Objectives: Hemodialysis (HD) time has been recognized as an important factor in dialysis adequacy. However, few studies have reported on associations between HD time and prognosis among maintenance HD patients. We present some findings from a prospective cohort study, the -Q-Cohort Study, which was set up to explore risk factors for mortality in Japanese HD patients. We hypothesized that HD ≥5 h was associated with a significant survival advantage compared with HD < 5 h. The present study examined association between HD time and mortality in Japanese HD patients. Methods: The prospective multicenter Q-Cohort Study was conducted between December 2006 and December 2010, following 3,456 Japanese HD patients for 4 years. We examined the association between HD time and prognosis using Cox proportional hazards modeling. Propensity scores were calculated using logistic regression. Results: During follow-up, 566 patients died from any cause. Patients with HD ≥5 h (n = 2,141) showed -significantly lower risk of all-cause death (hazards ratio = 0.82; 95% CI 0.68–0.99) than those with HD < 5 h (n = 1,315), after adjusting for confounding risk factors. This -association remained significant using a propensity score-based approach. After stratifying the analysis by patient age in 10-year increments, this finding remained -significant only in patients who were ≥80 years of age. Conclusion: Our results suggest that HD ≥5 h has a more favorable effect on mortality than HD < 5 h.

1.
Saran R, Bragg-Gresham JL, Levin NW, Twardowski ZJ, Wizemann V, Saito A, et al: Longer treatment time and slower ultrafiltration in hemodialysis: associations with reduced mortality in the DOPPS. Kidney Int 2006; 69: 1222–1228.
2.
Lowrie EG, Li Z, Ofsthun N, Lazarus JM: Measurement of dialyzer clearance, dialysis time, and body size: death risk relationships among patients. Kidney Int 2004; 66: 2077–2084.
3.
Marshall MR, Byrne BG, Kerr PG, McDonald SP: Associations of hemodialysis dose and session length with mortality risk in Australian and New Zealand patients. Kidney Int 2006; 69: 1229–1236.
4.
Brunelli SM, Chertow GM, Ankers ED, Lowrie EG, Thadhani R: Shorter dialysis times are associated with higher mortality among incident hemodialysis patients. Kidney Int 2010; 77: 630–636.
5.
Miller JE, Kovesdy CP, Nissenson AR, Mehrotra R, Streja E, Van Wyck D, et al: Association of hemodialysis treatment time and dose with mortality and the role of race and sex. Am J Kidney Dis 2010; 55: 100–112.
6.
Movilli E, Gaggia P, Zubani R, Camerini C, Vizzardi V, Parrinello G, et al: Association between high ultrafiltration rates and mortality in uraemic patients on regular haemodialysis. A 5-year prospective observational multicentre study. Nephrol Dial Transplant 2007; 22: 3547–3552.
7.
Flythe JE, Kimmel SE, Brunelli SM: Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality. Kidney Int 2011; 79: 250–257.
8.
Tentori F, Zhang J, Li Y, Karaboyas A, Kerr P, Saran R, et al: Longer dialysis session length is associated with better intermediate outcomes and survival among patients on in-center three times per week hemodialysis: results from the dialysis outcomes and practice patterns study (DOPPS). Nephrol Dial Transplant 2012; 27: 4180–4188.
9.
Eriguchi R, Taniguchi M, Ninomiya T, Hirakata H, Fujimi S, Tsuruya K, et al: Hyporesponsiveness to erythropoiesis-stimulating agent as a prognostic factor in Japanese hemodialysis patients: the Q-cohort study. J Nephrol 2015; 28: 217–225.
10.
D’Agostino RB: Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med Stat Med 1998; 17: 2265–2281.
11.
Austin PC: An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 2011; 46: 399–424.
12.
Tanaka S, Ninomiya T, Taniguchi M, Fujisaki K, Tokumoto M, Hirakata H, et al: Comparison of oral versus intravenous vitamin D receptor activator in -reducing infection-related mortality in hemodialysis patients: the Q-cohort Study. Nephrol Dial Transplant 2016; 31: 1152–1160.
13.
Lowrie EG, Laird NM, Parker TF, Sargent JA. Effect of the hemodialysis prescription of patient morbidity: report from the National Cooperative Dialysis Study. N Engl J Med 1981; 305: 1176–1181.
14.
Eknoyan G, Beck GJ, Cheung AK, Daugirdas JT, Greene T, Kusek JW, Allon M, Bailey J, Delmez JA, Depner TA, Dwyer JT, Levey AS, Levin NW, Milford E, Ornt DB, Rocco MV, Schulman G, Schwab SJ, Teehan BP, Toto R; Hemodialysis (HEMO) Study Group: Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 2002; 347: 2010–2019.
15.
Brunet P, Saingra Y, Leonetti F, Vacher-Coponat H, Ramananarivo P, Berland Y: Tolerance of haemodialysis: a randomized cross-over trial of 5-h versus 4-h treatment time. Nephrol Dial Transplant 1996; 11(suppl 8): 46–51.
16.
Charra B, Calemard M, Laurent G. Importance of treatment time and blood pressure control in achieving long-term survival on dialysis. Am J Nephrol 1996; 16: 35–44.
17.
Charra B, Jean G, Chazot C, Hurot JM, Terrat JC, Vanel T, Lorriaux C, Vovan C: Intensive dialysis and blood pressure control: a review. Hemodial Int 2004; 8: 51–60.
18.
Chan C, Floras JS, Miller JA, Pierratos A: Improvement in ejection fraction by nocturnal haemodialysis in end-stage renal failure patients with coexisting heart failure. Nephrol Dial Transplant 2002; 17: 1518–1521.
19.
Culleton BF, Walsh M, Klarenbach SW, Mortis G, Scott-Douglas N, Quinn RR, Tonelli M, Donnelly S, Friedrich MG, Kumar A, Mahallati H, Hemmelgarn BR, Manns BJ: Effect of frequent nocturnal hemodialysis vs conventional hemodialysis. JAMA 2007; 298: 1291–1299.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.