whereas higher mortality is observed after the first year of dialysis in those with the lowest RKF. Clinical trials are needed to examine the safety and effectiveness of twice-weekly hemodialysis. Maintenance hemodialysis is typically prescribed thrice weekly irrespective of a patient’s residual kidney function (RKF). We hypothesized that a less frequent schedule at hemodialysis therapy initiation is associated with greater preservation of RKF without compromising survival among patients with substantial RKF. A longitudinal cohort. 23,645 patients who initiated maintenance hemodialysis therapy in a large dialysis organization in the United States (January 2007 to December 2010), had available RKF data during the first 91 days (or quarter) of dialysis, and survived the first year. Incremental (routine twice weekly for >6 continuous weeks during the first 91 days upon transition to dialysis) versus conventional (thrice weekly) hemodialysis regimens during the same time. Changes in renal urea clearance and urine volume during 1 year after the first quarter and survival after the first year. Among 23,645 included patients, 51% had substantial renal urea clearance (≥3.0mL/min/1.73m2) at baseline. Compared with 8,068 patients with conventional hemodialysis regimens matched based on baseline renal urea clearance, urine volume, age, sex, diabetes, and central venous catheter use, 351 patients with incremental regimens exhibited 16% (95% CI, 5%-28%) and 15% (95% CI, 2%-30%) more preserved renal urea clearance and urine volume at the second quarter, respectively, which persisted across the following quarters. Incremental regimens showed higher mortality risk in patients with inadequate baseline renal urea clearance (≤3.0mL/min/1.73m2; HR, 1.61; 95% CI, 1.07-2.44), but not in those with higher baseline renal urea clearance (HR, 0.99; 95% CI, 0.76-1.28). Results were similar in a subgroup defined by baseline urine volume of 600mL/d. Potential selection bias and wide CIs. Among incident hemodialysis patients with substantial RKF, incremental hemodialysis may be a safe treatment regimen and is associated with greater preservation of RKF, whereas higher mortality is observed after the first year of dialysis in those with the lowest RKF. Clinical trials are needed to examine the safety and effectiveness of twice-weekly hemodialysis. Maintenance hemodialysis is typically prescribed thrice weekly irrespective of a patient's residual kidney function (RKF). We hypothesized that a less frequent schedule at hemodialysis therapy initiation is associated with greater preservation of RKF without compromising survival among patients with substantial RKF. A longitudinal cohort. 23,645 patients who initiated maintenance hemodialysis therapy in a large dialysis organization in the United States (January 2007 to December 2010), had available RKF data during the first 91 days (or quarter) of dialysis, and survived the first year. Incremental (routine twice weekly for >6 continuous weeks during the first 91 days upon transition to dialysis) versus conventional (thrice weekly) hemodialysis regimens during the same time. Changes in renal urea clearance and urine volume during 1 year after the first quarter and survival after the first year. Among 23,645 included patients, 51% had substantial renal urea clearance (≥3.0mL/min/1.73m(2)) at baseline. Compared with 8,068 patients with conventional hemodialysis regimens matched based on baseline renal urea clearance, urine volume, age, sex, diabetes, and central venous catheter use, 351 patients with incremental regimens exhibited 16% (95% CI, 5%-28%) and 15% (95% CI, 2%-30%) more preserved renal urea clearance and urine volume at the second quarter, respectively, which persisted across the following quarters. Incremental regimens showed higher mortality risk in patients with inadequate baseline renal urea clearance (≤3.0mL/min/1.73m(2); HR, 1.61; 95% CI, 1.07-2.44), but not in those with higher baseline renal urea clearance (HR, 0.99; 95% CI, 0.76-1.28). Results were similar in a subgroup defined by baseline urine volume of 600mL/d. Potential selection bias and wide CIs. Among incident hemodialysis patients with substantial RKF, incremental hemodialysis may be a safe treatment regimen and is associated with greater preservation of RKF, whereas higher mortality is observed after the first year of dialysis in those with the lowest RKF. Clinical trials are needed to examine the safety and effectiveness of twice-weekly hemodialysis. Maintenance hemodialysis is typically prescribed thrice weekly irrespective of a patient's residual kidney function (RKF). We hypothesized that a less frequent schedule at hemodialysis therapy initiation is associated with greater preservation of RKF without compromising survival among patients with substantial RKF.BACKGROUNDMaintenance hemodialysis is typically prescribed thrice weekly irrespective of a patient's residual kidney function (RKF). We hypothesized that a less frequent schedule at hemodialysis therapy initiation is associated with greater preservation of RKF without compromising survival among patients with substantial RKF.A longitudinal cohort.STUDY DESIGNA longitudinal cohort.23,645 patients who initiated maintenance hemodialysis therapy in a large dialysis organization in the United States (January 2007 to December 2010), had available RKF data during the first 91 days (or quarter) of dialysis, and survived the first year.SETTING & PARTICIPANTS23,645 patients who initiated maintenance hemodialysis therapy in a large dialysis organization in the United States (January 2007 to December 2010), had available RKF data during the first 91 days (or quarter) of dialysis, and survived the first year.Incremental (routine twice weekly for >6 continuous weeks during the first 91 days upon transition to dialysis) versus conventional (thrice weekly) hemodialysis regimens during the same time.PREDICTORIncremental (routine twice weekly for >6 continuous weeks during the first 91 days upon transition to dialysis) versus conventional (thrice weekly) hemodialysis regimens during the same time.Changes in renal urea clearance and urine volume during 1 year after the first quarter and survival after the first year.OUTCOMESChanges in renal urea clearance and urine volume during 1 year after the first quarter and survival after the first year.Among 23,645 included patients, 51% had substantial renal urea clearance (≥3.0mL/min/1.73m(2)) at baseline. Compared with 8,068 patients with conventional hemodialysis regimens matched based on baseline renal urea clearance, urine volume, age, sex, diabetes, and central venous catheter use, 351 patients with incremental regimens exhibited 16% (95% CI, 5%-28%) and 15% (95% CI, 2%-30%) more preserved renal urea clearance and urine volume at the second quarter, respectively, which persisted across the following quarters. Incremental regimens showed higher mortality risk in patients with inadequate baseline renal urea clearance (≤3.0mL/min/1.73m(2); HR, 1.61; 95% CI, 1.07-2.44), but not in those with higher baseline renal urea clearance (HR, 0.99; 95% CI, 0.76-1.28). Results were similar in a subgroup defined by baseline urine volume of 600mL/d.RESULTSAmong 23,645 included patients, 51% had substantial renal urea clearance (≥3.0mL/min/1.73m(2)) at baseline. Compared with 8,068 patients with conventional hemodialysis regimens matched based on baseline renal urea clearance, urine volume, age, sex, diabetes, and central venous catheter use, 351 patients with incremental regimens exhibited 16% (95% CI, 5%-28%) and 15% (95% CI, 2%-30%) more preserved renal urea clearance and urine volume at the second quarter, respectively, which persisted across the following quarters. Incremental regimens showed higher mortality risk in patients with inadequate baseline renal urea clearance (≤3.0mL/min/1.73m(2); HR, 1.61; 95% CI, 1.07-2.44), but not in those with higher baseline renal urea clearance (HR, 0.99; 95% CI, 0.76-1.28). Results were similar in a subgroup defined by baseline urine volume of 600mL/d.Potential selection bias and wide CIs.LIMITATIONSPotential selection bias and wide CIs.Among incident hemodialysis patients with substantial RKF, incremental hemodialysis may be a safe treatment regimen and is associated with greater preservation of RKF, whereas higher mortality is observed after the first year of dialysis in those with the lowest RKF. Clinical trials are needed to examine the safety and effectiveness of twice-weekly hemodialysis.CONCLUSIONSAmong incident hemodialysis patients with substantial RKF, incremental hemodialysis may be a safe treatment regimen and is associated with greater preservation of RKF, whereas higher mortality is observed after the first year of dialysis in those with the lowest RKF. Clinical trials are needed to examine the safety and effectiveness of twice-weekly hemodialysis. |
Author | Ravel, Vanessa Obi, Yoshitsugu Mathew, Anna T. Cupisti, Adamasco Rhee, Connie M. Kovesdy, Csaba P. Kalantar-Zadeh, Kamyar Streja, Elani Amin, Alpesh N. Mehrotra, Rajnish Chen, Jing |
AuthorAffiliation | 8 Kidney Research Institute and Harborview Medical Center, Division of Nephrology, University of Washington, Seattle, WA, USA 9 Fielding School of Public Health at UCLA, Los Angeles, CA, USA 4 Division of Nephrology, Huashan Hospital, Fudan University, Yangpu, Shanghai, China 2 Department of Medicine, University of California Irvine, Orange, CA, USA 3 Division of Nephrology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, PI, Italy 5 Hofstra North Shore-LIJ School of Medicine, Division of Kidney Diseases and Hypertension, North Shore-LIJ Health System, Great Neck, NY 6 Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA 1 Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA 10 Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA 7 Division of Nephrology, Memphis VA Medical Center, Memphis, TN, USA |
AuthorAffiliation_xml | – name: 2 Department of Medicine, University of California Irvine, Orange, CA, USA – name: 6 Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA – name: 3 Division of Nephrology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, PI, Italy – name: 7 Division of Nephrology, Memphis VA Medical Center, Memphis, TN, USA – name: 8 Kidney Research Institute and Harborview Medical Center, Division of Nephrology, University of Washington, Seattle, WA, USA – name: 5 Hofstra North Shore-LIJ School of Medicine, Division of Kidney Diseases and Hypertension, North Shore-LIJ Health System, Great Neck, NY – name: 10 Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA – name: 1 Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA – name: 4 Division of Nephrology, Huashan Hospital, Fudan University, Yangpu, Shanghai, China – name: 9 Fielding School of Public Health at UCLA, Los Angeles, CA, USA |
Author_xml | – sequence: 1 givenname: Yoshitsugu orcidid: 0000-0001-7032-4383 surname: Obi fullname: Obi, Yoshitsugu organization: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA – sequence: 2 givenname: Elani surname: Streja fullname: Streja, Elani organization: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA – sequence: 3 givenname: Connie M. surname: Rhee fullname: Rhee, Connie M. organization: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA – sequence: 4 givenname: Vanessa surname: Ravel fullname: Ravel, Vanessa organization: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA – sequence: 5 givenname: Alpesh N. surname: Amin fullname: Amin, Alpesh N. organization: Department of Medicine, University of California Irvine, Orange, CA – sequence: 6 givenname: Adamasco surname: Cupisti fullname: Cupisti, Adamasco organization: Division of Nephrology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy – sequence: 7 givenname: Jing surname: Chen fullname: Chen, Jing organization: Division of Nephrology, Huashan Hospital, Fudan University, Yangpu, Shanghai, China – sequence: 8 givenname: Anna T. surname: Mathew fullname: Mathew, Anna T. organization: Hofstra North Shore-LIJ School of Medicine, Division of Kidney Diseases and Hypertension, North Shore-LIJ Health System, Great Neck, NY – sequence: 9 givenname: Csaba P. surname: Kovesdy fullname: Kovesdy, Csaba P. organization: Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN – sequence: 10 givenname: Rajnish surname: Mehrotra fullname: Mehrotra, Rajnish organization: Kidney Research Institute and Harborview Medical Center, Division of Nephrology, University of Washington, Seattle, WA – sequence: 11 givenname: Kamyar surname: Kalantar-Zadeh fullname: Kalantar-Zadeh, Kamyar email: kkz@uci.edu organization: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/26867814$$D View this record in MEDLINE/PubMed |
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Keywords | residual kidney function (RKF) standard Kt/V frequent hemodialysis mortality Incremental hemodialysis dialysis initiation twice-weekly hemodialysis renal urea clearance interdialytic weight gain treatment regimen |
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Snippet | Maintenance hemodialysis is typically prescribed thrice weekly irrespective of a patient’s residual kidney function (RKF). We hypothesized that a less frequent... Background Maintenance hemodialysis is typically prescribed thrice weekly irrespective of a patient’s residual kidney function (RKF). We hypothesized that a... Maintenance hemodialysis is typically prescribed thrice weekly irrespective of a patient's residual kidney function (RKF). We hypothesized that a less frequent... |
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SubjectTerms | Aged Cohort Studies dialysis initiation Female frequent hemodialysis Humans Incremental hemodialysis interdialytic weight gain Kidney - physiopathology Kidney Failure, Chronic - mortality Kidney Failure, Chronic - physiopathology Kidney Failure, Chronic - therapy Longitudinal Studies Male Middle Aged mortality Nephrology Renal Dialysis - methods renal urea clearance residual kidney function (RKF) Risk standard Kt/V treatment regimen twice-weekly hemodialysis |
Title | Incremental Hemodialysis, Residual Kidney Function, and Mortality Risk in Incident Dialysis Patients: A Cohort Study |
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