Intensive Hemodialysis and Mortality Risk in Australian and New Zealand Populations

摘要: Background There is a resurgence of interest in home hemodialysis (HD), especially frequent or extended forms involving unconventionally (>3 times/wk) and/or long (>6 hours) treatments. This driven by cost containment and experience suggesting lower mortality risk compared with facility HD peritoneal dialysis (PD). Study Design We performed an observational cohort study using the Australia New Zealand Dialysis Transplant Registry, marginal structural modeling to adjust for time-varying medical comorbidity as both source selection bias intermediary variable on causal pathway death. Setting & Participants All adult patients starting renal replacement therapy since March 31, 1996, followed up December 2007. Predictor The main predictor was modality (conventional HD, conventional frequent/extended PD). adjusted confounding effects patient demographics comorbid conditions. Outcome Patient mortality. Results analyzed 26,016 856,007 patient-months follow-up. Relative HRs were 0.51 (95% CI, 0.44-0.59) 1.16 0.94-1.44) 0.53 0.41-0.68) 1.10 1.06-1.16) PD. apparent benefit less who nonwhite, non-Asian, older. Limitations Potential residual from limited collection conditions (no cognitive motor impairment, depression, left ventricular volume structure, blood pressure/fluid status) lack socioeconomic, medication, biochemical data analyses. Conclusions Our supports survival advantage without difference between modalities. Suitably designed clinical trials are needed determine presence extent this modality.