Daily Dialysis Linked to Increased Mortality

Patients receiving daily in-center dialysis have a higher risk of death than those receiving conventional three-times-weekly dialysis, according to a report in Kidney International.

Using an international registry, the researchers identified 556 patients in France, the United States, and Canada who received daily hemodialysis (more than five times weekly) between 2001 and 2010. Propensity score techniques were used to match 318 patients receiving daily hemodialysis with 575 patients receiving conventional hemodialysis (three times weekly) during the same period. Mortality on the two dialysis schedules was compared by Cox proportional hazards.

The daily hemodialysis group received dialysis nearly twice as often as the conventional group: mean 5.8 sessions per week. The mean weekly dialysis times were 15.7 hours versus 11.9 hours, respectively.

There were 170 deaths over 1382 patient-years of follow-up. The mortality was substantially higher for patients receiving daily hemodialysis: 15.6 versus 10.9 deaths per 100 person-years, hazard ratio 1.6. The results were similar in matched and unmatched adjusted analyses and in specified subgroup analyses. There was also evidence that daily hemodialysis was poorly tolerated—30 percent of patients switched to conventional hemodialysis after a median of 10 months.

Previous reports have suggested improvement in health-related quality of life and other outcomes for patients undergoing daily hemodialysis. This cohort study, however, finds that mortality is actually higher for patients receiving daily hemodialysis compared with the conventional schedule. Although daily dialysis may have quality-of-life benefits, it cannot be recommended on the basis of improved survival [Suri RS, et al. A multinational cohort study of in-center daily hemodialysis and patient survival. Kidney Int 2013; 83:300–307].

March 2013 (Vol. 5, Number 3)