Open AccessImpact of old age on the association between in-center extended-hours hemodialysis and mortality in patients on incident hemodialysis
Author(s) -
Masaki Okazaki,
Daijo Inaguma,
Tsutomu Imaizumi,
Manabu Hishida,
Shimon Kurasawa,
Yoko Kubo,
Shinichi Kato,
Yoshinari Yasuda,
Takayuki Kuriyama,
Fumika Kaneda,
Shoichi Maruyama
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0235900
Subject(s) - hemodialysis , medicine , hazard ratio , proportional hazards model , dialysis , mortality rate , single center , home hemodialysis , regimen , surgery , confidence interval
With the global problem of aging, it has become more difficult to improve the prognosis of older dialysis patients. Extended-hours hemodialysis offers longer treatment time compared to conventional hemodialysis regimen and provides favorable metabolic status, hemodynamic stability, and increased dietary intake. Despite prior studies reporting that in-center extended-hours hemodialysis can reduce the mortality rate, the treatment impact on elderly patients remains unclear. Therefore, we examined the association between extended-hours hemodialysis compared to conventional hemodialysis and all-cause mortality. Survival analyses using Cox proportional hazard model with multivariable adjustments and propensity-score based method were performed to compare mortality risk between 198 consecutive patients who started in-center extended-hours hemodialysis (Extended-HD) and 1407 consecutive patients who initiated conventional hemodialysis. The median age was 67.1 years in the Extended-HD group and 70.7 years in the conventional hemodialysis group. Extended-HD was associated with lower all-cause mortality in overall patients and the subgroup >70 years (adjusted hazard ratios of 0.60 [95% CI, 0.39–0.91] and 0.35 [95% CI, 0.18–0.69], respectively). There was a significant interaction between age >70 years and Extended-HD. In conclusion, extended-hours hemodialysis was associated with a lower mortality rate, especially in elderly patients.