Member Research and Reports

Member Research and Reports

Brown: Session Duration and Mortality among Hemodialysis Patients

Since the Medicare program extended coverage to end-stage renal disease four decades ago, the average number of hours per hemodialysis session has declined from 6 hours in 1973 to 3.5-4 hours in 2010. Although this decline may be partly explained by the improved efficiency of dialyzers, the clinical consequences of shorter session durations for this high-risk cohort remain unclear.

The purpose of this retrospective cohort study, led by Dr. Shailender Swaminathan, Assistant Professor of Health Services, Policy and Practice, was to evaluate the relationship between initial hemodialysis session duration and mortality in patients undergoing maintenance hemodialysis. Dr. Swaminathan, along with colleagues at the Brown University School of Public Health and the University of Washington Department of Medicine, evaluated mortality rates in patients with end-stage renal disease beginning maintenance hemodialysis between 2006 and 2010; 39,172 patients attended treatment in facilities that had sessions for longer than 4 hours while 47,721 patients had their initial treatment at facilities that had sessions for 3 hours.

Total number of deaths observed within 2 years after initiating dialysis therapy were 8,945 in the ≥4-hour group and 15,624 in the 3-hour group. Those in the 3-hour group had a significantly higher probability of mortality within 1 year and 2 years after initiating therapy. These results were robust when analyses were restricted to specific subgroups of patients classified by age, sex, race, and select clinical characteristics.

This nationally represented study of hemodialysis provides evidence that suggests that longer hemodialysis sessions may improve outcomes. Further research along these lines is needed to establish the degree to which these findings generalize to facilities that prescribe varying hemodialysis session durations.

This study was published in American Journal of Kidney Diseases, 2017 (ahead of print).

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