Twice-Weekly Hemodialysis and Clinical Outcomes in the China Dialysis Outcomes and Practice Patterns Study
Introduction: In China, a quarter of patients are undergoing 2-times weekly hemodialysis. Using data from the China Dialysis Outcomes and Practice Patterns Study (DOPPS), we tested the hypothesis that whereas survival and hospitalizations would be similar in the presence of residual kidney function...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2018-07-01
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| Series: | Kidney International Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024918300639 |
| _version_ | 1818526012398370816 |
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| author | Yucheng Yan Mia Wang Jarcy Zee Doug Schaubel Charlotte Tu JiaQi Qian Brian Bieber Mei Wang Nan Chen Zuo Li Friedrich K. Port Bruce M. Robinson Shuchi Anand |
| author_facet | Yucheng Yan Mia Wang Jarcy Zee Doug Schaubel Charlotte Tu JiaQi Qian Brian Bieber Mei Wang Nan Chen Zuo Li Friedrich K. Port Bruce M. Robinson Shuchi Anand |
| author_sort | Yucheng Yan |
| collection | DOAJ |
| description | Introduction: In China, a quarter of patients are undergoing 2-times weekly hemodialysis. Using data from the China Dialysis Outcomes and Practice Patterns Study (DOPPS), we tested the hypothesis that whereas survival and hospitalizations would be similar in the presence of residual kidney function (RKF), patients without RKF would fare worse on 2-times weekly hemodialysis. Methods: In our cohort derived from 15 units randomly selected from each of 3 major cities (total N = 45), we generated a propensity score for the probability of dialysis frequency assignment, estimated a survival function by propensity score quintiles, and averaged stratum-specific survival functions to generate mean survival time. We used the proportional rates model to assess hospitalizations. We stratified all analyses by RKF, as reported by patients (urine output <1 vs. ≥1 cup/day). Results: Among 1265 patients, 123 and 133 were undergoing 2-times weekly hemodialysis with and without evidence of RKF. Over 2.5 years, adjusted mean survival times were similar for 2- versus 3-times weekly dialysis groups: 2.20 versus 2.23 and 2.20 versus 2.15 for patients with and without RKF (P = 0.65). Hazard ratios for hospitalization rates were similar for 2- versus 3-times weekly groups, with (1.15, 95% confidence interval = 0.66−2.00) and without (1.10, 95% confidence interval 0.68−1.79]) RKF. The normalized protein catabolic rate was lower and intradialytic weight gain was not substantially higher in the 2- versus 3-times weekly dialysis group, suggesting greater restriction of dietary sodium and protein. Conclusion: In our study of patients in China’s major cities, we could not detect differences in survival and hospitalization for those undergoing 2- versus 3-times weekly dialysis, regardless of RKF. Our findings indicate the need for pragmatic studies regarding less frequent dialysis with associated nutritional management. Keywords: dialysis frequency, dialysis provision in low-resource settings, outcomes on hemodialysis, 2-times weekly hemodialysis |
| first_indexed | 2024-12-11T06:17:13Z |
| format | Article |
| id | doaj.art-005200f03178488280d77edf0464a1f9 |
| institution | Directory Open Access Journal |
| issn | 2468-0249 |
| language | English |
| last_indexed | 2024-12-11T06:17:13Z |
| publishDate | 2018-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj.art-005200f03178488280d77edf0464a1f92022-12-22T01:17:57ZengElsevierKidney International Reports2468-02492018-07-0134889896Twice-Weekly Hemodialysis and Clinical Outcomes in the China Dialysis Outcomes and Practice Patterns StudyYucheng Yan0Mia Wang1Jarcy Zee2Doug Schaubel3Charlotte Tu4JiaQi Qian5Brian Bieber6Mei Wang7Nan Chen8Zuo Li9Friedrich K. Port10Bruce M. Robinson11Shuchi Anand12Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, ChinaDepartment of Biostatistics, University of Michigan, Ann Arbor, Michigan, USAArbor Research Collaborative for Health, Ann Arbor, Michigan, USADepartment of Biostatistics, University of Michigan, Ann Arbor, Michigan, USAArbor Research Collaborative for Health, Ann Arbor, Michigan, USARenal Division, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, ChinaArbor Research Collaborative for Health, Ann Arbor, Michigan, USADepartment of Nephrology, People’s Hospital, School of Medicine, Peking University, Beijing, ChinaDepartment of Nephrology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, ChinaPeking University First Hospital, Beijing, China Institute of Nephrology, Peking University, Beijing, ChinaArbor Research Collaborative for Health, Ann Arbor, Michigan, USAArbor Research Collaborative for Health, Ann Arbor, Michigan, USADivision of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA; Correspondence: Shuchi Anand, Division of Nephrology, Stanford University School of Medicine, 777 Welch Road, Suite DE, Palo Alto, California 94304, USA.Introduction: In China, a quarter of patients are undergoing 2-times weekly hemodialysis. Using data from the China Dialysis Outcomes and Practice Patterns Study (DOPPS), we tested the hypothesis that whereas survival and hospitalizations would be similar in the presence of residual kidney function (RKF), patients without RKF would fare worse on 2-times weekly hemodialysis. Methods: In our cohort derived from 15 units randomly selected from each of 3 major cities (total N = 45), we generated a propensity score for the probability of dialysis frequency assignment, estimated a survival function by propensity score quintiles, and averaged stratum-specific survival functions to generate mean survival time. We used the proportional rates model to assess hospitalizations. We stratified all analyses by RKF, as reported by patients (urine output <1 vs. ≥1 cup/day). Results: Among 1265 patients, 123 and 133 were undergoing 2-times weekly hemodialysis with and without evidence of RKF. Over 2.5 years, adjusted mean survival times were similar for 2- versus 3-times weekly dialysis groups: 2.20 versus 2.23 and 2.20 versus 2.15 for patients with and without RKF (P = 0.65). Hazard ratios for hospitalization rates were similar for 2- versus 3-times weekly groups, with (1.15, 95% confidence interval = 0.66−2.00) and without (1.10, 95% confidence interval 0.68−1.79]) RKF. The normalized protein catabolic rate was lower and intradialytic weight gain was not substantially higher in the 2- versus 3-times weekly dialysis group, suggesting greater restriction of dietary sodium and protein. Conclusion: In our study of patients in China’s major cities, we could not detect differences in survival and hospitalization for those undergoing 2- versus 3-times weekly dialysis, regardless of RKF. Our findings indicate the need for pragmatic studies regarding less frequent dialysis with associated nutritional management. Keywords: dialysis frequency, dialysis provision in low-resource settings, outcomes on hemodialysis, 2-times weekly hemodialysishttp://www.sciencedirect.com/science/article/pii/S2468024918300639 |
| spellingShingle | Yucheng Yan Mia Wang Jarcy Zee Doug Schaubel Charlotte Tu JiaQi Qian Brian Bieber Mei Wang Nan Chen Zuo Li Friedrich K. Port Bruce M. Robinson Shuchi Anand Twice-Weekly Hemodialysis and Clinical Outcomes in the China Dialysis Outcomes and Practice Patterns Study Kidney International Reports |
| title | Twice-Weekly Hemodialysis and Clinical Outcomes in the China Dialysis Outcomes and Practice Patterns Study |
| title_full | Twice-Weekly Hemodialysis and Clinical Outcomes in the China Dialysis Outcomes and Practice Patterns Study |
| title_fullStr | Twice-Weekly Hemodialysis and Clinical Outcomes in the China Dialysis Outcomes and Practice Patterns Study |
| title_full_unstemmed | Twice-Weekly Hemodialysis and Clinical Outcomes in the China Dialysis Outcomes and Practice Patterns Study |
| title_short | Twice-Weekly Hemodialysis and Clinical Outcomes in the China Dialysis Outcomes and Practice Patterns Study |
| title_sort | twice weekly hemodialysis and clinical outcomes in the china dialysis outcomes and practice patterns study |
| url | http://www.sciencedirect.com/science/article/pii/S2468024918300639 |
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