Premium
No evidence of a legacy effect on survival following randomization to extended hours dialysis in the ACTIVE Dialysis trial
Author(s) -
Smyth Brendan,
Zuo Li,
Gray Nicholas A.,
Chan Christopher T.,
Zoysa Janak R.,
Hong Daqing,
Rogers Kris,
Wang Jia,
Cass Alan,
Gallagher Martin,
Perkovic Vlado,
Jardine Meg
Publication year - 2020
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.13737
Subject(s) - medicine , dialysis , hazard ratio , randomization , confounding , randomized controlled trial , observational study , transplantation , peritoneal dialysis , proportional hazards model , surgery , confidence interval
Aim Extended hours haemodialysis is associated with superior survival to standard hours. However, residual confounding limits the interpretation of this observation. We aimed to determine the effect of a period of extended hours dialysis on long‐term survival among participants in the ACTIVE Dialysis trial. Methods Two‐hundred maintenance haemodialysis recipients were randomized to extended hours dialysis (median 24 h/wk) or standard hours dialysis (median 12 h/wk) for 12 months. Further pre‐specified observational follow up occurred at 24, 36 and 60 months. Vital status and modality of renal replacement therapy were ascertained. Results Over the 5 years, 38 participants died, 30 received a renal transplant, and 6 were lost to follow up. Total weekly dialysis hours did not differ between standard and extended groups during the follow‐up period (14.1 hours [95%CI 13.4‐14.8] vs 14.8 hours [95%CI 14.1‐15.6]; P = .16). There was no difference in all‐cause mortality (hazard ratio for extended hours 0.91 [95%CI 0.48‐1.72]; P = .77). Similar results were obtained after censoring participants at transplantation, and after adjusting for potential confounding variables. Subgroup analysis did not reveal differences in treatment effect by region, dialysis setting or vintage ( P ‐interaction .51, .54, .12, respectively). Conclusion Twelve months of extended hours dialysis did not improve long‐term survival nor affect dialysis hours after the intervention period. An urgent need remains to further define the optimal dialysis intensity across the broad range of dialysis recipients.