Benefits of Incremental Hemodialysis Seen in a Historical Cohort Study.
arteriovenous vascular access
hospitalization
incremental hemodialysis
mortality
residual kidney function
Journal
Therapeutics and clinical risk management
ISSN: 1176-6336
Titre abrégé: Ther Clin Risk Manag
Pays: New Zealand
ID NLM: 101253281
Informations de publication
Date de publication:
2021
2021
Historique:
received:
06
08
2021
accepted:
25
10
2021
entrez:
22
11
2021
pubmed:
23
11
2021
medline:
23
11
2021
Statut:
epublish
Résumé
Previous research on incremental hemodialysis transition has mainly focused on one or two benefits or prognoses. We aimed to conduct a comprehensive analysis by investigating whether incremental hemodialysis was simultaneously associated with adequate dialysis therapy, stable complication indicators, long-lasting arteriovenous vascular access, and long-lasting preservation of residual kidney function (RKF) without increasing mortality or hospitalization. Incident hemodialysis patients from Huashan Hospital in Shanghai, China, over the period of 2012 to 2019, were enrolled and followed every three months until death or the time of censoring. Changes in complication indicators from baseline to all post-baseline visits were analyzed by mixed-effects models. The outcomes of RKF loss, arteriovenous vascular access complications, and the composite of all-cause mortality and cardiovascular events were compared between incremental and conventional hemodialysis by Cox proportional hazards model. Of the 113 patients enrolled in the study, 45 underwent incremental and 68 conventional hemodialysis. There were no significant differences in the changes from baseline to post-baseline visits in complication indicators between the two groups. Incremental hemodialysis reduced the risks of RKF loss (HR, 0.33; 95% CI, 0.14-0.82), de novo arteriovenous access complication (HR, 0.26; 95% CI, 0.08-0.82), and recurrent arteriovenous access complications under the Andersen-Gill (AG) model (HR, 0.27; 95% CI, 0.10-0.74) and the Prentice, Williams and Peterson Total Time (PWP-TT) model (HR, 0.31; 95% CI, 0.12-0.80). There were no significant differences in all-cause hospitalization or the composite outcome between groups. Incremental hemodialysis is an effective dialysis transition strategy that preserves RKF and arteriovenous access without affecting dialysis adequacy, patient stability, hospitalization risk and mortality risk. Randomized controlled trials are warranted.
Identifiants
pubmed: 34803381
doi: 10.2147/TCRM.S332218
pii: 332218
pmc: PMC8598204
doi:
Types de publication
Journal Article
Langues
eng
Pagination
1177-1186Informations de copyright
© 2021 Chen et al.
Déclaration de conflit d'intérêts
The authors declare no potential conflicts of interest.
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