Two-times weekly hemodialysis in China: frequency, related

Two-times weekly hemodialysis in China: frequency, associated
April 30, 2021 0 Comments

Nephrol Dial Transplant (2014) 29: 1770–1777
doi: 10.1093/ndt/gft472
Advance Entry publication 8 December 2013
Authentic Article
Two-times weekly hemodialysis in China: frequency,
related affected person and remedy traits and High quality of
Life within the China Dialysis Outcomes and Observe Patterns research
Brian Bieber1*, Jiaqi Qian2,*, Shuchi Anand3, Yucheng Yan2, Nan Chen4, Mia Wang1, Mei Wang5, Li Zuo6,7,
Fan Fan Hou8, Ronald L. Pisoni1, Bruce M. Robinson1 and Sylvia P.B. Ramirez1
1
Arbor Analysis Collaborative for Well being, Ann Arbor, MI, USA, 2Renal Division, Renji Hospital, Shanghai Jiaotong College Faculty of
Medication, Shanghai, China, 3Division of Nephrology, Stanford College Faculty of Medication, Palo Alto, CA, USA, 4Department of Nephrology,
Ruijin Hospital, Shanghai Jiaotong College Faculty of Medication, Shanghai, China, 5People’s Hospital, Peking College, Beijing, China,
6
Peking College First Hospital, Beijing, China, 7Institute of Nephrology, Peking College, Beijing, China and 8Division of Nephrology,
Nanfang Hospital, Southern Medical College, Guangzhou, China
Correspondence and offprint requests to: B. Bieber; E-mail: [email protected]
*
Co-first writer.
related to dialyzing two instances weekly (versus thrice
weekly). Sufferers dialyzing two instances per week had longer
remedy instances and decrease standardized Kt/V, however comparable
high quality of life scores.
Conclusions. Two-times weekly dialysis is widespread in China,
notably amongst sufferers, who began dialysis extra not too long ago, have a decrease comorbidity burden and have financial constraints. High quality of life scores don't differ between the twotimes and three-times weekly teams. The impact on scientific
outcomes deserves additional research.
A B S T R AC T
Background. Renal alternative remedy is quickly increasing
in China, and two-times weekly dialysis is widespread, however detailed information on apply patterns are at the moment restricted. Utilizing
cross-sectional information from the China Dialysis Outcomes and
Observe Patterns Examine (DOPPS), we describe the hemodialysis apply in China in contrast with different DOPPS nations,
analyzing demographic, social and scientific traits of
sufferers on two-times weekly dialysis.
Strategies. The DOPPS protocol was applied in 2011
amongst a cross-section of 1379 sufferers in 45 services in
Beijing, Guangzhou and Shanghai. Knowledge from China have been
in contrast with a cross part of 11 054 sufferers from the core
DOPPS nations (collected 2009–11). Amongst China DOPPS
sufferers, logistic and linear regression have been used to explain
the affiliation of dialysis frequency with affected person and remedy traits and high quality of life.
Outcomes. A complete of 26% of the sufferers in China have been dialyzing
two instances weekly, in contrast with < 5% in other DOPPS
regions. Standardized Kt/V was lowest in China (2.01) compared with other regions (2.12–2.27). Female sex, shorter dialysis vintage, lower socioeconomic status, less health insurance
coverage, and lack of diabetes and hypertension were
© The Author 2013. Published by Oxford University Press
on behalf of ERA-EDTA. All rights reserved.
Keywords: hemodialysis adequacy, hemodialysis frequency,
outcomes, practice patterns, quality of life
INTRODUCTION
The prevalence of chronic kidney disease (CKD) in China approaches that of the United States [1]. The use of renal replacement therapy (RRT) for patients reaching end-stage renal
disease (ESRD) is rising rapidly: in Shanghai, the incidence of
RRT more than doubled between 2000 and 2005 [2]. Though
there are regional variations, a majority of patients with ESRD
are on hemodialysis (HD) [3]. However, data on HD practice
and outcomes remain sparse.
1770
M AT E R I A L S A N D M E T H O D S
Patients and data collection
Begun in 1996, the DOPPS is an international prospective
cohort study of HD patients ≥18 years of age in Australia,
Belgium, Canada, France, Germany, Italy, Japan, New
Zealand, Spain, Sweden, the United Kingdom and the United
States (core DOPPS countries). Patients in the DOPPS are selected randomly from a representative sample of HD facilities
within each nation [10, 11]. In 2011, cross-sectional data were
collected in China using the baseline DOPPS questionnaires
and study protocols. Due to feasibility considerations, the
China study was limited to representative data from the metropolitan areas in the three largest cities in China (Beijing,
Guangzhou and Shanghai). These cities were identified based
on feasibility of data collection and availability of registry information should a comparison between DOPPS and registry
data be required. In each metropolitan area, 15 HD facilities
were randomly selected from a comprehensive roster of HD
units (total selected Chinese HD facilities = 45). Study approval and patient consent were obtained as required by national
and local ethics committee regulations.
A study coordinator at each participating site collected clinical data. At the time of patient enrollment, the study coordinator abstracted demographic data, comorbid conditions,
laboratory values, insurance status and medications from
patient records. Practice-level data were obtained through a
survey administered to the medical director at each facility. Individual patients completed a questionnaire that included the
Kidney Disease Quality of Life-Short Form (KDQOL-SF) 12
China DOPPS dialysis adequacy and vascular access
and questions related to socioeconomic status [12, 13]. Singlepool Kt/V was calculated using the Daugirdas formula among
patients dialyzing 3 × per week for at least 1 year. To account
for patients dialyzing at a frequency other than three times per
week, a standardized Kt/V was calculated from the equation
reported by Leypoldt et al. [14]. Normalized protein catabolic
rate (nPCR) was calculated by the equations reported by
Depner and Daugirdas [15].
Data from 10 947 patients sampled in the DOPPS 4 prevalent cross section of HD patients in the core DOPPS countries
between 2009 and 2011 were compared with data from 1379
prevalent Chinese patients collected in 2011. Standard descriptive analyses were used to characterize the DOPPS patients and practices in each country as well as within China, by
frequency of dialysis. Generalized estimating equation (GEE)
models with a logit link were used to describe the adjusted association of patient characteristics with two-times (versus
three-times) per week HD, accounting for facility clustering.
Mixed models were used to describe the adjusted association
between HD frequency and laboratory values and quality of
life, accounting for facility clustering. All analyses used SAS
software, version 9.2 (SAS Institute, Cary, NC).
R E S U LT S
Facility and patient characteristics
Of the 45 sampled facilities from the three metropolitan
areas in China (Beijing, Guangzhou and Shanghai), 23 were
academic or military facilities and 22 were non-academic facilities. On average, the Chinese facilities treated a comparable
number of HD patients (95) to facilities in Japan (97). In contrast, facilities in North America and Europe-Australia/New
Zealand (EUR-A/NZ) treated substantially fewer patients on
average (∼72) (Table 1).
Compared with study patients in the other DOPPS regions,
the Chinese patients were younger, more likely to be female
and less likely to have diabetes as the cause of ESRD (Table 1).
Time on dialysis in China was comparable with that in North
America and Eur-A/NZ, but shorter than in Japan. The
average body mass index (BMI) among patients in China was
similar to that in Japan but lower than in North America and
Eur-A/NZ.
Dialysis access and prescription
A native arteriovenous (AV) fistula for HD access was used
by 88% of China DOPPS patients compared with 91% in
Japan, 58% in North America and 70% in Eur-A/NZ
(Table 1). The mean number of prescribed HD sessions per
week was lower in China (2.8) than in the other DOPPS countries (range 3.0–3.1) (Table 1, Figure 1A). Twenty-six percent
of HD patients in China were dialyzing less than three times
weekly (88% of this group were undergoing two-times weekly
dialysis) compared with 1–6% in other DOPPS countries. The
median Chinese facility reported 26% of patients dialyzing less
than three times weekly (22% two times weekly) compared
with a range of 0–4% for the median facility in other DOPPS
countries (Figure 1B).
1771
ORIGINAL ARTICLE
The recently launched Chinese Renal Data System and
published data from city registries have reported that a significant proportion of patients are on two-times weekly HD [2, 4–
6]. Given that patients may shoulder a significant share of cost
for HD care in China [7], complex factors—such as patients’
comorbidity burden, residual function, preference to start HD
gradually and insurance status—may underlie a decision to
pursue two-times weekly dialysis. The effect on Chinese patients’ health-related quality of life (HR-QOL) and survival is
unknown.
Using cross-sectional data from the China Dialysis Outcomes and Practice Patterns (DOPPS) study, we describe the
current state of HD in China in comparison with other
DOPPS countries. We also tested the hypothesis that the decision to pursue two-times weekly HD would be related to both
clinical and economic factors. As such, we expected that patients with lower comorbidity burden, greater residual function, shorter dialysis vintage (i.e., years since initiation of
dialysis) and greater share of cost for treatment would be more
likely to undergo two-times weekly HD. Despite attempts to
select a ‘healthier’ group of patients for less frequent dialysis,
we expected that this group would face a greater likelihood of
‘inadequate’ dialysis therapy and require strict diet restrictions.
We therefore hypothesized that this group would exhibit
poorer control of anemia and markers of mineral-bone
disease, and experience worse quality of life [8, 9].
Table 1. Facility and patient characteristics by region
ORIGINAL ARTICLE
Measure
Facility characteristics
Facility, n
Facility size
Facility size, range
Patient demographics
Study population, n
Age, years
Female, %
Time on dialysis, years
Urine output >1 cup/day, %a
BMI, kg/m2
Comorbidities
Reason for ESRD, %
Diabetes
Glomerular illness
Different
Comorbidities, %
Coronary coronary heart illness
Congestive coronary heart failure
Cerebrovascular illness
Peripheral vascular illness
Different heart problems
Diabetes
Hypertension
Dialysis prescription
# Prescribed HD classes/week
Dialysis session size, min
Blood flow fee, mL/min
Single-pool Kt/V b
Single-pool Kt/V <1.2, %b
Standardized Kt/V c
Standardized Kt/V <2.0c
Intra-dialytic weight reduction, %
Vascular entry, %
Fistula
Graft
Catheter
Labs
BUN, mg/dL
Pre-dialysis
Publish-dialysis
nPCR, g urea nitrogen/kg/day
Urea discount ratio, %
Serum calcium, mg/dLd
Serum albumin, g/dL
Serum PTH, pg/mL
Serum phosphorus, mg/dL
Hemoglobin, g/dL
High quality of Life
Bodily element abstract
Psychological element
China
Japan
North America
Eur-A/NZe
45
95 (74)
21–379
60
97 (73)
20–411
167
72 (53)
20–294
157
71 (35)
21–216
1379
59.4 (14.6)
46.6
4.8 (4.6)
62
21.9 (3.5)
1587
64.7 (12.0)
37.3
8.5 (7.5)
51.5
21.1 (3.3)
5106
62.9 (15.1)
44.5
4.0 (4.2)
46.8
28.5 (7.0)
4361
65.9 (14.7)
40.7
5.0 (5.7)
56.8
26.0 (5.5)
20.2
46.1
33.8
31.7
44.8
23.5
42.5
11.3
46.2
25.0
19.7
55.3
38.3
31.5
17.8
10.8
28.0
24.0
89.5
32.8
21.0
15.7
19.8
32.5
35.2
79.6
48.5
35.5
18.0
34.9
29.6
61.2
93.6
38.8
20.9
18.0
34.9
34.5
36.1
84.3
2.76 (0.55)
243 (22)
235 (30)
1.38 (0.31)
29.1
2.01 (0.41)
42.8
4.1 (2.0)
2.96 (0.21)
237 (29)
202 (29)
1.42 (0.26)
19.3
2.12 (0.28)
25.3
3.9 (1.7)
2.98 (0.24)
218 (34)
413 (68)
1.59 (0.27)
6.5
2.23 (0.28)
13.8
3.1 (1.7)
3.03 (0.33)
245 (39)
317 (57)
1.58 (0.31)
9.6
2.27(0.32)
14.3
2.8 (1.6)
88.0
1.8
10.2
90.7
7.0
2.3
57.8
17.5
24.7
69.7
7.3
23.1
49.2 (22.1)
15.7 (9.8)
0.80 (0.31)
67.8 (10.4)
9.0 (1.0)
3.9 (0.5)
386 (410)
6.1 (2.1)
10.5 (2.0)
66.5 (15.4)
21.3 (7.0)
1.01 (0.21)
67.9 (7.2)
9.2 (0.8)
3.7 (0.4)
167 (161)
5.5 (1.4)
10.4 ((1.2)
55.9 (18.7)
15.1 (7.2)
0.96 (0.26)
73.3 (7.4)
9.2 (0.7)
3.8 (0.4)
350(315)
5.3 (1.6)
11.5 (1.2)
62.0 (20.2)
17.2 (8.8)
1.08 (0.28)
72.7 (8.5)
9.2 (0.8)
3.7 (0.5)
312 (302)
5.0 (1.6)
11.5 (1.4)
36.2 (9.2)
43.8 (9.3)
42.5 (10.0)
43.4 (9.3)
35.4 (10.7)
47.4 (10.8)
34.9 (10.6)
44.7 (12.4)
EUR-A/NZ, Europe-Australia/New Zealand; BMI, physique mass index; ESRD, end-stage renal illness; HD, hemodialysis; BUN, blood urea nitrogen; nPCR, normalized protein catabolic
fee; PTH, parathyroid hormone.
Imply values are proven with (normal deviation) in parentheses; all values lacking for <10% of sufferers in China except single-pool Kt/V b (39%), and standardized Kt/V c
(45%), post-dialysis BUN (31%), albumin adjusted calcium (15%), PTH (23%) and high quality of life (22%).
a
Restricted to sufferers having ESRD <1 yr.
b
Restricted to sufferers having ESRD ≥1 yr, and acquired 3 HD classes per week; single-pool Kt/V was calculated utilizing the Daugirdas system.
c
To account for sufferers dialyzing at a frequency apart from 3× per week, a standardized Kt/V was calculated from the equation reported by Leypoldt et al. [14].
d
Albumin-adjusted calcium.
e
The European DOPPS nations embrace Belgium, France, Germany, Italy, Spain, Sweden, and the UK.
The imply HD session size in Chinese language services (243
min) was comparable with that in Eur-A/NZ (245 min) and
Japan (237 min) however larger than that in North America (218
min) (Desk 1). Session size didn't range significantly amongst
1772
Chinese language services, with half of all Chinese language services reporting a
imply remedy time of ≥240 min, the fourth highest amongst
the DOPPS nations. The imply blood flow fee of 235 mL/
min was considerably larger than in Japan (202 mL/min) however
B. Bieber et al.
ORIGINAL ARTICLE
F I G U R E 1 : Frequency of dialysis classes/week by nation: (A) affected person frequency classes, (B) distribution of facility % of sufferers dialyzing
<3× per week. † Amongst services with at the very least 7 sufferers with non-missing frequency information.
markedly decrease than in North America (414) and Eur-A/NZ
(317) (Desk 1).
Amongst sufferers on HD for at the very least 1 yr who dialyzed
thrice per week, imply single-pool Kt/V in Chinese language services (1.38) was decrease than that seen in different DOPPS areas,
and for these sufferers, extra had Kt/V < 1.2 in China (29%)
than in different DOPPS nations (Desk 1). Accounting for
variety of classes per week, the typical standardized Kt/V
was lowest in China (2.01) in contrast with different DOPPS
areas (2.12–2.27), and China had the very best proportion of
sufferers with a standardized Kt/V < 2.0 (43 versus 14–25%).
Laboratory values and high quality of life
Pre-dialysis blood urea nitrogen (BUN) was markedly
decrease within the China DOPPS sufferers (49.2 mg/dL) than in
different DOPPS areas (vary, 55.9–66.5 mg/dL) (Desk 1).
nPCR was decrease in China (0.8) than in different DOPPS areas
(0.96–1.08). Serum phosphorus (6.1 mg/dL), serum albumin
(3.9 g/dL) and intra-dialytic weight reduction (IDWL, 4.1%) have been
larger in China than in different DOPPS areas. Common
China DOPPS dialysis adequacy and vascular entry
hemoglobin ranges in China (10.5 g/dL) have been comparable with
Japan (10.4) however decrease than in Eur-A/NZ and North America
(11.5). General, the standard of life in China was comparable when
in contrast with different DOPPS areas.
Traits of sufferers on two-times weekly HD in
China
Limiting to sufferers dialyzing two or thrice per
week in China (95% of the China DOPPS pattern), sufferers
dialyzing two instances weekly have been extra prone to be feminine, had
shorter classic (23% have been on dialysis for < 1 yr) and have been
extra prone to have residual urine output (Desk 2). Additionally they
had a decrease comorbidity burden, notably of diabetes,
hypertension and coronary coronary heart illness. Sufferers with <12
years of education, those bearing higher out-of-pocket costs
(Table 2 footnote) or without national health insurance coverage were much more likely to receive two-times weekly HD,
whereas patients who had retired or had close to full coverage
from the national health insurance were much less likely to be
on two-times weekly HD. Finally, lack of sufficient HD station
1773
Table 2. China DOPPS: Patient characteristics associated with odds of dialyzing two times versus three times per week
ORIGINAL ARTICLE
Mean (SD) or %
Odds ratio: 2 sessions per week versus 3
Patient characteristics
2× per week(n = 304)
3× per week(n = 982)
Unadjusteda,OR (95% CI)
Age, years [OR per 10 years]
Female, %
Dialysis vintage, years
BMI, kg/m2
Urine output >200 mL/day, %
<12 years schooling
Employment standing
Unemployed
Retired
Employed and otherc
Well being insuranced,e
No nationwide insurance coverage
Nat. ins. protection <50%
Nat. ins. protection 50–84%
Nat. ins. protection 85–94%
Nat. ins. protection 95+%
Comorbidities, % [OR – yes versus no]
Coronary coronary heart illness
Congestive coronary heart failure
Cerebrovascular illness
Peripheral vascular illness
Different heart problems
Diabetes
Hypertension
59.0 (15.2)
52.0
3.51 (3.54)
21.6 (3.4)
52.5
14.8
59.6 (14.4)
44.6
5.16 (4.82)
21.9 (3.6)
25.1
8.7
0.95 (0.86–1.05)
1.31 (1.07–1.62)*
0.91 (0.86–0.95)*
0.98 (0.95–1.01)
3.39 (2.33–4.93)*
1.48 (1.07–2.04)*
Adjustedb,
OR (95% CI)
1.12 (0.99,1.26)
1.28 (1.06,1.54)*
0.94 (0.90,0.98)*
0.99 (0.96,1.02)
2.92 (1.92,4.43)*
1.55 (1.08,2.21)*
20.1
53.3
26.6
10.1
70.8
19.0
1.13 (0.79–1.63)
0.48 (0.35–0.65)*
(ref)
1.07 (0.74,1.54)
0.55 (0.39,0.77)*
(ref)
7.9
5.0
24.8
29.7
25.4
2.0
3.2
18.6
32.9
36.1
4.45 (2.13–9.33)*
2.34 (0.95–5.75)
2.03 (1.38–2.99)*
(ref)
0.67 (0.48–0.95)*
2.49 (1.04,5.92)*
1.89 (0.74,4.87)
1.44 (0.96,2.17)
(ref)
0.69 (0.48,0.99)*
34.9
30.6
16.4
10.2
25.7
16.9
85.5
39.7
32.3
18.5
10.8
28.8
26.1
90.9
0.78 (0.61–1.00)
0.94 (0.68–1.30)
0.80 (0.53–1.18)
0.92 (0.58–1.45)
0.85 (0.62–1.16)
0.54 (0.39–0.75)*
0.51 (0.32–0.81)*
1.03 (0.78,1.36)
0.97 (0.72,1.29)
0.92 (0.60,1.42)
1.12 (0.65,1.93)
1.02 (0.71,1.47)
0.49 (0.34,0.71)*
0.51 (0.31,0.83)*
Imply values are proven with (normal deviation) in parentheses.
a
Accounting for facility clustering.
b
Adjusted for variables listed in Desk 1.
c
‘Different’ employment standing contains ‘employed full time’ (7%), ‘employed half time’ (7%), ‘homemaker’(7%) and ‘disabled’ (0.1%).
d
7% of sufferers have been lacking information on the % of nationwide medical health insurance.
e
Affected person-reported out-of-pocket medical healthcare prices have been 2588 versus 1831 yuan for two-times weekly versus three-times weekly HD (unadjusted OR = 1.01 per 100 yuan, 95%
CI = 1.00, 1.02, P < 0.01). Out-of-pocket healthcare prices have been calculated because the sum of month-to-month dialysis, supplemental insurance coverage, prescription treatment and non-prescription
treatment prices. Out-of-pocket healthcare prices have been extremely correlated with degree of nationwide insurance coverage protection so solely insurance coverage protection was included as covariate in desk.
*P < 0.05.
capacity was rare in China (only cited by 3 of 44 medical directors in a survey regarding facility practices and resources) and
was not associated with patients receiving two-times weekly
HD (P = 0.63).
Dialysis-related prescriptions, laboratory values and
quality of life associated with two-times weekly HD in
China
Patients dialyzing two times weekly (versus three times) in
China were much more likely to be prescribed session lengths
>270 or 300+ min (Desk 3). On a weekly foundation, these sufferers
have been dialyzed for a mean of 8.4 h in contrast with 12.0 h for
sufferers dialyzing thrice weekly. Common blood flow charges
and vascular entry have been comparable. Sufferers dialyzing two instances
weekly (versus thrice) in China had comparable erythropoietin-stimulating agent prescription charges (95%) however have been much less
prone to be prescribed intravenous iron (33 versus 43%),
vitamin D (48 versus 60%) or a phosphate binder (52 versus
60%).
Chinese language sufferers dialyzing two instances weekly had considerably decrease imply weekly clearance (Desk 4, standardized Kt/
1774
Desk 3. China DOPPS: Dialysis session prescription patterns in sufferers
dialyzing two instances versus thrice per week
Imply (SD) or %
Odds ratio (OR) or distinction
(β): 2× (versus 3×)
Dialysis session
prescriptions
2× per
week
(n = 304)
3× per
week
(n = 982)
Unadjusteda,
OR or β (95%
CI)
Adjustedb,
OR or β
(95% CI)
Session size,
min (OR: >240
versus ≤240)
< 240 min
240 min
270 min
300+ min
Blood flow fee,
mL/min
Catheter use, %
(OR: versus
fistula)
253 (28)
240 (17)
5.55 (2.88–
10.68)*
6.82 (2.97–
15.63)*
5
65
10
20
233 (33)
7
88
4
1
235 (28)
11
10
+0.2 (−3.0,3.4) +0.4
(−2.9,3.7)
1.00 (0.68–
0.64 (0.38–
1.47)
1.09)
Imply values are proven with (normal deviation) in parentheses.
a
Accounting for facility clustering.
b
Adjusted for variables listed in Desk 2 and all different remedy variables listed in Desk 3.
*P < 0.05.
B. Bieber et al.
Desk 4. China DOPPS: Laboratory values and high quality of life in sufferers dialyzing two instances versus thrice per week
Imply (SD)
End result measures
Urea discount ratio, %
Standardized Kt/V c
Intradialytic weight reduction, %
nPCR, g urea nitrogen/kg/day
Serum calciumAlb, mg/dLd
Serum albumin, g/dL
Serum PTH, pg/mL
Serum phosphorus, mg/dL
Hemoglobin, g/dL
QoL: SF-12 bodily element abstract
QoL: SF-12 psychological element abstract
2× per week(n = 304)
69.1 (11.4)
1.45 (0.19)
4.1 (2.5)
0.68 (0.24)
8.7 (1.1)
4.0 (0.5)
398 (425)
6.3 (2.3)
10.2 (2.2)
36.7 (9.5)
43.4 (9.0)
Distinction (β): 2× (versus 3×)
3× per week(n = 982)
67.4 (10.0)
2.11 (0.26)
4.1 (1.8)
0.83 (0.32)
9.1 (1.0)
3.9 (0.5)
376 (408)
6.0 (2.1)
10.6 (2.0)
36.1 (9.1)
43.8 (9.5)
Unadjusteda,β (95% CI)
+2.02 (0.39,3.66)*
−0.67 (−0.72, −0.62)*
−0.02 (−0.28,0.25)
−0.13 (−0.17, −0.09)*
−0.35 (−0.49, −0.21)*
+0.06 (−0.01,0.12)
+20.6 (−44.2,85.4)
+0.22 (−0.07,0.51)
−0.31 (−0.57, −0.04)*
+0.78 (−0.57,2.14)
−0.24 (−1.61,1.14)
Adjustedb,β (95% CI)
+0.29 (−1.45,2.02)
−0.73 (−0.77, −0.69)*
+0.25 (−0.03,0.52)
−0.16 (−0.20, −0.11)*
−0.26 (−0.42, −0.10)*
+0.03 (−0.03,0.10)
+65.3 (−5.3,135.9)
+0.25 (−0.08,0.57)
−0.23 (−0.53,0.07)
−0.61 (−2.03,0.82)
−1.13 (−2.72,0.45)
Imply values are proven with (normal deviation) in parentheses.
a
Accounting for facility clustering.
b
Adjusted for variables listed in Tables 2 and three, however not different variables in Desk 4.
c
To account for sufferers dialyzing at a frequency apart from 3× per week, a standardized Kt/V was calculated from the equation reported by Leypoldt et al. [14].
d
Albumin-adjusted calcium.
*P < 0.05.
DISCUSSION
We report information on affected person traits, and HD entry and
prescription practices from a consultant pattern of 45 HD
items in three main Chinese language metropolitan areas. To our
data, these are the first analyses that make the most of comparable
information assortment strategies in China and different nations, permitting us to current systematic comparisons in apply patterns
between the three cities in China and different DOPPS nations.
Preliminary findings recommend necessary variations within the
affected person inhabitants in addition to HD-prescribing practices in
China in contrast with different DOPPS nations.
Chinese language sufferers have been youthful, had smaller physique measurement as
measured by BMI and skilled a typically decrease co-morbidity burden, in comparison with different DOPPS nations.
The proportion with diabetic nephropathy was additionally decrease than
different DOPPS nations. A majority of Chinese language sufferers used a
native AV fistula for HD remedy, whereas the prescribed entry
blood flow fee was significantly decrease in Chinese language HD services
than that seen in different DOPPS nations, with the exception
of Japan. Most strikingly, at the very least 1 / 4 of Chinese language sufferers
underwent HD two instances weekly in contrast with fewer than
5% in most DOPPS nations. Moreover, 29% of Chinese language
sufferers dialyzing thrice per week achieved a Kt/V < 1.2
in contrast with at or beneath 10% within the majority of DOPPS
nations.
China DOPPS dialysis adequacy and vascular entry
The sizeable fraction of sufferers present process two-times
weekly HD in our research is in line with that reported by
single metropolis registry information in China. Twenty-eight % of registered Beijing sufferers have been present process two-times weekly
HD in 2002, in keeping with the Beijing Hemodialysis High quality
Management and Enchancment Heart [4]. The 2005 Shanghai Dialysis Registry reported sufferers have been dialyzing for a mean of
2.6 instances per week, just like the two.8 instances per week noticed
in our research [2].
One Chinese language research restricted to Shanghai has beforehand
characterised this inhabitants of sufferers present process twotimes weekly HD. Lin et al. [5] adopted ∼2500 sufferers in
Shanghai for a interval of two years. Of their cohort, sufferers on
two-times (versus thrice) weekly HD have been youthful, had
decrease physique floor space, shorter classic on HD and better
serum albumin concentrations. Equally, in our research, sufferers on two-times weekly HD had shorter classic, higher residual operate and a decrease comorbidity burden. We additionally
discovered that ladies have been extra prone to be prescribed this frequency, and we hypothesize that this can be as a result of their
smaller physique measurement. Their findings in addition to ours point out that
Chinese language nephrologists are prescribing two-times weekly HD to
sufferers who're comparatively more healthy and probably extra ready
to ‘tolerate’ the much less intensive fluid and electrolyte administration.
As well as, we discovered that sufferers with out nationwide insurance coverage have been extra prone to be on two-times weekly HD. In reality,
many sufferers with out nationwide insurance coverage might not be capable to
entry remedy in any respect. Though newly applied insurance coverage insurance policies subsidize remedy to some extent for some sufferers (e.g. authorities staff), massive co-payments for HD
remedy (annual complete value $7500) possible severely pressure affected person
assets [7]. For instance, a dialysis heart from China’s
Guangxi province reported that one-third of sufferers presenting with superior CKD refused initiation of RRT; a majority
cited the price of HD remedy as a deterrent [1]. For sufferers
who do provoke remedy, lowering frequency of remedy
1775
ORIGINAL ARTICLE
V distinction = −0.67) and nPCR (−0.16 g urea nitrogen/kg/
day). Additionally they had decrease ranges of serum calcium (−0.26),
with a suggestion of upper common serum phosphorous ranges
and parathyroid hormone (PTH) ranges and decrease hemoglobin.
Serum ranges of albumin amongst sufferers dialyzing two instances
weekly have been comparable with these dialyzing thrice per
week. There was no significant distinction in reported high quality
of life for sufferers dialyzing two instances versus thrice
weekly.
ORIGINAL ARTICLE
could also be an necessary methodology of defraying direct and oblique
(journey) prices. These constraints, not skilled by sufferers
residing in most different established DOPPS nations, are the
possible foundation for ‘the frequency choice’ in a majority of instances.
Our information on drugs help this conclusion. Regardless of laboratory values demonstrating equal to barely poorer
management of mineral bone illness and anemia amongst sufferers
present process two-times weekly HD, this group was a lot much less
prone to be taking phosphate binders, vitamin D analogs or
iron than the group present process three-times weekly HD. This
discrepancy once more factors to potential financial constraints that
might restrict entry to quite a lot of remedies within the two-times
weekly group.
In america, the Nationwide Kidney Basis/
Kidney Illness Outcomes High quality Initiative scientific apply
pointers advocate at the very least three-times weekly HD for people with <3 mL/min/1.73 m2 of residual kidney urea
clearance [16]. Aside from necessitating stricter restrictions on
fluid and electrolyte intake, two-times weekly HD can be expected to increase time-average urea concentrations and attenuate clearance of solutes with small volume of distribution
[17].
Clinical data on the effect of less frequent HD are sparse.
Lin et al. [5] reported that patients on two- or three-times
weekly HD had equivalent survival over a period of 2 years,
even for the subgroup on dialysis for >5 years. One other research
from Taiwan examined preservation of renal operate amongst
23 sufferers present process two-times weekly HD in contrast with
51 sufferers present process three-times weekly HD [18]. After 18
months of follow-up, the research reported a slower decline in
renal operate for two-times weekly sufferers, and comparable vitamin and bone parameters within the two teams. In our research as
nicely, standardized Kt/V was significantly decrease amongst sufferers
present process two-times weekly HD. There was a suggestion of
poorer laboratory indicators (together with hypocalcemia, hyperphosphatemia and anemia) amongst sufferers present process twotimes weekly HD, which may reflect inadequacies within the delivered dose of dialysis however have to be interpreted with warning
on condition that this group was additionally much less prone to be taking supporting drugs. The decrease nPCR measurement amongst sufferers within the two-times weekly group additionally indicated that
sufferers have been both following extra strict protein restrictions
or have been extra malnourished, however their HR-QOL didn't differ
from the sufferers present process three-times weekly HD.
These information elevate the query of whether or not two-times weekly
HD could also be acceptable for a choose group, notably given
the useful resource constraints of low- and middle-income nations.
Nonetheless, a serious methodological concern is confounding-byindication, as a specific more healthy group could also be prescribed
less-frequent HD, and the noticed equal outcomes might
merely be a reflection of their underlying well being and never an
analysis of the dialysis prescription per se.
An extended and appropriately powered research analyzing survival, hospitalizations and HR-QOL—controlling for elements
akin to age, comorbid situations, residual operate and HD
adequacy—can reply the query of whether or not much less frequent
(however longer) prescriptions can help some Chinese language sufferers
to yield outcomes that strategy these with three-times per
1776
week frequency utilized in most DOPPS nations. The longitudinal element of China DOPPS, which started in autumn
2012, has the potential to handle a few of the methodological
points that could be current in beforehand printed research.
Our research has a number of strengths. It is without doubt one of the first to
present consultant information describing apply patterns and
related affected person traits from a pattern of three main
metropolitan areas—in a rustic new to widespread use of
HD remedy. Using normal DOPPS protocols and questionnaires permits for comparisons with different DOPPS nations with well-documented HD practices. Moreover, the
consultant facility sampling in DOPPS allowed us to
evaluate the vary of practices throughout services inside every
studied area or nation. We've got validated information collected
from 42 of the 45 taking part Chinese language services by means of reabstraction of 25 information components for seven randomly chosen
research sufferers at every of those research websites through the usage of an exterior information collector. There was a excessive degree of settlement
between the info initially abstracted by the research coordinator
and the re-abstracted information for all variables included on this reliability research evaluation.
Our outcomes for China signify HD sufferers from three
massive city areas of China, with a complete basic inhabitants of
>50 million individuals. Though a majority of sufferers on HD are
concentrated in a lot of these city areas, our research is probably going
not consultant of the general Chinese language HD inhabitants, and
we aren't capable of describe the distinctive set of challenges that sufferers and clinicians face in rural areas—together with not being
capable of seize sufferers who die with out ever accessing remedy. The cross-sectional nature of the info thus far limits us
to a willpower of affiliation with none means to deduce
causation. Detailed information on dietary consumption ( notably
dietary protein) weren't obtainable. Lastly, we couldn't describe practices and outcomes related to peritoneal dialysis, though this modality is utilized by a minority of sufferers
present process dialytic remedy in China.
In abstract, our research highlights necessary features of
affected person traits and HD practices in China. Sufferers on
HD in China are typically youthful and more healthy than in most
different DOPPS nations. Most obtain HD utilizing a local AV
fistula. A considerable proportion are dialyzing two instances
weekly; the sufferers dialyzing two instances weekly have shorter
classic, higher residual operate, decrease co-morbidity and/or
face having to pay a big share of value for HD. A longitudinal
element of the China DOPPS in these three main metropolitan areas was initiated in autumn 2012, which can assist
elucidate uncertainty relating to the outcomes related to
apply variations identified within the present cross-sectional
analyses of Chinese language HD sufferers.
AC Okay N O W L E D G E M E N T S
Heather Van Doren, MFA, a senior medical editor with Arbor
Analysis Collaborative for Well being, offered editorial help on this manuscript. The DOPPS is run by
Arbor Analysis Collaborative for Well being and is supported by
scientific analysis grants from Amgen (since 1996), Kyowa
B. Bieber et al.
Hakko Kirin (since 1999, in Japan), Sanofi Renal (since
2009), AbbVie (since 2009), Baxter (since 2011) and Vifor
Fresenius Renal Pharma (since 2011), with out restrictions on
publications.
C O N F L I C T O F I N T E R E S T S TAT E M E N T
The DOPPS is run by Arbor Analysis Collaborative
for Well being and is supported by scientific analysis grants from
Amgen (since 1996), Kyowa Hakko Kirin (since 1999, in
Japan), Sanofi Renal (since 2009), AbbVie (since 2009), Baxter
(since 2011) and Vifor Fresenius Renal Pharma (since 2011),
with out restrictions on publications. The authors declare no
competing financial pursuits. The authors confirm that the
outcomes offered on this paper haven't been printed beforehand in complete or partly, besides in summary type.
(See associated article by Kalantar-Zadeh and On line casino. Allow us to give
twice-weekly hemodialysis an opportunity: revisiting the taboo.
Nephrol Dial Transplant 2014; 29: 1618–1620.)
REFERENCES
China DOPPS dialysis adequacy and vascular entry
Acquired for publication: 26.4.2013; Accepted in revised type: 9.10.2013
1777
ORIGINAL ARTICLE
1. Zhang L, Zhang P, Wang F et al. Prevalence and elements related to
CKD: a inhabitants research from Beijing. Am J Kidney Dis 2008; 51:
373–384
2. Yao Q, Zhang W, Qian J. Dialysis standing in China: a report from the
Shanghai Dialysis Registry (2000–2005). Ethn Dis 2009; 19: S1–23–26
3. Dialysis and Transplantation Registration Group. The report concerning the
registration of dialysis and transplantation in China 1999. Chin J Nephrol
2001; 17: 77–78
4. Zuo L, Wang M. Present standing of hemodialysis remedy in Beijing,
China. Ethn Dis 2006; 16: S2-31–34
5. Lin X, Yan Y, Ni Z et al. Medical consequence of twice-weekly hemodialysis
sufferers in Shanghai. Blood Purif 2011; 33: 66–72
6. Chen X. Current progress of nephrology in China 2009–2011. Beijing:
Individuals’s Navy Medical Press, 2011
7. Lin S. Nephrology in China: an amazing mission and momentous problem .
Kidney Int Suppl 2003; 63: S108–S110
8. Locatelli F, Del Vecchio L, Pozzoni P et al. Dialysis adequacy and response
to erythropoiesis-stimulating brokers: what's the proof base? Semin
Nephrol 2006; 26: 269–274
9. Ifudu O, Feldman J, Friedman EA. The depth of hemodialysis and the
response to erythropoietin in sufferers with end-stage renal illness. N Engl
J Med 1996; 334: 420–425
10. Younger EW, Goodkin DA, Mapes DL et al. The Dialysis Outcomes and
Observe Patterns Examine (DOPPS): a world hemodialysis research.
Kidney Int 2000; 57: S74–S81
11. Pisoni RL, Gillespie BW, Dickinson DM et al. The Dialysis Outcomes and
Observe Patterns Examine (DOPPS): design, information components, and methodology. Am J Kidney Dis 2004; 44: 7–15
12. Hays RD, Kallich JD, Mapes DL et al. Growth of the kidney illness
high quality of life (KDQOL) instrument. Qual Life Res 1994; 3: 329–338
13. Ware J, Jr, Kosinski M, Keller SD. A 12-Merchandise Brief-Type Well being Survey:
development of scales and preliminary checks of reliability and validity. Med
Care 1996; 34: 220–233
14. Leypoldt JK, Jaber BL, Zimmerman DL. Every day hemodialysis—chosen
matters: predicting remedy dose for novel therapies utilizing urea normal
Kt/V. Semin Dial 2004; 17: 142–145
15. Depner TA, Daugirdas JT. Equations for normalized protein catabolic fee
primarily based on two-point modeling of hemodialysis urea kinetics. J Am Soc
Nephrol 1996; 7: 780–785
16. KDOQI scientific apply pointers for hemodialysis adequacy, replace
2006, 2006. http://www.kidney.org/professionals/kdoqi/guideline_uphd_
pd_va/index.htm.
17. Meyer TW, Sirich TL, Hostetter TH. Dialysis can't be dosed. Semin Dial
2011; 24: 471–479
18. Lin YF, Huang JW, Wu MS et al. Comparability of residual renal operate in
sufferers present process twice-weekly versus three-times-weekly haemodialysis. Nephrology (Carlton) 2009; 14: 59–64

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