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Titolo Survival among nocturnal home haemodialysis patients compared to kidney transplant recipients
Autore Robert P. Pauly1, John S. Gill2, Caren L. Rose2, Reem A. Asad3, Anne Chery4, Andreas Pierratos5 and Christopher T. Chan3 - 1Division of Nephrology, Department ofMedicine, University of Alberta Hospital, University of Alberta, Edmonton, AB, 2Division of Nephrology, Department of Medicine, St. Paul?s Hospital, University of British Columbia, Vancouver, BC, 3Division of Nephrology, Department of Medicine, Toronto General Hospital, University of Toronto, 4Toronto Region Dialysis Registry, University Health Network and 5Department of Nephrology, Humber River Regional Hospital, University of Toronto, Toronto, ON, Canada Correspondence and offprint requests to: Robert P. Pauly; E-mail: robert.pauly@ualberta.ca
Referenza Nephrol Dial Transplant 2009; 24: 2915-2919
Contenuto Background. Kidney transplantation is the gold standard renal replacement therapy. Nocturnal haemodialysis (NHD) is an intensive dialysis modality (6-8 h/session, 3-7 sessions/week) associated with a significant improvement of clinical and biochemical parameters compared to conventional dialysis. To date, no studies have compared survival in patients treated with NHD and kidney transplantation. Methods. Using data from two regional NHD programmes and the USRDS from 1994 to 2006, we performed a matched cohort study comparing survival between NHD and deceased and living donor kidney transplantation (DTX and LTX) by randomly matchingNHDpatients to transplant recipients in a 1:3:3 ratio. The independent association of treatment modality with survivalwas determined using Cox multivariate regression. Results. The total study population consisted of 177 NHD patients matched to 1062 DTX and LTX recipients (total 1239 patients) followed for a maximum of 12.4 years. During the follow-up period, the proportion of deaths among NHD, DTX and LTX patients was 14.7%, 14.3% and 8.5%, respectively (P = 0.006). We found no difference in the adjusted survival between NHD and DTX (HR 0.87, 95% CI 0.50-1.51; NHD reference group), while LTX survival was better (HR 0.51, 95% CI 0.28-0.91). Conclusions. These results indicate that NHD and DTX survival is comparable, and suggest that this intensive dialysis modality may be a bridge to transplantation or even a suitable alternative in the absence of LTX in the current era of growing transplant waiting lists and organ shortage.
Data 28.09.2009
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