02851nas a2200229   4500000000100000008004100001100001700042700001400059700001500073700001400088700001200102700001200114700001200126700001100138700001700149700001400166700001900180245007600199250001500275520228500290020004602575       2012                            d1 aMasterson R.1 aHawley C.1 avan Eps C.1 aCass Alan1 aKerr P.1 aAgar J.1 aGray N.1 aJun M.1 aGallagher M.1 aJardine M1 aPerkovic Vlado00aOutcomes of Extended-Hours Hemodialysis Performed Predominantly at Home  a2012/10/063 a<p>
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 &amp; 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. CONCLUSIONS: 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.
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