Treatment frequency and mortality among incident hemodialysis patients in the United States comparing incremental with standard and more frequent dialysis

Anna Mathew, Yoshitsugu Obi, Connie M. Rhee, Joline L.T. Chen, Gaurang Shah, Wei Ling Lau, Csaba Kovesdy, Rajnish Mehrotra, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

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Abstract

Most patients with end-stage renal disease in the United States are initiated on thrice-weekly hemodialysis (HD) regimens. However, an incremental approach to HD may provide several patient benefits. We tested whether initiation of incremental HD does or does not compromise survival compared with a conventional HD regimen. The survival of 434 incremental, 50,162 conventional, and 160 frequent HD patients were compared using Cox regression analysis after matching for demographic and comorbid factors in a longitudinal national cohort of adult incident HD patients enrolled between January 2007 and December 2011. Sensitivity analysis included adjustment for residual kidney function. After adjustment for residual kidney function, all-cause mortality was not significantly different in the incremental compared with conventional HD group (hazard ratio 0.88, 95% confidence interval 0.72–1.08), but was higher in the frequent compared with the conventional HD group (hazard ratio, 1.56, 95% confidence interval 1.21–2.03). The comorbidity burden modified the association of treatment frequency and mortality, with higher comorbidity associated with higher mortality in the incremental HD group (hazard ratio, 1.77, 95% confidence interval 1.20–2.62) for a Charlson Comorbidity Index of ≥5. Thus, among incident HD patients with low or moderate comorbid disease, survival was similar for patients initiated on an incremental or conventional HD regimen. Clinical trials are needed to examine the safety and effectiveness of incremental HD and the selected patient populations who may benefit from an incremental approach to HDs initiation.

Original languageEnglish (US)
Pages (from-to)1071-1079
Number of pages9
JournalKidney International
Volume90
Issue number5
DOIs
StatePublished - Nov 1 2016

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Renal Dialysis
Dialysis
Mortality
Therapeutics
Comorbidity
Confidence Intervals
Survival
Kidney
Chronic Kidney Failure
Regression Analysis
Demography
Clinical Trials
Safety

All Science Journal Classification (ASJC) codes

  • Nephrology

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Treatment frequency and mortality among incident hemodialysis patients in the United States comparing incremental with standard and more frequent dialysis. / Mathew, Anna; Obi, Yoshitsugu; Rhee, Connie M.; Chen, Joline L.T.; Shah, Gaurang; Lau, Wei Ling; Kovesdy, Csaba; Mehrotra, Rajnish; Kalantar-Zadeh, Kamyar.

In: Kidney International, Vol. 90, No. 5, 01.11.2016, p. 1071-1079.

Research output: Contribution to journalArticle

Mathew, Anna ; Obi, Yoshitsugu ; Rhee, Connie M. ; Chen, Joline L.T. ; Shah, Gaurang ; Lau, Wei Ling ; Kovesdy, Csaba ; Mehrotra, Rajnish ; Kalantar-Zadeh, Kamyar. / Treatment frequency and mortality among incident hemodialysis patients in the United States comparing incremental with standard and more frequent dialysis. In: Kidney International. 2016 ; Vol. 90, No. 5. pp. 1071-1079.
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