Survival and hospitalization among patients using nocturnal and short daily

Kidney International (2009) 76, 984–990; doi:10.1038/ki.2009.291; published online 19 August 2009
Survival and hospitalization among patients using nocturnal and short daily compared to conventional hemodialysis: a USRDS study

Kirsten L Johansen1,2, Rebecca Zhang1, Yijian Huang1, Shu-Cheng Chen3, Christopher R Blagg4, Alexander S Goldfarb-Rumyantzev5, Chistopher D Hoy6, Robert S Lockridge Jr7, Brent W Miller8, Paul W Eggers9 and Nancy G Kutner1

1. 1USRDS Rehabilitation/QoL Special Studies Center, Emory University, Atlanta, Georgia, USA
2. 2Nephrology Section, San Francisco VA Medical Center and Division of Nephrology, University of California, San Francisco, San Francisco, California, USA
3. 3USRDS Coordinating Center, Minneapolis, Minnesota, USA
4. 4Northwest Kidney Centers, Seattle, Washington, USA
5. 5Harvard Medical School, Boston, Massachusetts, USA
6. 6Rubin Dialysis Center, Saratoga Springs, New York, USA
7. 7Lynchburg Nephrology Dialysis, Lynchburg, Virginia, USA
8. 8Washington University School of Medicine, St Louis, Missouri, USA
9. 9National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA

Correspondence: Nancy Kutner, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Road NE, Atlanta, Georgia 30322, USA. E-mail nkutner@emory.edu

Received 6 August 2008; Revised 30 April 2009; Accepted 17 June 2009; Published online 19 August 2009.
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Abstract

We estimated the survival and hospitalization among frequent hemodialysis users in comparison to those patients undergoing thrice-weekly conventional hemodialysis. All patients had similar characteristics and medical histories. In this cohort study of frequent hemodialysis users and propensity score–matched controls, the collaborating clinicians identified 94 patients who used nocturnal hermodialysis (NHD) and 43 patients who used short-duration daily hemodialysis (SDHD) for a minimum of 60 days. Ten propensity score–matched control patients for each NHD and SDHD patient were identified from the United States Renal Data System database. Primary outcomes were risk for all-cause mortality and risk for the composite outcome of mortality or major morbid event (acute myocardial infarction or stroke) estimated using Cox proportional hazards models. Risks for all-cause, cardiovascular-related, infection-related, and vascular access–related hospital admissions were also studied. Nocturnal hemodialysis was associated with significant reductions in mortality risk and risk for mortality or major morbid event when compared to conventional hemodialysis. There was a reduced but non-significant risk of death for patients using SDHD compared to controls. All-cause and specific hospitalizations did not differ significantly between NHD and SDHD patients and their matched control cohorts. Our study suggests that NHD may improve patient survival.
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