​Observational studies have consistently demonstrated the survival benefits of a greater dialysis dose in maintenance hemodialysis (MHD) patients, whereas randomized controlled trials have shown conflicting results. The possible causal impact of dialysis dose on mortality needs to be investigated using rich cohort data analyzed with novel statistical methods such as marginal structural models (MSMs) that account for time-varying confounding and exposure.

The authors quantified the effect of delivered dose of hemodialysis (HD) on mortality risk in a contemporary cohort of 68,110 patients undergoing HD three times weekly. The study compared conventional Cox proportional hazard and MSM survival analyses, accounting for time-varying confounding by applying longitudinally modeled inverse-probability-of-dialysis-dose weights to each observation.   The authors concluded that higher HD doses were robustly associated with greater survival in MSM analyses that more fully and appropriately accounted for time-varying confounding.  

Publication Authors:

• Paungpaga Lertdumrongluk
• Elani Streja
• Onyebuchi A. Arah, M.D., Ph.D., M.P.H.
• et al