Ifudu O, Paul H, Friedman EA
Effect of missed hemodialysis treatments on mortality in
patients with end-stage renal disease
43rd Annual ASAIO Conference, Atlanta
ASAIO J
(Apr) 43:76 1997
I was unaware that, as reported here, a higher frequency of missed
treatments in the US has been a proposed explanation for
European-American differences in dialysis survival. In any case, this
study doesn't clarify much about the issue, demonstrating only that
missed treatments during one 10-week period do not impact mortality over
the next 36 months. The implicit assumption is that patients' behavior
during the study period is representative of their treatment compliance
over the entire followup, a rather chancy supposition. One cannot fault
the conclusion that it is unlikely that missed treatments is a dominant
reason for excess dialysis mortality in the U.S. (although it doesn't
really derive from the data presented), but the compliance issue is
important enough to study in a more complete way, which is to say
analyze missed treatments throughout the follow-up period as a
time-dependent covariate, adjusting for some measure of dialysis dose.
(Robert H. Barth, M.D., VA Medical Center, Brooklyn, NY)
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43rd Annual ASAIO Conference, Atlanta
CRF: Problem Areas :
Outcomes (Morbidity, Mortality)