Shorter dialysis times associated with higher mortality for hemodialysis patient

[okarol]

Kidney International (2010) 77, 630–636; doi:10.1038/ki.2009.523; published online 20 January 2010
Shorter dialysis times are associated with higher mortality among incident hemodialysis patients

Steven M Brunelli1,2, Glenn M Chertow3, Elizabeth D Ankers4, Edmund G Lowrie5 and Ravi Thadhani2,4

   1. 1Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
   2. 2Harvard Medical School, Boston, Massachusetts, USA
   3. 3Nephrology Division, Stanford University School of Medicine, Palo Alto, California, USA
   4. 4Renal Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
   5. 5Retired: Cape Neddick, Maine, USA

Correspondence: Steven M. Brunelli, Renal Division, Brigham and Women's Hospital, 75 Francis Street, MRB-4, Boston, Massachusetts 02115, USA. E-mail: sbrunelli@partners.org

Received 15 July 2009; Revised 19 October 2009; Accepted 11 November 2009; Published online 20 January 2010.
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Abstract

There is an association between hemodialysis session length and mortality independent of the effects of session duration on urea clearance. However, previous studies did not consider changes in session length over time nor did they control for the influence of time-dependent confounding. Using data from a national cohort of 8552 incident patients on thrice-weekly, in-center hemodialysis, we applied marginal structural analysis to determine the association between session length and mortality. Exposure was based on prescribed session length with the outcome being death from any cause. On the 31st day after initiating dialysis, the patients were considered at-risk and remained so until death, censoring, or completion of 1 year on dialysis. On primary marginal structural analysis, session lengths <4 h were associated with a 42% increase in mortality. Sensitivity analyses showed a dose–response relationship between session duration and mortality, and a consistency of findings across prespecified subgroups. Our study suggests that shorter hemodialysis sessions are associated with higher mortality when marginal structural analysis was used to adjust for time-dependent confounding. Further studies are needed to confirm these findings and determine causality.
Keywords:

adequacy; dialysis; epidemiology; mortality; outcome; session length

for full article with graphs and charts go to http://www.nature.com/ki/journal/v77/n7/full/ki2009523a.html

[galvo]

Please explain.

[sullidog]

Is there a better version of this article? I don't understand.
Troy

[monrein]

I wouldn't worry too much about this "study".  Sounds like someone needed to publish something and this study which needs further study might just have filled a line on someone's list of publications.

[okarol]

Shorter dialysis times (less than 4 hours at 3X per week) raise risks to patients.

[galvo]

Yo!

[Zach]

More hemodialysis is better.