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Titolo	Shorter dialysis times are associated with higher mortality among incident hemodialysis patients
Autore	Steven M. Brunelli1,2, Glenn M. Chertow3, Elizabeth D. Ankers4, Edmund G. Lowrie5 and Ravi Thadhani2,4 1Renal Division, Brigham and Women?s Hospital, Boston, Massachusetts, USA; 2Harvard Medical School, Boston, Massachusetts, USA; 3Nephrology Division, Stanford University School of Medicine, Palo Alto, California, USA; 4Renal Unit, Massachusetts General Hospital, Boston, Massachusetts, USA and 5Retired: Cape Neddick, Maine, USA
Referenza	Kidney International (2010); 77: 630-636
Contenuto	There is an association between hemodialysis session length and mortality independent of the effects of session duration on urea clearance. However, previous studies did not consider changes in session length over time nor did they control for the influence of time-dependent confounding. Using data from a national cohort of 8552 incident patients on thrice-weekly, in-center hemodialysis, we applied marginal structural analysis to determine the association between session length and mortality. Exposure was based on prescribed session length with the outcome being death from any cause. On the 31st day after initiating dialysis, the patients were considered at-risk and remained so until death, censoring, or completion of 1 year on dialysis. On primary marginal structural analysis, session lengths o4 h were associated with a 42% increase in mortality. Sensitivity analyses showed a dose-response relationship between session duration and mortality, and a consistency of findings across prespecified subgroups. Our study suggests that shorter hemodialysis sessions are associated with higher mortality when marginal structural analysis was used to adjust for time-dependent confounding. Further studies are needed to confirm these findings and determine causality.
Data	12.03.2010

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