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Abstract: SA-OR35

Comparison of Clinical Outcomes Between Twice- vs. Thrice-Weekly Hemodialysis in Thai Elderly Patients: A Single-Center Study

Session Information

Category: Geriatric Nephrology

  • 1200 Geriatric Nephrology

Authors

  • Pattrapornpisut, Prapa, Bhumirajanagarindra Kidney Institute Hospital, Bangkok, Thailand
  • Khrueawang, Kittiphon, Bhumirajanagarindra Kidney Institute Hospital, Bangkok, Thailand
  • Buddeewong, Darunee, Bhumirajanagarindra Kidney Institute Hospital, Bangkok, Thailand
  • Srichaichana, Inthira, Bhumirajanagarindra Kidney Institute Hospital, Bangkok, Thailand
  • Srila, Kanyapa, Bhumirajanagarindra Kidney Institute Hospital, Bangkok, Thailand
  • Yincharoen, Picha, Bhumirajanagarindra Kidney Institute Hospital, Bangkok, Thailand
  • Teerapornlertratt, Tanyarat, Bhumirajanagarindra Kidney Institute Hospital, Bangkok, Thailand
  • Tungsanga, Kriang, Bhumirajanagarindra Kidney Institute Hospital, Bangkok, Thailand
Background

Hemodialysis (HD) in the elderly is a complex process, given the physiologic changes and comorbidities. Although studies, which included patients aged>18, suggested twice-weekly HD (BWD) may not be inferior to thrice-weekly HD (TWD), there are scarce studies in the elderly.

Methods

We conducted a single-center, prospective cohort study to observe whether BWD and TWD would result in different outcomes in the elderly. All end-stage kidney disease patients, aged>65, who had received HD for >3 months at our center, were enrolled. Those who had received kidney transplantation, peritoneal dialysis or refused to give informed consent were excluded. Patients were allocated into 2 groups: BWD and TWD. The decision about HD frequency was shared between treating nephrologists and a patient. The primary outcome was the composite endpoint of all-cause mortality, cardiovascular (CVS) events, and hospitalization from any cause over 36months.

Results

210 patients were enrolled: 94 in the BWD group and 116 in the TWD group. The overall mean age was 77.4(+7.8) years old, 38%aged over80. Comparing with the TWD group, the BWD group had shorter dialysis vintage (692 IQR 332,1207 vs 1324 IQR 884,1790 days,p<0.001) and a higher proportion of cases with Kr>2mL/min (36.7% vs 6%,p<0.001). There was no difference in the proportion of cases who reached the primary outcome between the 2groups [62(66%) vs 88(76%) cases, long-rank p=0.25]. There was also no difference in each component of the primary outcome.

Conclusion

In summary, over 36months, elderly patients on BWD did not differ from those on TWD with respect to a composite endpoint of all-cause mortality, CVS events and hospitalization from any cause. This study provides information on outcomes exclusively in the elderly on HD and suggests TWD might not be necessary for this age group. Nevertheless, a RCT is needed to confirm this finding.

Kaplan-Meier showing the cumulative primary outcome

Funding

  • Private Foundation Support