Baxter Latin America, Bogotá D.C., Colombia.
University of Illinois Chicago, Chicago, Illinois, USA.
Ther Apher Dial. 2021 Oct;25(5):621-627. doi: 10.1111/1744-9987.13620. Epub 2021 Jan 31.
To examine new evidence linking expanded hemodialysis (HDx) using a medium cut-off (MCO) membrane with hospitalizations, hospital days, medication use, costs, and patient utility. This retrospective study utilized data from Renal Care Services medical records database in Colombia from 2017 to 2019. Clinics included had switched all patients from high flux hemodialysis (HD HF) to HDx and had at least a year of data on HD HF and HDx. Data included demographic characteristics, comorbidities, years on dialysis, hospitalizations, medication use, and quality of life measured by the 36 item and Short Form versions of the Kidney Disease Quality of Life survey at the start of HDx, and 1 year after HDx, which were mapped to EQ-5D utilities. Generalized linear models were run on the outcomes of interest with an indicator for being on HDx. Annual cost estimates were also constructed. The study included 81 patients. HDx was significantly associated with lower dosing of erythropoietin stimulating agents, iron, hypertension medications, and insulin. HDx was also significantly associated with lower hospital days per year (5.94 on HD vs. 4.41 on HDx) although not with the number of hospitalizations. Estimates of annual hospitalization costs were 23.9% lower using HDx and patient utilities did not appear to decline. HDx was statistically significantly associated with reduced hospitalization days and lower medication dosages. Furthermore, this preliminary analysis suggested potential for HDx being a dominant strategy in terms of costs and utility and should motivate future work with larger samples and better controls.
探讨使用中分子量截留（MCO）膜进行扩充血液透析（HDx）与住院、住院天数、药物使用、成本和患者效用之间的新关联。
本回顾性研究使用了哥伦比亚 2017 年至 2019 年期间肾脏护理服务医疗记录数据库中的数据。纳入的诊所已将所有患者从高通量血液透析（HD HF）切换至 HDx，并具有至少一年的 HD HF 和 HDx 数据。数据包括人口统计学特征、合并症、透析年限、住院、药物使用和生活质量，使用肾脏病生活质量调查的 36 项和短表版本在开始 HDx 时以及 HDx 后 1 年进行测量，并映射到 EQ-5D 效用。对感兴趣的结果运行广义线性模型，并使用 HDx 作为指标。还构建了年度成本估算。
该研究纳入了 81 名患者。HDx 与红细胞生成素刺激剂、铁、高血压药物和胰岛素的低剂量使用显著相关。HDx 还与每年的住院天数显著相关（HD 为 5.94 天，HDx 为 4.41 天），但与住院次数无关。使用 HDx 的年度住院费用估计降低了 23.9%，患者效用似乎并未下降。HDx 与住院天数减少和药物剂量降低显著相关。此外，这项初步分析表明，HDx 在成本和效用方面可能是一种优势策略，应该激励未来进行更大样本和更好对照的研究。
