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Kidney Week

Abstract: SA-PO737

Impact of Hemodialysis Hours on Outcomes in Elderly Hemodialysis Patients

Session Information

  • Geriatric Nephrology
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Yeung, Emily K., Monash Health, Melbourne, Victoria, Australia
  • Polkinghorne, Kevan, Monash Medical Centre and Monash University, Melbourne, Victoria, Australia
  • Roberts, Matthew A., Eastern Health and Monash University, Melbourne, Victoria, Australia
Background

Longer treatment time is associated with improved outcomes in hemodialysis (HD) patients. Longer treatment times pose additional challenges in the elderly, who are more likely to suffer from conditions like arthritis which make sitting for long periods uncomfortable. The aim of this study is to determine whether or not a mortality benefit exists with longer treatment time in elderly (age ≥ 65 years) HD patients.

Methods

Data was obtained from the Australia and New Zealand Dialysis & Transplant Registry. Incident patient on thrice weekly HD were included if they were ≥65 years of age at HD commencement. Subjects entered the analysis at 90 days after start of HD. The exposure of interest was treatment time (hours per HD session) at HD commencement categorised into 5 groups. The primary outcome was all-cause mortality. Censoring events were transplantation, switch to another dialysis modality, recovery of kidney function, or loss to follow up. Cox regression models adjusting for age and treatment time and age interaction were assessed.

Results

8992 subjects were included in the analysis with 30541 person-years of data. The incidence rate of death was 16 per 100 person-years. The risk of death decreased with increasing duration of dialysis. However, inclusion of age in the model attenuated this association. The interaction of age and hours was not significant (p=0.895). Inclusion of gender in the model did not alter associations.

Conclusion

Longer treatment times are associated with reduced risk of mortality in a dose-response relationship. However, once adjusted for age, there is no longer a significant mortality benefit to longer hours. This suggests that in the elderly, longer dialysis hours may not reduce mortality risk, and other factors such as quality of life should be considered in a dialysis prescription.

 Unadjusted HR (95% CI)p-valueAdjusted HR (95% CI)p-value
Age1.03 (1.02-1.04)<0.0011.05 (1.04-1.06)<0.001
Treatment Time    
<4 hours1.00 1.00 
4 to <4.5 hours0.85 (0.77-0.95)0.0040.95 (0.60-1.50)0.834
4.5 to <5 hours0.72 (0.64-0.81)<0.0010.90 (0.37-2.18)0.820
5 to <5.5 hours0.70 (0.62-0.78)<0.0010.92 (0.25-3.37)0.897
>5.5 hours0.57 (0.36-0.90)0.0160.86 (0.15-4.90)0.866