The association between longer haemodialysis treatment times and hospitalization and mortality after the two-day break in individuals receiving three times a week haemodialysis.

Background: On the first haemodialysis (HD) day after the 2-day break in three times a week (3×W) in-centre HD, mortality and hospitalization are higher. If longer HD sessions prescribed 3×W is associated with a reduction in these events is unknown. Methods: HD session length in 19 557 prevalent European in-centre 3×W HD patients participating in the Dialysis Outcomes and Practice Patterns Study (1998-2011) were categorized into 250 min. Standardized event rates on the first (HD1) versus the second (HD2) HD day after the 2-day break, with supporting Cox proportional hazards models adjusted for patient and dialysis characteristics, were generated for all-cause mortality, all-cause hospitalization, out-of-hospital death and fluid overload hospitalization. Results: By comparing HD1 with HD2, increased rates of all endpoints were observed (all P 250 min were at significantly greater risk on HD1 when compared with their HD2 for out-of-hospital death [hazard ratio (HR) = 2.1, 95% CI 1.0-4.3], all-cause hospitalization (HR = 1.3, 95% CI 1.2-1.4) and fluid overload hospitalization (HR = 3.2, 95% CI 1.8-6.0). Conclusions: Despite the association between reduced mortality across all dialysis days in patients performing longer sessions, elevated risk on the first dialysis day relative to the second persists even in patients dialysing 4.5 h 3×W

The association of functional status with mortality and dialysis modality change : results from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS)

BACKGROUND: Little is known about the prevalence of functional impairment in peritoneal dialysis (PD) patients, its variation by country, and its association with mortality or transfer to hemodialysis. METHODS: A prospective cohort study was conducted in PD patients from 7 countries in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) (2014 - 2017). Functional status (FS) was assessed by combining self-reports of 8 instrumental and 5 basic activities of daily living, using the Lawton-Brody and the Katz questionnaires. Summary FS scores, ranging from 1.25 (most dependent) to 13 (independent), were based on the patient's ability to perform each activity with or without assistance. Logistic regression was used to estimate the odds ratio (OR; 95% confidence interval [CI]) of a FS score < 11 comparing each country with the United States (US). Cox regression was used to estimate the hazard ratio (HR; 95% CI) for the effect of a low FS score on mortality and transfer to hemodialysis, adjusting for case mix. RESULTS: Of 2,593 patients with complete data on FS, 48% were fully independent (FS = 13), 32% had a FS score 11 to < 13, 14% had a FS score 8 to < 11, and 6% had a FS score < 8. Relative to the US, low FS scores (< 11; more dependent) were more frequent in Thailand (OR = 10.48, 5.90 - 18.60) and the United Kingdom (UK) (OR = 3.29, 1.77 - 6.08), but similar in other PDOPPS countries. The FS score was inversely and monotonically associated with mortality but not with transfer to hemodialysis; the HR, comparing a FS score < 8 vs 13, was 4.01 (2.44 - 6.61) for mortality and 0.91 (0.58 - 1.43) for transfer to hemodialysis. CONCLUSION: Regional differences in FS scores observed across PDOPPS countries may have been partly due to differences in regional patient selection for PD. Functional impairment was associated with mortality but not with permanent transfer to hemodialysis

Gender, low K t/ V , and mortality in J apanese hemodialysis patients: Opportunities for improvement through modifiable practices

Guidelines have recommended single pool K t/ V  > 1.2 as the minimum dose for chronic hemodialysis ( HD ) patients on thrice weekly HD . The Dialysis Outcomes and Practice Patterns Study ( DOPPS ) has shown that “low Kt/ V ” (1 year and receiving thrice weekly dialysis. Logistic regression models estimated the relationships of patient characteristics with K t/ V . Logistic models also were used to estimate the proportion of low K t/ V cases attributable to various treatment practices. Multivariable C ox regression was used to estimate the associations of low K t/ V , blood flow rate ( BFR ), and treatment time ( TT ), with all‐cause mortality. From 1999 to 2009, the prevalence of low K t/ V declined in men (37–27%) and women (15–10%). BFR <200 mL/min, TT <240 minutes, and dialyzate flow rate ( DFR ) < 500 mL/min were common (35, 13, and 19% of patients, respectively) and strongly associated with low K t/ V . Fifteen percent of low K t/ V cases were attributable to BFR <200 and 13% to TT <240, compared to only 3% for DFR <500. Lower K t/ V was associated with elevated mortality, more so among women (hazard ratio [ HR ] = 1.13 per 0.1 lower K t/ V , 95% CI : 1.07–1.20) than among men ( HR  = 1.06 per 0.1 lower K t/ V , 95% CI : 1.00–1.12). The relatively large proportion of low K t/ V cases in J apanese facilities may potentially be reduced 30% by increasing BFR to 200 mL/min and TT to 4 hours thrice weekly in HD patients. Associations of low K t/ V with elevated mortality suggest that modification of these practices may further improve survival for J apanese HD patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108046/1/hdi12142.pd

Potassium-Binding Resins: Associations with Serum Chemistries and Interdialytic Weight Gain in Hemodialysis Patients

BACKGROUND: Although potassium-binding sodium-based resins (K resins) have been prescribed to treat hyperkalemia for 50 years, there have been no large studies of their effects among hemodialysis patients. METHODS: Data from 11,409 patients in the Dialysis Outcomes and Practice Patterns Study in Belgium, Canada, France, Italy, and Sweden (nations where ≥ 5% of patients were prescribed a sodium based K resin; seven other countries had <5% use) between 2002-2011 were analyzed. Linear mixed models examined associations between K resin use and interdialytic weight gain (IDWG) and serum electrolyte concentrations. Mortality was analyzed using Cox regression. An instrumental variable approach was used to partially account for unmeasured confounders. RESULTS: The K resin prescription rate was 20% overall. As hypothesized, patients prescribed a K resin had greater IDWG and higher serum bicarbonate, phosphorus, and sodium (but not calcium) concentrations. Patients prescribed a K resin had higher serum K, but lower serum K in an instrumental variable analysis to limit treatment by indication bias. K resin use was not associated with mortality risk. CONCLUSION: We report the first large study of K resin use and associated lab and clinical outcomes in HD patients. The prescription rate of K resins varied dramatically by country and dialysis center. The results suggest that K resin use may effectively lower serum K, although at the expense of somewhat higher phosphatemia and greater IDWG, and had no clear association with mortality. Additional study is warranted to elucidate the optimal role for K resins in modern dialysis care

Long- Versus Short-Acting Erythropoiesis-Stimulating Agent Type and Mortality

International audienceNo abstract availabl

Supplementary Material for: Potassium-Binding Resins: Associations with Serum Chemistries and Interdialytic Weight Gain in Hemodialysis Patients

<b><i>Background:</i></b> Although potassium-binding sodium-based resins (K resins) have been prescribed to treat hyperkalemia for 50 years, there have been no large studies of their effects among hemodialysis (HD) patients. <b><i>Methods:</i></b> Data from 11,409 patients in the Dialysis Outcomes and Practice Patterns Study in Belgium, Canada, France, Italy, and Sweden (nations where ≥5% of patients were prescribed a sodium- based K resin; seven other countries had <5% use) between 2002 and 2011 were analyzed. Linear mixed models examined associations between K resin use and interdialytic weight gain (IDWG) and serum electrolyte concentrations. Mortality was analyzed using Cox regression. An instrumental variable approach was used to partially account for unmeasured confounders. <b><i>Results:</i></b> The K resin prescription rate was 20% overall. As hypothesized, patients prescribed a K resin had greater IDWG and higher serum bicarbonate, phosphorus, and sodium (but not calcium) concentrations. Patients prescribed a K resin had higher serum K levels, but serum K levels were lower in an instrumental variable analysis limiting treatment by indication bias. K resin use was not associated with mortality risk. <b><i>Conclusion:</i></b> We report the first large study of K resin use and associated laboratory and clinical outcomes in HD patients. The prescription rate of K resins varied dramatically by country and dialysis center. The results suggest that K resin use may effectively lower serum K, although at the expense of somewhat higher phosphatemia and greater IDWG, and had no clear association with mortality. Further study is warranted to elucidate the optimal role for K resins in modern dialysis care