Outcomes of extended-hours hemodialysis performed predominantly at home

Recent evidence suggests that increased frequency and/or duration of dialysis are associated with improved outcomes. We aimed to describe the outcomes associated with patients starting extended-hours hemodialysis and assess for risk factors for these outcomes. STUDY DESIGN: Case series. SETTING PARTICIPANTS: Patients were from 6 Australian centers offering extended-hours hemodialysis. Cases were patients who started treatment for 24 hours per week or longer at any time. OUTCOMES: All-cause mortality, technique failure (withdrawal from extended-hours hemodialysis therapy), and access-related events. MEASUREMENTS: Baseline patient characteristics (sex, primary cause of end-stage kidney disease, age, ethnicity, diabetes, and cannulation technique), presence of a vascular access-related event, and dialysis frequency. RESULTS: 286 patients receiving extended-hours hemodialysis were identified, most of whom performed home (96 ) or nocturnal (77 ) hemodialysis. Most patients performed alternate-daily dialysis (52 ). Patient survival rates using an intention-to-treat approach at 1, 3, and 5 years were 98 , 92 , and 83 , respectively. Of 24 deaths overall, cardiac death (n = 7) and sepsis (n = 5) were the leading causes. Technique survival rates at 1, 3, and 5 years were 90 , 77 , and 68 , respectively. Access event-free rates at the same times were 80 , 68 , and 61 , respectively. Access events significantly predicted death (HR, 2.85; 95 CI, 1.14-7.15) and technique failure (HR, 3.76; 95 CI, 1.93-7.35). Patients with glomerulonephritis had a reduced risk of technique failure (HR, 0.31; 95 CI, 0.14-0.69). Higher dialysis frequency was associated with elevated risk of developing an access event (HR per dialysis session, 1.56; 95 CI, 1.03-2.36). LIMITATIONS: Selection bias, lack of a comparator group. CONCLUSIONS: Extended-hours hemodialysis is associated with excellent survival rates and is an effective treatment option for a select group of patients. The ma