No Survival Benefit in Octogenarians and Nonagenarians with Extended Hemodialysis Treatment Time

Gang Jee Ko, Yoshitsugu Obi, Melissa Soohoo, Tae Ik Chang, Soo Jeong Choi, Csaba Kovesdy, Elani Streja, Connie M. Rhee, Kamyar Kalantar-Zadeh

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Abstract

Background: The population of elderly end-stage renal disease patients initiating dialysis is rapidly growing. Although longer treatment is supposed to benefit for hemodialysis (HD) patients through more solute clearance and slower fluid removal, it is not yet clear how treatment session length affects mortality risk in octogenarians and nonagenarians. Methods: In a cohort of 112,026 incident HD patients between 2007 and 2011, we examined the association of treatment session length with all-cause mortality, adjusting for demographics and comorbid conditions. We also used restricted spline functions for age to evaluate continuous changes in the association of short (< 210 min) and extended (≥240 min) HD treatment (vs. 210 to < 240 min) with all-cause mortality over continuous age. Results: During the first 91 days of dialysis, patients aged ≥80 years tended to have the lowest treatment session length (median [interquartile range] 211 [193-230] min, r > 0.5). Longer treatment was associated with better survival in patients < 65 and 65 to < 80 years but not in octogenarians/nonagenarians. The association of extended treatment (≥240 min) with better survival was attenuated across age and not significant among patients aged ≥80 years with a hazard ratio of 1.10 (95% CI 0.99-1.20). Shorter treatment sessions (< 210 min) was associated with higher mortality across all age groups. Conclusion: Extended HD was not associated with lower mortality among octogenarians and nonagenarians, while it was associated with better survival among younger patients. Further studies are needed to determine the optimal treatment session length in elderly incident HD patients.

Original languageEnglish (US)
Pages (from-to)389-398
Number of pages10
JournalAmerican Journal of Nephrology
Volume48
Issue number5
DOIs
StatePublished - Nov 1 2018

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Renal Dialysis
Survival
Mortality
Therapeutics
Chronic Kidney Failure
Dialysis
Age Groups
Demography
Population

All Science Journal Classification (ASJC) codes

  • Nephrology

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No Survival Benefit in Octogenarians and Nonagenarians with Extended Hemodialysis Treatment Time. / Ko, Gang Jee; Obi, Yoshitsugu; Soohoo, Melissa; Chang, Tae Ik; Choi, Soo Jeong; Kovesdy, Csaba; Streja, Elani; Rhee, Connie M.; Kalantar-Zadeh, Kamyar.

In: American Journal of Nephrology, Vol. 48, No. 5, 01.11.2018, p. 389-398.

Research output: Contribution to journalArticle

Ko, GJ, Obi, Y, Soohoo, M, Chang, TI, Choi, SJ, Kovesdy, C, Streja, E, Rhee, CM & Kalantar-Zadeh, K 2018, 'No Survival Benefit in Octogenarians and Nonagenarians with Extended Hemodialysis Treatment Time', American Journal of Nephrology, vol. 48, no. 5, pp. 389-398. https://doi.org/10.1159/000494336
Ko, Gang Jee ; Obi, Yoshitsugu ; Soohoo, Melissa ; Chang, Tae Ik ; Choi, Soo Jeong ; Kovesdy, Csaba ; Streja, Elani ; Rhee, Connie M. ; Kalantar-Zadeh, Kamyar. / No Survival Benefit in Octogenarians and Nonagenarians with Extended Hemodialysis Treatment Time. In: American Journal of Nephrology. 2018 ; Vol. 48, No. 5. pp. 389-398.
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AU - Choi, Soo Jeong

AU - Kovesdy, Csaba

AU - Streja, Elani

AU - Rhee, Connie M.

AU - Kalantar-Zadeh, Kamyar

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