The effect of long, slow haemodialysis on patient survival

Innes, Andrew; Charra, Bernard; Burden, Richard; Morgan, A. G.; Laurent, Guy

doi:10.1093/ndt/14.4.919

Cited by 85 publications

(64 citation statements)

References 2 publications

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“…Ok et al [13] report a survival advantage for in-center NHD with a hazard ratio of 0.28 (95% CI 0.09, 0.85). The results of these four studies are in keeping with previous modality comparisons based on smaller cohorts and/or indirect standardization [14][15][16][17][18].…”

Section: Contemporary Intensive Dialysis Survival Literaturesupporting

confidence: 81%

Survival comparison between intensive hemodialysis and transplantation in the context of the existing literature surrounding nocturnal and short-daily hemodialysis

Pauly

2013

Nephrology Dialysis Transplantation

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Our contemporary paradigms of nocturnal and short-daily hemodialysis (NHD and SDHD) have their origins in the earliest era of dialysis care for end-stage renal disease. However, these therapies have received considerably more attention in recent years owing to an increasing body of literature, suggesting a myriad of benefits attributable to these intensive dialysis regimens compared with conventional thrice-weekly hemodialysis. Analyses suggest a survival benefit for NHD and SDHD versus traditional hemodialysis prescriptions, and it is in this context that survival comparisons between intensive dialysis and transplantation must be considered. This literature and its limitations are reviewed here.

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Section: Contemporary Intensive Dialysis Survival Literaturesupporting

confidence: 81%

Survival comparison between intensive hemodialysis and transplantation in the context of the existing literature surrounding nocturnal and short-daily hemodialysis

Pauly

2013

Nephrology Dialysis Transplantation

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“…Volume overload has already been associated with LVH and mortality in patients on MHD (21)(22)(23). Combined volume correction with angiotensin-converting enzyme inhibition has been shown to improve aortic PWV in patients on MHD (24).…”

Section: Introductionmentioning

confidence: 99%

Changes in Pulse Pressure during Hemodialysis Treatment and Survival in Maintenance Dialysis Patients

Lertdumrongluk

Streja²,

Rhee

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Pulse pressure has been shown as a risk factor for mortality in patients on maintenance hemodialysis (MHD). However, the effect of change in pulse pressure during hemodialysis on survival in a large cohort of patients on MHD has not been sufficiently investigated.Design, setting, participants, & measurements This study examined the association between time-varying D pulse pressure (postdialysis minus predialysis pulse pressure) and mortality in a cohort of 98,577 patients on MHD (July 2001-June 2006) using Cox proportional hazard models with restricted cubic splines.Results The average patient age was 62 years old; among the patients, 33% were black and 59% had diabetes. During 134,814 patient-years of at-risk time, 16,054 (16%) patients died, with 6827 (43%) of the deaths caused by cardiovascular causes. In the models including adjustment for either predialysis systolic BP or mean arterial BP, there was a U-shaped association between change in pulse pressure during hemodialysis and all-cause mortality. In the systolic BP plus case mix plus malnutrition-inflammation complex syndrome-adjusted model, large declines in pulse pressure (.-25 mmHg) and increases in pulse pressure .5 mmHg were associated with higher all-cause mortality (reference: $-5 to ,5 mmHg): hazard ratios (95% confidence intervals [95% CIs]) for change pulse pressures of ,-25, $-25 to ,-15, $-15 to ,-5, 5 to ,15, 15 to ,25, and $25 mmHg were 1.21 (95% CI, 1.14 to 1.29), 1.03 (95% CI, 0.97 to 1.10), 1.01 (95% CI, 0.96 to 1.06), 1.06 (95% CI, 1.01 to 1.11), 1.17 (95% CI, 1.11 to 1.24), and 1.15 (95% CI, 1.08 to 1.23), respectively. The U-shaped association was observed with cardiovascular death.Conclusions Modest reductions in pulse pressure after hemodialysis are associated with the greatest survival, whereas large declines or rises in pulse pressure are related to higher mortality. Trials determining how to modify pulse pressure response to improve survival in the hemodialysis population are indicated.

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“…In relation to haemodialysis, the effect of extended treatment has been demonstrated at Tassin, where only 1% of patients require antihypertensive therapy [16]. A study comparing BP control and survival between haemodialysis patients in Tassin (8 h, 3 times a week) and those in Nottingham (4–4.5 h, 3 times a week) showed significantly better BP control and survival in the former group [17]. …”

Section: Discussionmentioning

confidence: 99%

Blood Pressure Control before and after Starting Dialysis

Dasgupta¹,

Burden²

2005

Nephron Clin Pract

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Background/Aim: We have previously reported a study on the adequacy of management of hypertension in patients developing end-stage renal failure (ESRF) over a period of 3 years from a single health district in the UK (n = 107). There were significant shortcomings in all aspects of management of hypertension including blood pressure (BP) control. Methods: In this report, we have compared BP control in the same cohort of patients before and after starting renal replacement therapy (RRT). Results: BP control improved significantly after the patients were established on dialysis (mean 158/ 87 mm Hg pre-RRT vs. 152/82 mm Hg post-RRT; p < 0.0001), and fewer antihypertensive agents were prescribed to control BP (mean 2.45 vs. 1.74) in this period (p < 0.0001). Moreover, patients on continuous ambulatory peritoneal dialysis (n = 50) had a better systolic BP control compared with the haemodialysis patients (n = 57; p = 0.03). Conclusions: This study shows significant improvement in BP control in a cohort of patients with ESRF following the start of dialysis.

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The effect of long, slow haemodialysis on patient survival

Abstract: Overall survival is increased on long, slow haemodialysis. Although the benefits are seen in the most favourable prognostic categories, they are also present in patients with comorbid illness (medium-risk group) and pre-existing cardiovascular disease.

Cited by 85 publications

References 2 publications

Survival comparison between intensive hemodialysis and transplantation in the context of the existing literature surrounding nocturnal and short-daily hemodialysis

Survival comparison between intensive hemodialysis and transplantation in the context of the existing literature surrounding nocturnal and short-daily hemodialysis

Changes in Pulse Pressure during Hemodialysis Treatment and Survival in Maintenance Dialysis Patients

Blood Pressure Control before and after Starting Dialysis

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