Initial Session Duration and Mortality Among Incident Hemodialysis Patients

Area of Science:

• Nephrology
• Clinical Epidemiology
• Public Health

Background:

• The association between dialysis session duration and mortality in maintenance hemodialysis patients remains unclear.
• This study investigates mortality rates in patients treated in facilities with differing initial session durations.

Purpose of the Study:

• To compare mortality rates between patients initiating maintenance hemodialysis with initial session durations of ≥4 hours versus 3 hours.
• To assess the impact of initial dialysis session length on patient survival.

Main Methods:

• Retrospective cohort study design.
• Inclusion of 39,172 patients initiating treatment for ≥4 hours and 47,721 patients initiating for 3 hours, from January 2006 to December 2012.
• Analysis of 1- and 2-year mortality rates using adjusted hazard ratios (HR).

Main Results:

• The 2-year adjusted HR for mortality in the ≥4-hour group versus the 3-hour group was 0.79 (95% CI, 0.73-0.86).
• The 1-year adjusted HR was 0.77 (95% CI, 0.70-0.84).
• Results remained robust across various patient subgroups.

Conclusions:

• Facilities routinely initiating hemodialysis for ≥4 hours may be associated with substantially lower mortality rates compared to those initiating for 3 hours.
• Limitations include lack of data on subsequent session durations, dialysis dosage, and baseline residual kidney function.