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Superior patient and technique survival with very high standard K t/ V in quotidian home hemodialysis
Author(s) -
Lockridge Robert,
Ting George,
Kjellstrand Carl M.
Publication year - 2012
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/j.1542-4758.2012.00696.x
Subject(s) - medicine , hemodialysis , hazard ratio , dialysis , home hemodialysis , proportional hazards model , cohort , survival analysis , surgery , gastroenterology , confidence interval
We studied the association of patient and dialysis factors with patient and technique survival in a cohort of all of our 191 of patients surviving >3 months on quotidian home hemodialysis ( QHHD ). Eighty‐one patients were on nocturnal QHHD and 110 on short ‐daily QHHD . Weekly dialysis time was 7.5–48 hours, single pool K t/ V was 0.38–4.5 per treatment, and weekly standard K t/ V was 2.1–7.5. The association of 18 patient and dialysis variables with patient and technique survival was analyzed by K aplan‐ M eier and C ox analyses. Ninety‐nine patients (52%) remained on QHHD , 34 (18%) were transplanted, 31 (16%) returned to 3/week HD , and 27 (14%) died. The 5‐year patient survival was 71% ± 6% (night: 79% ± 7%, day: 69% ± 9%, P = 0.002). The 5‐year technique survival was 80% ± 4% (night: 93% ± 3%, day: 46% ± 17%, P = 0.001). In Cox analyses, patient survival was independently associated with standard K t/ V (hazard ratio [ HR ] = 0.29, P < 0.0001), graduating from high school ( HS ) ( HR = 0.11, P = 0.0002), and use of graft/fistula ( HR = 0.22, P = 0.007). Technique survival was independently associated with standard K t/ V ( HR = 0.50, P = 0.0003) and start of QHHD after 2003 ( HR = 0.18, P = 0.007). Every increase in standard K t/ V was associated with improved survival. The highest survival occurred when standard K t/ V exceeded 5.1, only possible when weekly dialysis hours exceed 35 hours. In QHHD , higher standard K t/ V , education, and subcutaneous access are associated with better patient survival and higher standard K t/ V and longer experience of center with better technique survival. There was no upper limit of standard K t/ V , where survival plateaus. The amount of minimally “adequate” dialysis should be much increased.