Association between daily haemodialysis, access to renal transplantation and patients' survival in France

Pladys, A.; Vigneau, Cécile; Hourmant, Maryvonne; Duneau, Gabrielle; Couchoud, Cécile; Bayat, Sahar

doi:10.1111/nep.12974

Cited by 4 publications

(6 citation statements)

References 35 publications

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“…In agreement, in the present French cohort, patients on early DHD were very different from patients on late DHD. Overall, French patients on early DHD were older and with several comorbidities, although we previously identified also a subgroup of young patients with high access to renal transplantation [16]. Therefore, in France, DHD is mainly used by two groups: 1) older and frail patients, presumably in response to cardiac instability and comorbidities, and 2) young patients to maintain their quality of life before kidney transplantation [15, 16].…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, other studies reported that DHD is associated with better survival [18–23]. These contradictory results could be explained by differences in the practices associated with DHD between France and other countries [16, 17].…”

Section: Introductionmentioning

confidence: 96%

“…In France, the Renal Epidemiological and Information Network (REIN) registry collects data on all patients who start renal replacement therapy in the entire country [14]. Analysis of the REIN data highlighted the clinical feature heterogeneity of patients starting DHD (i.e., 5 or 6 HD sessions/week) [15], and showed that the risk of death is higher in patients on DHD than in matched patients on HD 3 times/week [16]. This confirmed a previous study by Suri et al that included patients undergoing in-center HD [17].…”

Section: Introductionmentioning

confidence: 99%

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Daily hemodialysis practices in Australia/New Zealand and in France: a comparative cohort study

et al. 2019

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Background As patients on daily hemodialysis (DHD) have heterogeneous profiles, DHD benefit in terms of survival is still debated. The aim of this study was to compare DHD practices in France and in Australia and New Zealand . Methods This study was based on data from the French Renal Epidemiology and Information Network (REIN) and the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). All incident patients from both registries who underwent DHD (i.e., 5–6 sessions/week, including short daily hemodialysis and long nocturnal hemodialysis) at least once during their trajectories were included, and their characteristics and care trajectories were compared. For survival analyses, one French patient was matched to one Australian or New Zealand patient, based on age, sex and year of dialysis start. Survival was assessed using the Cox proportional hazards model, and access to renal transplantation was evaluated using the Fine & Gray model to take into account death as competing risk. Results Between 2003 and 2012, 523 patients from the AZNDATA and 753 from the REIN registry started DHD. ANZDATA patients were younger (54.8 vs 64.0 years, p < 0.001) and had comorbidities more frequently than French patients. In both registries, one third of patients were on early DHD (i.e., DHD started less than one year after dialysis initiation). Long nocturnal hemodialysis was more frequent in the ANZDATA than in the REIN cohort (20.8 and 3%, respectively). Comparison of the matched subgroups showed comparable survival rates between French and Australian/New Zealand patients (HRadjusted = 1.08; 95%CI: 0.78–1.50). Access to renal transplantation also was similar between matched groups (SHRadjusted = 1.30, 95%CI: 0.86–1.97). Conclusions Our study shows that, despite differences in terms of patients’ characteristics and DHD regimens, the mortality risk and access to renal transplantation are similar in France and Australia and New Zealand. Electronic supplementary material The online version of this article (10.1186/s12882-019-1330-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Daily hemodialysis practices in Australia/New Zealand and in France: a comparative cohort study

et al. 2019

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“…Previous studies have shown improved survival with longer session durations only in patients receiving conventional 3 sessions/week . Whereas studies on the effect of increased session frequency, including the FHN trials, have compared frequent regimens that have varying session durations, including short duration, longer nocturnal sessions and more broadly intensive regimens that are some combination of more frequent or longer duration . This study separates the independent effects of increased session frequency and session durations to determine whether it is session frequency, session duration or both that is associated with improved survival in patients receiving more intensive HD regimens.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16][17][18][19]24 Whereas studies on the effect of increased session frequency, including the FHN trials, have compared frequent regimens that have varying session durations, including short duration, longer nocturnal sessions and more broadly intensive regimens that are some combination of more frequent or longer duration. [5][6][7][8][9][10][25][26][27][28] This study separates the independent effects of increased session frequency and session durations to determine whether it is session frequency, session duration or both that is associated with improved survival in patients receiving more intensive HD regimens. Previous analysis of ANZDATA cohorts have suggested that it is the location of dialysis (home vs in-centre) that has been the main mediator of improved survival.…”

Section: Figmentioning

confidence: 99%

Independent effect of haemodialysis session frequency and duration on survival in non‐indigenous Australians on haemodialysis

et al. 2019

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Background End‐stage kidney disease patients have increased mortality compared to the general population. Haemodialysis (HD) of more frequent and of longer duration has been proposed to improve survival but it remains unclear if this is attributed to increased frequency, duration, or both. We aimed to examine the independent effects of session frequency and duration on mortality in incident HD patients. Methods A retrospective cohort study was performed using data from the Australian and New Zealand Dialysis and Transplant Registry examining non‐Indigenous patients aged ≥18 years who initiated HD of ≥3 sessions/week in Australia from 2001 to 2015. Initial dialysis prescription was categorized as session duration >5 h/session compared to ≤5 h/session and session frequency as >3 sessions/week compared to 3 sessions/week. Survival analysis was performed using Cox regression analysis, with multivariable analysis controlling for available covariates. Results We examined 16 944 patients of whom 757 (4.5%) received >3 sessions/week and 518 (3.1%) received >5 h/session. After controlling for frequency, patients initiated on HD sessions >5 h had a significantly reduced risk of mortality compared with patients with HD session ≤5 h (adjusted hazard ratio (HR) = 0.57; 95% confidence interval (CI) = 0.44–0.74). In contrast, patients initiated on >3 sessions/week of HD had a similar risk of death when compared with patients on 3 sessions/week of HD (adjusted HR = 0.97; 95% CI = 0.84–1.13), after controlling for duration. Limitations include potential residual confounding and changes in exposure over time. Conclusion Longer duration rather than increased frequency of treatment appears to reduce mortality in HD patients. This has implications for management and requires further study.

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Pratiques de l’hémodialyse quotidienne en France, en Australie et Nouvelle-Zélande : une étude comparative

Pladys

Bayat

Couchoud

et al. 2017

Néphrologie & Thérapeutique

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Association between daily haemodialysis, access to renal transplantation and patients' survival in France

Cited by 4 publications

References 35 publications

Daily hemodialysis practices in Australia/New Zealand and in France: a comparative cohort study

Daily hemodialysis practices in Australia/New Zealand and in France: a comparative cohort study

Independent effect of haemodialysis session frequency and duration on survival in non‐indigenous Australians on haemodialysis

Pratiques de l’hémodialyse quotidienne en France, en Australie et Nouvelle-Zélande : une étude comparative

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