Comparison of 4- and 8-h dialysis sessions in thrice-weekly in-centre haemodialysis

WOS: 000289309400027PubMed ID: 21148270Background. Longer dialysis sessions may improve outcome in haemodialysis (HD) patients. We compared the clinical and laboratory outcomes of 8- and 4-h thrice-weekly HD. Methods. Two-hundred and forty-seven HD patients who agreed to participate in a thrice-weekly 8-h in-centre nocturnal HD (NHD) treatment and 247 age-, sex-, diabetes status-and HD duration-matched control cases to 4-h conventional HD (CHD) were enrolled in this prospective controlled study. Echocardiography and psychometric measurements were performed at baseline and at the 12th month. The primary outcome was 1-year overall mortality. Results. Overall mortality rates were 1.77 (NHD) and 6.23 (CHD) per 100 patient-years (P = 0.01) during a mean 11.3 +/- 4.7 months of follow-up. NHD treatment was associated with a 72% risk reduction for overall mortality compared to the CHD treatment (hazard ratio = 0.28, 95% confidence interval 0.09-0.85, P = 0.02). Hospitalization rate was lower in the NHD arm. Post-HD body weight and serum albumin levels increased in the NHD group. Use of antihypertensive medications and erythropoietin declined in the NHD group. In the NHD group, left atrium and left ventricular end-diastolic diameters decreased and left ventricular mass index regressed. Both use of phosphate binders and serum phosphate level decreased in the NHD group. Cognitive functions improved in the NHD group, and quality of life scores deteriorated in the CHD group. Conclusions. Eight-hour thrice-weekly in-centre NHD provides morbidity and possibly mortality benefits compared to conventional 4-h HD.European Nephrology and Dialysis Institution (E.N.D.I, Germany)The study was supported by the European Nephrology and Dialysis Institution (E.N.D.I, Germany) with an unrestricted grant. The sponsor had no role in study design and conduction, data management, collection and analysis, preparation and submission of the manuscript. The following investigators participated in the 'Long Dialysis Study': Ali Basci, Fatih Kircelli, Ebru Sevinc, Ender Hur, Pinar Ergin, Ismet Onder Isik, Murat Zengin, Alfert Sagdic, Erkan Kayali, Can Boydak, Taskin Colak, Sihli Cahskan, Hakan Kaplan, Hasibe Ulas, Sait Kirbiyik and Hakan Berktas. We thank Dr Christopher R. Blagg, Dr Zbylut J. Twardowski and Dr Evert J. Dorhout Mees for their expert advice in writing and revising the manuscript