Please use this identifier to cite or link to this item: http://ir.swu.ac.th/jspui/handle/123456789/13919
Title: Dose of hemodialysis and survival: A marginal structural model analysis
Authors: Lertdumrongluk P.
Streja E.
Rhee C.M.
Park J.
Arah O.A.
Brunelli S.M.
Nissenson A.R.
Gillen D.
Kalantar-Zadeh K.
Keywords: albumin
creatinine
phosphorus
adult
aged
albumin blood level
article
body mass
body size
cohort analysis
creatinine blood level
diabetes mellitus
female
follow up
hemodialysis
human
major clinical study
male
marginal structural model
mortality
outcome assessment
priority journal
proportional hazards model
sensitivity analysis
statistical analysis
survival
treatment duration
Article
correlation analysis
middle aged
mortality
risk reduction
statistical model
Kidney Failure, Chronic
procedures
renal replacement therapy
retrospective study
survival
Adult
Aged
Female
Humans
Kidney Failure, Chronic
Male
Middle Aged
Models, Statistical
Proportional Hazards Models
Renal Dialysis
Retrospective Studies
Survival Analysis
Issue Date: 2014
Abstract: Background: Observational studies have consistently demonstrated the survival benefits of a greater dialysis dose in maintenance hemodialysis (MHD) patients, whereas randomized controlled trials have shown conflicting results. The possible causal impact of dialysis dose on mortality needs to be investigated using rich cohort data analyzed with novel statistical methods such as marginal structural models (MSMs) that account for time-varying confounding and exposure. Methods: We quantified the effect of delivered dose of hemodialysis (HD) [single-pool Kt/V (spKt/V)] on mortality risk in a contemporary cohort of 68,110 patients undergoing HD 3 times weekly (7/2001-9/2005). We compared conventional Cox proportional hazard and MSM survival analyses, accounting for time-varying confounding by applying longitudinally modeled inverse-probability-of-dialysis-dose weights to each observation. Results: In conventional Cox models, baseline spKt/V showed a weak negative association with mortality, while higher time-averaged spKt/V was strongly associated with lower mortality risk. In MSM analyses, compared to a spKt/V range of 1.2-<1.4, a spKt/V range of <1.2 was associated with a higher risk of mortality [HR (95% CI) 1.67 (1.54-1.80)], whereas mortality risks were significantly lower with higher spKt/V [HRs (95% CI): 0.74 (0.70-0.78), 0.63 (0.59-0.66), 0.56 (0.52-0.60), and 0.56 (0.52-0.61) for spKt/V ranges of 1.4-<1.6, 1.6-<1.8, 1.8-<2.0, and ≥2.0, respectively]. Thus, MSM analyses showed that the greatest survival advantage of a higher dialysis dose was observed for a spKt/V range of 1.8-<2.0, and the dialysis dose-mortality relationship was robust in almost all subgroups of patients. Conclusions: Higher HD doses were robustly associated with greater survival in MSM analyses that more fully and appropriately accounted for time-varying confounding. © 2014 S. Karger AG, Basel.
URI: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84899615517&doi=10.1159%2f000362285&partnerID=40&md5=2c5eddfd053a835ed40176ca98d8993c
http://ir.swu.ac.th/jspui/handle/123456789/13919
ISSN: 2508095
Appears in Collections:SCOPUS 1983-2021

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