Survival Better With Short, Daily Dialysis Than With Conventional Hemodialysis

Marlene Busko

December 13, 2006

December 13, 2006 — Survival among 117 patients treated by short, daily hemodialysis was 61% better than that of the US population on conventional hemodialysis. This finding is from a study published in the December issue of Hemodialysis International. The researchers used the standardized mortality ratio (SMR) to adjust for patient differences in age, sex, race, and cause of renal failure.

In a comment to Medscape, lead author Christopher R. Blagg, MD, professor emeritus of medicine at the University of Washington in Seattle, said the main message is, "If you do more dialysis, your survival is better." He added that study strengths include the fact that it used SMRs, which are what the US government uses to compare different dialysis units, and it was done in a reasonably large US patient population.

The group writes that most recent publications that have described the benefits of frequent (5 or more times weekly) hemodialysis have been from small observational studies done in several countries. These studies used no control cohorts and might have been biased in favor of healthier patients receiving frequent dialysis. The current study used SMRs to reduce the effect of selection bias.

They collected data from 117 patients who were treated with short, daily dialysis (5 or more times a week for 2 to 3.5 hours as required to ensure adequate dialysis) for some time between January 1, 2003 and December 31, 2004.

The study population comprised 71 men and 46 women, with an average age of 55.5 years (range, 19 – 89 years). Most (91) were white, and the cause of renal failure was diabetes in 22 patients and hypertension in 25 patients. A total of 19 patients received their short, daily dialysis in the center, with conventional equipment, and 98 patients received their treatment at home, with the PHD System (Aksys Ltd, Lincolnshire, Illinois).

The team calculated estimated mortality for each participant based on 2003 United States Renal Data System (USRDS) data for annual mortality of US hemodialysis patients.

Better-Than-Expected Survival

Survival on Daily Dialysis

Expected Deaths (95% CI)*
Actual Deaths
SMR (95% CI)
P
25.7 (22.8 – 28.6)
10
0.39 (0.19 – 0.51)
< . 005
*Expected deaths based on USRDS data for patients on conventional dialysis, adjusted for age, sex, race, and cause of kidney failure.
SMR = standardized mortality ratio = actual deaths/expected deaths.

"The current study shows that based on the calculated SMR, daily hemodialysis is associated with a 61% better survival than that of US hemodialysis patients in general," the group summarizes, noting that this improved survival compares to that found after renal transplantation. They add that the large, ongoing National Institutes of Health/Centers for Medicare and Medicaid Services trial should soon be able to confirm and extend these findings.

Case for More Frequent Home Dialysis

In a related study presented at the American Society of Nephrology (ASN) Renal Week 2006, in San Diego, California, Bessie A. Young, MD, from the Northwest Kidney Centers in Seattle, Washington, and colleagues report better survival among patients receiving more frequent (daily) home hemodialysis than those receiving conventional, thrice-weekly home hemodialysis. The group evaluated 5-year data from all 190 patients entering their home hemodialysis program from 2001 to 2006. Of these patients, 47 received more frequent treatment with home hemodialysis machines or conventional machines for nocturnal hemodialysis, and 143 received conventional, thrice-weekly home hemodialysis. After adjustment for age, race, sex, and cause of kidney failure, patients receiving more frequent home hemodialysis had a 65% improved survival (HR, 0.35; 95% CI, 0.13 – 0.95) compared with patients receiving conventional, thrice-weekly home hemodialysis.

Dr. Blagg is a scientific consultant for Aksys Ltd. Dr. Young is a consultant for Aksys and has received honoraria from Aksys, and her group's research was supported by a grant from Aksys.

Hemodial Int. 2006;10:371-374.
Renal Week 2006: ASN Annual Meeting: Abstract F-PO002.

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