Quotidian dialysis Survival in 221 patients treated by short daily hemodialysis for 315 patient years
Bibliographic record
Abstract
Daily hemodialysis greatly improves clinical and biochemical parameters and patient quality of life compared to conventional thrice weekly dialysis. However, mortality statistics are lacking as most centers providing daily dialysis have treated only a small number of relatively selected patients for relatively short observation times. To study patient survival we pooled experience from three sources: 51 French and 128 U.S. patients selected for daily home hemodialysis and 42 U.S. patients selected for short daily center hemodialysis because of many medical complications and cardiovascular instability. Results were compared to age‐matched patients from the USRDS 2003 data base. The age of the patients was 51 ± 16 (18–89) years; 29% were female; they had 3.3 ± 1.8 comorbidities (twice that of USRDS patients); 32% had diabetes or hypertension as cause of renal disease (USRDS patients 70%); blood access was 61% fistulae, 25% grafts, and 14% CV‐catheters. Mean duration of ESRD treatment at start of short daily hemodialysis was 6 ± 7 years. The observation period was 315 patient years. Patients had been on daily hemodialysis for a mean of 17 ± 18 (0–92) months and 11 patients were observed for more than 5 years. 35 of the 221 patients died (16%); deaths were 111 per 1,000 patient years (53% of expected) and 5‐year cumulative survival was 63% compared to 32% for USRDS patients. Five‐year survival was 0% in patients with >3 comorbidities, 75% in patients with <3 comorbidities (p < 0.0001), and in patients aged <53 years was 80% vs. 50% in patients aged >53 years (p = 0.0007). On Cox stepwise hazards analysis, comorbidity alone predicted survival when used with age. Comorbidity >3 HR = 6.00 (95% CI 2.2–16.3). Conclusions: It is difficult to do survival comparisons between patient groups. However, these daily dialysis patients were age‐matched with patients from the USRDS database. There were fewer diabetic and hypertensive patients but the comorbidity index was twice that of USRDS patients. Survival, both deaths per 1,000 patient years and cumulative count was approximately twice that reported by the USRDS and strongly suggests superior survival with short daily hemodialysis compared to thrice weekly conventional dialysis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".