Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study
Abstract Background Globally, there is increased clinical interest and uptake of hemodiafiltration (HDF) for increased removal of uremic toxins. To date, there has been no epidemiological analysis of HDF in China. We present HDF practice patterns and associated mortality risk in Shanghai. Methods Th...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-02-01
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| Series: | BMC Nephrology |
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| Online Access: | http://link.springer.com/article/10.1186/s12882-019-1219-z |
| _version_ | 1828352835233775616 |
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| author | Weiming Zhang Changlin Mei Nan Chen Xiaoqiang Ding Zhaohui Ni Chuanming Hao Jinghong Zhang Jinyuan Zhang Niansong Wang Gengru Jiang Zhiyong Guo Chen Yu Yueyi Deng Haiming Li Qiang Yao Mark R. Marshall Martin J. Wolley Jiaqi Qian |
| author_facet | Weiming Zhang Changlin Mei Nan Chen Xiaoqiang Ding Zhaohui Ni Chuanming Hao Jinghong Zhang Jinyuan Zhang Niansong Wang Gengru Jiang Zhiyong Guo Chen Yu Yueyi Deng Haiming Li Qiang Yao Mark R. Marshall Martin J. Wolley Jiaqi Qian |
| author_sort | Weiming Zhang |
| collection | DOAJ |
| description | Abstract Background Globally, there is increased clinical interest and uptake of hemodiafiltration (HDF) for increased removal of uremic toxins. To date, there has been no epidemiological analysis of HDF in China. We present HDF practice patterns and associated mortality risk in Shanghai. Methods This is an observational, prospectively collected, retrospective analysis of 9351 Chinese patients initiating hemodialysis in Shanghai from 2007 to 2014. The primary exposure was hemodialysis sub-modality at inception, classified into hemodiafiltration (HDF) and hemodialysis (HD), with adjustment for concommitant hemoperfusion. The primary outcome was patient mortality. We used Cox proportional hazards regression and Fine and Gray’s proportional subhazards regression, with multiple imputation of missing co-variates by the chained equation method, adjusting for demographic and clinical variables. Results Overall, patients in the cohort were younger, with a more males, and with a lower body mass index when compared to corresponding non-Asian cohorts. Mortality rate was low although it doubled over the period of observation. HDF utilization increased from 7% of patients in 2007 to 42% of patients in 2014. The majority of patients received HDF once a week. The adjusted hazard ratio of death (95% confidence intervals) for HDF versus HD was 0.85 (0.71–1.03), and corresponding sub-hazard ratio 0.86 (0.71–1.03). There was strong effect modification by age. In those aged 40–60 years, the hazard ratio (95% confidence intervals) was 0.65 (0.45–0.94), and sub-hazard ratio also 0.65 (0.45–0.95). Conclusions Our study has certain limitations resulting from the limited number of co-variates available for modelling, missing data for some co-variates, and the lack of verification of data against source documentation. Notwithstanding, there is evidence of clinical benefit from HDF in China, and potential to improve patient outcomes through the greater removal of middle and larger uremic solutes. |
| first_indexed | 2024-04-14T01:58:43Z |
| format | Article |
| id | doaj.art-2ebd1471786d46329ab08f0a2ee3ef23 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-04-14T01:58:43Z |
| publishDate | 2019-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-2ebd1471786d46329ab08f0a2ee3ef232022-12-22T02:18:53ZengBMCBMC Nephrology1471-23692019-02-0120111210.1186/s12882-019-1219-zOutcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort studyWeiming Zhang0Changlin Mei1Nan Chen2Xiaoqiang Ding3Zhaohui Ni4Chuanming Hao5Jinghong Zhang6Jinyuan Zhang7Niansong Wang8Gengru Jiang9Zhiyong Guo10Chen Yu11Yueyi Deng12Haiming Li13Qiang Yao14Mark R. Marshall15Martin J. Wolley16Jiaqi Qian17Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong UniversityDepartment of Nephrology, Changzheng Hospital, Second Military Medical UniversityDepartment of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityDivision of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan UniversityDepartment of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong UniversityDivision of Nephrology, Huashan Hospital, Shanghai Medical College, Fudan UniversityDepartment of Nephrology, 85 Hospital of People’s Liberation ArmyDepartment of Nephrology, 455 Hospital of People’s Liberation ArmyDepartment of Nephrology, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong UniversityDepartment of Nephrology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong UniversityDepartment of Nephrology, Changhai Hospital, Second Military Medical University, ShanghaiDepartment of Nephrology, Tongji Hospital, Tongji UniversityDepartment of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese MedicineBaxter China Investment Co Ltd, Medical AffairsBaxter China Investment Co Ltd, Medical AffairsBaxter Healthcare (Asia) Pte Ltd, Medical AffairsDepartment of Renal Medicine, Royal Brisbane and Women’s HospitalDepartment of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong UniversityAbstract Background Globally, there is increased clinical interest and uptake of hemodiafiltration (HDF) for increased removal of uremic toxins. To date, there has been no epidemiological analysis of HDF in China. We present HDF practice patterns and associated mortality risk in Shanghai. Methods This is an observational, prospectively collected, retrospective analysis of 9351 Chinese patients initiating hemodialysis in Shanghai from 2007 to 2014. The primary exposure was hemodialysis sub-modality at inception, classified into hemodiafiltration (HDF) and hemodialysis (HD), with adjustment for concommitant hemoperfusion. The primary outcome was patient mortality. We used Cox proportional hazards regression and Fine and Gray’s proportional subhazards regression, with multiple imputation of missing co-variates by the chained equation method, adjusting for demographic and clinical variables. Results Overall, patients in the cohort were younger, with a more males, and with a lower body mass index when compared to corresponding non-Asian cohorts. Mortality rate was low although it doubled over the period of observation. HDF utilization increased from 7% of patients in 2007 to 42% of patients in 2014. The majority of patients received HDF once a week. The adjusted hazard ratio of death (95% confidence intervals) for HDF versus HD was 0.85 (0.71–1.03), and corresponding sub-hazard ratio 0.86 (0.71–1.03). There was strong effect modification by age. In those aged 40–60 years, the hazard ratio (95% confidence intervals) was 0.65 (0.45–0.94), and sub-hazard ratio also 0.65 (0.45–0.95). Conclusions Our study has certain limitations resulting from the limited number of co-variates available for modelling, missing data for some co-variates, and the lack of verification of data against source documentation. Notwithstanding, there is evidence of clinical benefit from HDF in China, and potential to improve patient outcomes through the greater removal of middle and larger uremic solutes.http://link.springer.com/article/10.1186/s12882-019-1219-zChinaHemodiafiltrationEpidemiologyMortalityHemodialysis |
| spellingShingle | Weiming Zhang Changlin Mei Nan Chen Xiaoqiang Ding Zhaohui Ni Chuanming Hao Jinghong Zhang Jinyuan Zhang Niansong Wang Gengru Jiang Zhiyong Guo Chen Yu Yueyi Deng Haiming Li Qiang Yao Mark R. Marshall Martin J. Wolley Jiaqi Qian Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study BMC Nephrology China Hemodiafiltration Epidemiology Mortality Hemodialysis |
| title | Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study |
| title_full | Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study |
| title_fullStr | Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study |
| title_full_unstemmed | Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study |
| title_short | Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study |
| title_sort | outcomes and practice patterns with hemodiafiltration in shanghai a longitudinal cohort study |
| topic | China Hemodiafiltration Epidemiology Mortality Hemodialysis |
| url | http://link.springer.com/article/10.1186/s12882-019-1219-z |
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