Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
Dianet Dialysis Centres, Utrecht, The Netherlands.
Nephrol Dial Transplant. 2020 Mar 1;35(3):488-495. doi: 10.1093/ndt/gfz208.
Previous US studies have indicated that haemodialysis with ≥6-h sessions [extended-hours haemodialysis (EHD)] may improve patient survival. However, patient characteristics and treatment practices vary between the USA and Europe. We therefore investigated the effect of EHD three times weekly on survival compared with conventional haemodialysis (CHD) among European patients.
We included patients who were treated with haemodialysis between 2010 and 2017 from eight countries providing data to the European Renal Association-European Dialysis and Transplant Association Registry. Haemodialysis session duration and frequency were recorded once every year or at every change of haemodialysis prescription and were categorized into three groups: CHD (three times weekly, 3.5-4 h/treatment), EHD (three times weekly, ≥6 h/treatment) or other. In the primary analyses we attributed death to the treatment at the time of death and in secondary analyses to EHD if ever initiated. We compared mortality risk for EHD to CHD with causal inference from marginal structural models, using Cox proportional hazards models weighted for the inverse probability of treatment and censoring and adjusted for potential confounders.
From a total of 142 460 patients, 1338 patients were ever treated with EHD (three times, 7.1 ± 0.8 h/week) and 89 819 patients were treated exclusively with CHD (three times, 3.9 ± 0.2 h/week). Crude mortality rates were 6.0 and 13.5/100 person-years. In the primary analyses, patients treated with EHD had an adjusted hazard ratio (HR) of 0.73 [95% confidence interval (CI) 0.62-0.85] compared with patients treated with CHD. When we attributed all deaths to EHD after initiation, the HR for EHD was comparable to the primary analyses [HR 0.80 (95% CI 0.71-0.90)].
EHD is associated with better survival in European patients treated with haemodialysis three times weekly.
之前的美国研究表明，每周进行≥6 次透析治疗[延长透析时间（EHD）]可能会改善患者的生存率。然而，美国和欧洲的患者特征和治疗实践存在差异。因此，我们研究了每周三次 EHD 治疗与常规透析（CHD）相比对欧洲患者的生存影响。
我们纳入了 2010 年至 2017 年期间，来自 8 个国家的向欧洲肾脏协会-欧洲透析和移植协会登记处提供数据的患者，这些患者接受血液透析治疗。每年或每次改变血液透析处方时都会记录血液透析治疗时间和频率，并将其分为三组：CHD（每周三次，每次 3.5-4 小时/治疗）、EHD（每周三次，每次≥6 小时/治疗）或其他。在主要分析中，我们将死亡归因于死亡时的治疗方法，在次要分析中，我们将死亡归因于是否开始 EHD。我们使用因果推断的边际结构模型比较 EHD 与 CHD 的死亡率，使用加权于治疗和随访的逆概率 Cox 比例风险模型，并调整了潜在混杂因素。
在总共 142460 名患者中，有 1338 名患者曾接受 EHD 治疗（每周三次，每次 7.1±0.8 小时），89819 名患者仅接受 CHD 治疗（每周三次，每次 3.9±0.2 小时）。未经调整的死亡率分别为 6.0 和 13.5/100 人年。在主要分析中，与接受 CHD 治疗的患者相比，接受 EHD 治疗的患者校正后的危险比（HR）为 0.73（95%置信区间[CI]0.62-0.85）。当我们在开始后将所有死亡归因于 EHD 时，EHD 的 HR 与主要分析结果相似[HR 0.80（95%CI 0.71-0.90）]。
在每周接受三次血液透析治疗的欧洲患者中，EHD 与生存率的提高相关。
