Prescription of twice-weekly hemodialysis in the MSA

Background/Aims: The purpose of this study was to investigate the frequency and characteristics of two hemodialysis sessions/week, to identify factors which influence or predict this prescription, and to examine the outcomes of patients receiving hemodialysis two times/week as compared to the more c ommon treatment of three times/week. Methods: Data from a national sample o f 15,067 adult hemodialysis patients were utilized to compare twice-weekly with thrice-weekly therapy by logistic regression. Results: Patients treate d less than one year were more likely to be treated twice-weekly (6.1%) tha n patients on dialysis for one year or more (2.7%) (AOR = 1.49, p = 0.002). Treatment schedules also varied significantly by geographic region. Factor s predictive of twice-weekly hemodialysis (p < 0.05) were older age, Caucas ian race, female gender, higher serum albumin, lower serum creatinine level s, and lower body mass index. A higher estimated renal function at the star t of ESRD was also predictive of a twice-weekly schedule among incident pat ients (AOR = 1.05, p = 0.05). In addition, Cox-adjusted survival analysis i ndicated a lower mortality risk (RR = 0.76, p = 0.02) for twice-weekly hemo dialysis compared to thrice-weekly among prevalent patients. For incident p atients, however, the results were not significant when adjusted for GFR at ESRD onset (RR = 0.85, p = 0.31). Conclusion: Geographic differences in pr escribed treatment remained unexplained by measured characteristics. The su rvival advantage associated with twice-weekly hemodialysis is likely to be related to patient selection and greater residual renal function. Copyright (C) 1999 S. Karger AG, Basel.