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Open Access 01-12-2019 | Research article

Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study

Authors: Weiming Zhang, Changlin Mei, Nan Chen, Xiaoqiang Ding, Zhaohui Ni, Chuanming Hao, Jinghong Zhang, Jinyuan Zhang, Niansong Wang, Gengru Jiang, Zhiyong Guo, Chen Yu, Yueyi Deng, Haiming Li, Qiang Yao, Mark R. Marshall, Martin J. Wolley, Jiaqi Qian

Published in: BMC Nephrology | Issue 1/2019

Abstract

Background

Globally, there is increased clinical interest and uptake of hemodiafiltration (HDF) for increased removal of uremic toxins. To date, there has been no epidemiological analysis of HDF in China. We present HDF practice patterns and associated mortality risk in Shanghai.

Methods

This is an observational, prospectively collected, retrospective analysis of 9351 Chinese patients initiating hemodialysis in Shanghai from 2007 to 2014. The primary exposure was hemodialysis sub-modality at inception, classified into hemodiafiltration (HDF) and hemodialysis (HD), with adjustment for concommitant hemoperfusion. The primary outcome was patient mortality. We used Cox proportional hazards regression and Fine and Gray’s proportional subhazards regression, with multiple imputation of missing co-variates by the chained equation method, adjusting for demographic and clinical variables.

Results

Overall, patients in the cohort were younger, with a more males, and with a lower body mass index when compared to corresponding non-Asian cohorts. Mortality rate was low although it doubled over the period of observation. HDF utilization increased from 7% of patients in 2007 to 42% of patients in 2014. The majority of patients received HDF once a week. The adjusted hazard ratio of death (95% confidence intervals) for HDF versus HD was 0.85 (0.71–1.03), and corresponding sub-hazard ratio 0.86 (0.71–1.03). There was strong effect modification by age. In those aged 40–60 years, the hazard ratio (95% confidence intervals) was 0.65 (0.45–0.94), and sub-hazard ratio also 0.65 (0.45–0.95).

Conclusions

Our study has certain limitations resulting from the limited number of co-variates available for modelling, missing data for some co-variates, and the lack of verification of data against source documentation. Notwithstanding, there is evidence of clinical benefit from HDF in China, and potential to improve patient outcomes through the greater removal of middle and larger uremic solutes.

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Title: Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study
Authors: Weiming Zhang
Changlin Mei
Nan Chen
Xiaoqiang Ding
Zhaohui Ni
Chuanming Hao
Jinghong Zhang
Jinyuan Zhang
Niansong Wang
Gengru Jiang
Zhiyong Guo
Chen Yu
Yueyi Deng
Haiming Li
Qiang Yao
Mark R. Marshall
Martin J. Wolley
Jiaqi Qian
Publication date: 01-12-2019
Publisher: BioMed Central
Published in: BMC Nephrology / Issue 1/2019
Electronic ISSN: 1471-2369
DOI: https://doi.org/10.1186/s12882-019-1219-z

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