Patient Survival Increases Steadily Along with Dialysis Dose

A new dialysis model has demonstrated longer survival times at a higher dose of dialysis, compared to no significant effect with the conventional method, according to a new study.

Researchers at the University of Pittsburgh Medical Center (UPMC; PA, USA) analyzed data from a large group of U.S. dialysis patients using a new statistical technique for examining dialysis rates--based on an accelerated failure time model--and compared it with conventional methods. The "accelerated failure time" model (which is inspired by considerations of what happens when the kidneys cease working and toxins start building up in the patient's bloodstream) showed longer survival times at a higher dose of dialysis, compared to no significant effect with the conventional model. Upon analysis using this statistical technique, patient survival increased steadily along with dialysis dose, after adjustment for other risk factors (age, heart disease, diabetes, and comorbid conditions).

According to the researchers, the results suggest that the conflicting results of previous studies may be related to the limitations of the statistical methods used. However, they caution, the study was limited by the lack of follow-up information on the dose of dialysis the patients received at multiple clinic visits; consequently, no conclusions should be drawn about the validity of existing national and international guidelines concerning an adequate dialysis dose, nor can the findings be generalized to non-U.S. patients. The study was published online on July 30, 2009, in the Journal of the American Society of Nephrology.

"From a public health perspective, it may be reasonable to reexamine the clinical trial data with unconventional, yet scientifically valid statistical techniques and encourage relevant basic research in statistics and epidemiology to facilitate future clinical studies in this area,” said lead author Christos Argyropoulos, M.D., Ph.D.

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