Ontology highlight
ABSTRACT: Background
Long-duration (7-8 hours) hemodialysis provides benefits compared with conventional thrice-weekly, 4-hour sessions. Nurse-administered, in-center nocturnal hemodialysis (INHD) may expand the population to whom an intensive dialysis schedule can be offered.Objective
The primary objective of this study was to determine predictors of INHD technique failure, disruptions, and technique survival.Design
This study used retrospective chart and database review methodology.Setting
This study was conducted at a single Canadian INHD program operating in Victoria, British Columbia, within a tertiary care hospital. Our program serves a catchment population of approximately 450 000 people.Patients/sample/participants
Forty-three consecutive incident INHD patients took part in the INHD program of whom 42 provided informed consent to participate in this study.Methods
We conducted a retrospective observational study including incident INHD patients from 2015 to 2017. The primary outcome was technique failure ?6 months (TF ?6). Secondary outcomes included technique survival and reasons for/predictors of INHD discontinuation or temporary disruption. Predictors of each outcome included demographics, comorbidities, and Clinical Frailty Scale (CFS) scoring.Results
Among 42 patients, mean (SD) age, dialysis vintage, CFS score, and follow-up were 63 (16) years, 46 (55) months, 4 (1), and 11 (9) months, respectively. 52% were aged ?65 years. TF ?6 occurred in 12 (29%) patients. One-year technique survival censored for transplants and home dialysis transitions was 60%. Discontinuation related to insomnia (32%), medical status change (27%), and vascular access (23%). In unadjusted Cox survival analysis, 1-point increases in CFS score associated with a higher risk of technique failure (hazard ratio: 2.04, 95% confidence interval [CI]: 1.26-3.31). In an adjusted analysis, higher frailty severity also associated with temporary INHD disruptions (incidence rate ratio: 2.64, 95% CI: 1.55-4.50, comparing CFS of ?4 to 1-3).Limitations
The retrospective, observational design of this study resulted in limited ability to control for confounding factors. In addition, the relatively small number of events observed owing to a small sample size diminished statistical power to inform study conclusions. Use of a single physician to determine the clinical frailty score is another limitation. Finally, the use of a single center for this study limits generalizability to other programs and clinic settings.Conclusions
INHD is a sustainable modality, even among older patients. Higher frailty associates with INHD technique failure and greater missed treatments. Inclusion of a CFS threshold of ?4 into INHD inclusion criteria may help to identify individuals most likely to realize the long-term benefits of INHD.Trial registration
Due to the retrospective and observational design of this study, trial registration was not necessary.
SUBMITTER: Schachter ME
PROVIDER: S-EPMC7724416 | biostudies-literature | 2020
REPOSITORIES: biostudies-literature
Canadian journal of kidney health and disease 20201207
<h4>Background</h4>Long-duration (7-8 hours) hemodialysis provides benefits compared with conventional thrice-weekly, 4-hour sessions. Nurse-administered, in-center nocturnal hemodialysis (INHD) may expand the population to whom an intensive dialysis schedule can be offered.<h4>Objective</h4>The primary objective of this study was to determine predictors of INHD technique failure, disruptions, and technique survival.<h4>Design</h4>This study used retrospective chart and database review methodolo ...[more]