No evidence of a legacy effect on survival following randomization to extended hours dialysis in the ACTIVE Dialysis trial.

Smyth, B; Zuo, L; Gray, NA; Chan, CT; de Zoysa, JR; Hong, D; Rogers, K; Wang, J; Cass, A; Gallagher, M; Perkovic, V; Jardine, M; ACTIVE Dialysis Study Investigators

No evidence of a legacy effect on survival following randomization to extended hours dialysis in the ACTIVE Dialysis trial.

Smyth, B Zuo, L Gray, NA Chan, CT de Zoysa, JR Hong, D Rogers, K

Wang, J Cass, A Gallagher, M Perkovic, V Jardine, M ACTIVE Dialysis Study Investigators

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Publisher:: Wiley
Publication Type:: Journal Article
Citation:: Nephrology (Carlton, Vic.), 2020, 25, (10), pp. 792-800
Issue Date:: 2020-10

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Field	Value	Language
dc.contributor.author	Smyth, B
dc.contributor.author	Zuo, L
dc.contributor.author	Gray, NA
dc.contributor.author	Chan, CT
dc.contributor.author	de Zoysa, JR
dc.contributor.author	Hong, D
dc.contributor.author	Rogers, K https://orcid.org/0000-0001-5497-4298
dc.contributor.author	Wang, J
dc.contributor.author	Cass, A
dc.contributor.author	Gallagher, M
dc.contributor.author	Perkovic, V
dc.contributor.author	Jardine, M
dc.contributor.author	ACTIVE Dialysis Study Investigators
dc.date.accessioned	2021-02-17T00:26:39Z
dc.date.available	2020-05-15
dc.date.available	2021-02-17T00:26:39Z
dc.date.issued	2020-10
dc.identifier.citation	Nephrology (Carlton, Vic.), 2020, 25, (10), pp. 792-800
dc.identifier.issn	1320-5358
dc.identifier.issn	1440-1797
dc.identifier.uri	http://hdl.handle.net/10453/146160
dc.description.abstract	AIM:Extended hours haemodialysis is associated with superior survival to standard hours. However, residual confounding limits the interpretation of this observation. We aimed to determine the effect of a period of extended hours dialysis on long-term survival among participants in the ACTIVE Dialysis trial. METHODS:Two-hundred maintenance haemodialysis recipients were randomized to extended hours dialysis (median 24 h/wk) or standard hours dialysis (median 12 h/wk) for 12 months. Further pre-specified observational follow up occurred at 24, 36 and 60 months. Vital status and modality of renal replacement therapy were ascertained. RESULTS:Over the 5 years, 38 participants died, 30 received a renal transplant, and 6 were lost to follow up. Total weekly dialysis hours did not differ between standard and extended groups during the follow-up period (14.1 hours [95%CI 13.4-14.8] vs 14.8 hours [95%CI 14.1-15.6]; P = .16). There was no difference in all-cause mortality (hazard ratio for extended hours 0.91 [95%CI 0.48-1.72]; P = .77). Similar results were obtained after censoring participants at transplantation, and after adjusting for potential confounding variables. Subgroup analysis did not reveal differences in treatment effect by region, dialysis setting or vintage (P-interaction .51, .54, .12, respectively). CONCLUSION:Twelve months of extended hours dialysis did not improve long-term survival nor affect dialysis hours after the intervention period. An urgent need remains to further define the optimal dialysis intensity across the broad range of dialysis recipients.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Wiley
dc.relation.ispartof	Nephrology (Carlton, Vic.)
dc.relation.isbasedon	10.1111/nep.13737
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1103 Clinical Sciences
dc.subject.classification	Urology & Nephrology
dc.title	No evidence of a legacy effect on survival following randomization to extended hours dialysis in the ACTIVE Dialysis trial.
dc.type	Journal Article
utslib.citation.volume	25
utslib.location.activity	Australia
utslib.for	1103 Clinical Sciences
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney
utslib.copyright.status	closed_access	*
dc.date.updated	2021-02-17T00:26:36Z
pubs.issue	10
pubs.publication-status	Published
pubs.volume	25
utslib.citation.issue	10

Abstract:

AIM:Extended hours haemodialysis is associated with superior survival to standard hours. However, residual confounding limits the interpretation of this observation. We aimed to determine the effect of a period of extended hours dialysis on long-term survival among participants in the ACTIVE Dialysis trial. METHODS:Two-hundred maintenance haemodialysis recipients were randomized to extended hours dialysis (median 24 h/wk) or standard hours dialysis (median 12 h/wk) for 12 months. Further pre-specified observational follow up occurred at 24, 36 and 60 months. Vital status and modality of renal replacement therapy were ascertained. RESULTS:Over the 5 years, 38 participants died, 30 received a renal transplant, and 6 were lost to follow up. Total weekly dialysis hours did not differ between standard and extended groups during the follow-up period (14.1 hours [95%CI 13.4-14.8] vs 14.8 hours [95%CI 14.1-15.6]; P = .16). There was no difference in all-cause mortality (hazard ratio for extended hours 0.91 [95%CI 0.48-1.72]; P = .77). Similar results were obtained after censoring participants at transplantation, and after adjusting for potential confounding variables. Subgroup analysis did not reveal differences in treatment effect by region, dialysis setting or vintage (P-interaction .51, .54, .12, respectively). CONCLUSION:Twelve months of extended hours dialysis did not improve long-term survival nor affect dialysis hours after the intervention period. An urgent need remains to further define the optimal dialysis intensity across the broad range of dialysis recipients.

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