Outcomes of patients receiving extended hours haemodialysis (EHHD)

Abstract

Aim: To describe the outcomes of patients receiving extended hours haemodialysis (EHHD) in Australia and the effects of patient and dialysis variables upon these outcomes. Background: Standard thrice-weekly haemodialysis (up to 15 hrs/wk) is associated with poor outcomes. Some evidence suggests increased frequency and/or duration of dialysis, which are increasingly being used in Australian units, improve outcomes. Methods: Data from six Australian centres providing EHHD (dialysing >=24 hrs/ week) were pooled. Cox modelling was used to identify the effect of baseline and dialysis characteristics upon outcomes (all-cause mortality, technique failure, and access-related events). Results: In the decade from 1999, 287 patients commenced EHHD at the six participating centres. Median follow-up was 2.7 yrs with the majority of patients dialysing at night for 8 hrs/session (96%). Mean age was 50 yrs (SD 13.2), 77% were male, and 90% Caucasian. The most common causes of kidney disease were glomerulonephritis (38%), polycystic kidney disease (11%), and diabetes (12%). The patient survival, technique survival, and access event-free survival rates at 5 yrs were 82%, 68%, and 61%, respectively. Among the 25 deaths, cardiac death was the most common cause (32%). Failing health was the most common cause (27%) of technique failure, and infection was the most common form of access event (59%). Age was significantly associated with death (HR: 1.04 per year; 95% CI: 1.04-1.07; p = 0.049) and technique failure (HR: 1.03 per year; 95% CI: 1.00-1.05; p = 0.018). Dialysis frequency was associated with increased risk of access events (HR: 1.53 per session; 95% CI: 1.01-2.33; p = 0.046). Conclusion: Patients on EHHD have excellent survival, but also have baseline characteristics associated with better prognosis on dialysis. Increased dialysis frequency was associated with adverse access events. Randomized trials, avoiding selection bias, are required to assess the balance of risks and benefits from use of EHHD.<br />