Publication:
Dose of hemodialysis and survival: A marginal structural model analysis

1
0

Issued Date

2014

Resource Type

Article

File Type

application/pdf

ISSN

2508095

DOI

10.1159/000362285

Other identifier(s)

2-s2.0-84899615517

Rights Holder(s)

Scopus

Bibliographic Citation

American Journal of Nephrology. Vol 39, No.5 (2014), p.383-391

Suggested Citation

Lertdumrongluk P., Streja E., Rhee C.M., Park J., Arah O.A., Brunelli S.M., Nissenson A.R., Gillen D., Kalantar-Zadeh K. Dose of hemodialysis and survival: A marginal structural model analysis. American Journal of Nephrology. Vol 39, No.5 (2014), p.383-391. doi:10.1159/000362285 Retrieved from: https://hdl.handle.net/20.500.14740/6440

Title

Dose of hemodialysis and survival: A marginal structural model analysis

Author(s)

Lertdumrongluk P.
 Streja E.
 Rhee C.M.
 Park J.
 Arah O.A.
 Brunelli S.M.
 Nissenson A.R.
 Gillen D.
 Kalantar-Zadeh K.

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.

Subject(s)

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

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URI

https://hdl.handle.net/20.500.14740/6440

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Scopus: Year 1983-2021

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