@article{16132,
  author = {Masterson R. and Hawley C. and van Eps C. and Cass Alan and Kerr P. and Agar J. and Gray N. and Jun M. and Gallagher M. and Jardine M and Perkovic Vlado},
  title = {Outcomes of Extended-Hours Hemodialysis Performed Predominantly at Home},
  abstract = {<p>
BACKGROUND: Recent evidence suggests that increased frequency and/or duration of dialysis are associated with improved outcomes. We aimed to describe the outcomes associated with patients starting extended-hours hemodialysis and assess for risk factors for these outcomes. STUDY DESIGN: Case series. SETTING &amp; PARTICIPANTS: Patients were from 6 Australian centers offering extended-hours hemodialysis. Cases were patients who started treatment for 24 hours per week or longer at any time. OUTCOMES: All-cause mortality, technique failure (withdrawal from extended-hours hemodialysis therapy), and access-related events. MEASUREMENTS: Baseline patient characteristics (sex, primary cause of end-stage kidney disease, age, ethnicity, diabetes, and cannulation technique), presence of a vascular access-related event, and dialysis frequency. RESULTS: 286 patients receiving extended-hours hemodialysis were identified, most of whom performed home (96%) or nocturnal (77%) hemodialysis. Most patients performed alternate-daily dialysis (52%). Patient survival rates using an intention-to-treat approach at 1, 3, and 5 years were 98%, 92%, and 83%, respectively. Of 24 deaths overall, cardiac death (n = 7) and sepsis (n = 5) were the leading causes. Technique survival rates at 1, 3, and 5 years were 90%, 77%, and 68%, respectively. Access event-free rates at the same times were 80%, 68%, and 61%, respectively. Access events significantly predicted death (HR, 2.85; 95% CI, 1.14-7.15) and technique failure (HR, 3.76; 95% CI, 1.93-7.35). Patients with glomerulonephritis had a reduced risk of technique failure (HR, 0.31; 95% CI, 0.14-0.69). Higher dialysis frequency was associated with elevated risk of developing an access event (HR per dialysis session, 1.56; 95% CI, 1.03-2.36). LIMITATIONS: Selection bias, lack of a comparator group. CONCLUSIONS: Extended-hours hemodialysis is associated with excellent survival rates and is an effective treatment option for a select group of patients. The major treatment-associated adverse events were related to complications of vascular access, particularly infection. The risk of developing vascular access complications may be increased in extended-hours hemodialysis, which may negatively affect long-term outcomes.
</p>
},
  year = {2012},
  journal = {American Journal of Kidney Diseases},
  edition = {2012/10/06},
  isbn = {1523-6838 (Electronic)0272-6386 (Linking)},
  note = {Jun, MinJardine, Meg JGray, NicholasMasterson, RosemaryKerr, Peter GAgar, John W MHawley, Carmel Mvan Eps, CarolynCass, AlanGallagher, MartinPerkovic, VladoAm J Kidney Dis. 2012 Oct 2. pii: S0272-6386(12)01146-8. doi: 10.1053/j.ajkd.2012.08.032.},
  language = {Eng},
}