Impact of old age on the association between in-center extended-hours hemodialysis and mortality in patients on incident hemodialysis
Impact of old age on the association between in-center extended-hours hemodialysis and mortality in patients on incident hemodialysis
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DOI：
10.1371/journal.pone.0235900
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发表时间：
2020-07-10
期刊：
影响因子：
3.7
通讯作者：
Maruyama, Shoichi
中科院分区：
文献类型：
--
作者：
Okazaki, Masaki;Inaguma, Daijo;Maruyama, Shoichi
随着全球老龄化问题的出现，改善老年透析患者的预后变得更加困难。与传统血液透析方案相比，延长时间血液透析提供了更长的治疗时间，并提供了有利的代谢状态、血流动力学稳定性和增加的饮食摄入。尽管先前的研究报告称，中心延长时间血液透析可以降低死亡率，但对老年患者的治疗影响仍不清楚。因此，我们研究了延长时间血液透析与常规血液透析和全因死亡率之间的关系。采用考克斯比例风险模型和多变量调整和基于倾向评分的方法进行生存分析，以比较198例开始中心延长时间血液透析（延长-HD）的连续患者和1407例开始常规血液透析的连续患者的死亡风险。延长HD组的中位年龄为67.1岁，常规血液透析组为70.7岁。在总体患者和>70岁的亚组中，延长HD与较低的全因死亡率相关（调整后的风险比分别为0.60 [95% CI，0.39-0.91]和0.35 [95% CI，0.18-0.69]）。年龄>70岁与Extended-HD之间存在显着的相互作用。总之，延长血液透析时间与较低的死亡率相关，尤其是在老年患者中。
With the global problem of aging, it has become more difficult to improve the prognosis of older dialysis patients. Extended-hours hemodialysis offers longer treatment time compared to conventional hemodialysis regimen and provides favorable metabolic status, hemodynamic stability, and increased dietary intake. Despite prior studies reporting that in-center extended-hours hemodialysis can reduce the mortality rate, the treatment impact on elderly patients remains unclear. Therefore, we examined the association between extended-hours hemodialysis compared to conventional hemodialysis and all-cause mortality. Survival analyses using Cox proportional hazard model with multivariable adjustments and propensity-score based method were performed to compare mortality risk between 198 consecutive patients who started in-center extended-hours hemodialysis (Extended-HD) and 1407 consecutive patients who initiated conventional hemodialysis. The median age was 67.1 years in the Extended-HD group and 70.7 years in the conventional hemodialysis group. Extended-HD was associated with lower all-cause mortality in overall patients and the subgroup >70 years (adjusted hazard ratios of 0.60 [95% CI, 0.39-0.91] and 0.35 [95% CI, 0.18-0.69], respectively). There was a significant interaction between age >70 years and Extended-HD. In conclusion, extended-hours hemodialysis was associated with a lower mortality rate, especially in elderly patients.