Rationale & Objective

Longer and more frequent hemodialysis sessions are associated with both benefits and harms. However, their relative importance to patients and how they influence acceptability for patients have not been quantified.

Study Design

Discrete-choice experiment in which a scenario followed by 12 treatment choice sets were presented to patients in conjunction with varying information about the clinical impact of the treatments offered.

Setting & Participants

Patients with kidney failure treated with maintenance dialysis for ≥1 year in 5 UK kidney centers.

Predictors

Length and frequency of hemodialysis sessions and their prior reported associations with survival, quality of life, need for fluid restriction, hospitalization, and vascular access complications.

Outcome

Selection of longer (4.5 hours) or more frequent (4 sessions per week) hemodialysis regimens versus remaining on 3 sessions per week with session lengths of 4 hours.

Analytical Approach

Multinomial mixed effects logistic regression estimating the relative influence of different levels of the predictors on the selection of longer and more frequent dialysis, controlling for patient demographic characteristics.

Results

Among 183 prevalent in-center hemodialysis patients (mean age of 63.7 years, mean dialysis vintage of 4.7 years), 38.3% (70 of 183) always chose to remain on regimens of 3 sessions per week with session duration of 4 hours. Depicted associations of increasing survival and quality of life, reduced need for fluid restriction, and avoiding additional access complications were all significantly associated with choosing longer or more frequent treatment regimens. Younger age, fatigue, previous experience of vascular access complications, absence of heart failure, and shorter travel time to dialysis centers were associated with preference for 4 sessions per week. Patients expressed willingness to trade up to 2 years of life to avoid regimens of 4 sessions per week or access complications. After applying estimated treatment benefits and harms from existing literature, the fully adjusted model revealed that 27.1% would choose longer regimens delivered 3 times per week and 34.3% would choose 4 hours 4 times per week. Analogous estimates for younger fatigued patients living near their unit were 23.5% and 62.5%, respectively.

Limitations

Estimates were based on stated preferences rather than observed behaviors. Predicted acceptance of regimens was derived from data on treatment benefits and harms largely sourced from observational studies.

Conclusions

Predicted acceptance of longer and more frequent hemodialysis regimens substantially exceeds their use in current clinical practice. These findings underscore the need for robust data on clinical effectiveness of these more intensive regimens and more extensive consideration of patient choice in the selection of dialysis regimens.

中文翻译：

---

患者对更长时间或更频繁的中心血液透析方案的偏好：一项多中心离散选择研究

理由和目标

更长、更频繁的血液透析既有好处也有坏处。然而，它们对患者的相对重要性以及它们如何影响患者的可接受性尚未量化。

学习规划

离散选择实验，其中向患者呈现一个场景，随后提供 12 种治疗选择集，并结合有关所提供治疗的临床影响的不同信息。

背景及参与者

在英国 5 个肾脏中心接受维持性透析治疗 1 年以上的肾衰竭患者 。

预测因素

血液透析疗程的长度和频率及其先前报告的与生存、生活质量、液体限制需求、住院治疗和血管通路并发症的关系。

结果

选择更长（4.5 小时）或更频繁（每周 4 次）的血液透析方案，而不是保持每周 3 次、疗程长度为 4 小时。

分析法

多项混合效应逻辑回归估计不同水平的预测因素对选择更长时间和更频繁的透析的相对影响，并控制患者的人口统计特征。

结果

在 183 名中心内血液透析患者中​​（平均年龄 63.7 岁，平均透析年限 4.7 年），38.3%（183 名患者中的 70 名）始终选择维持每周 3 次疗程、疗程持续时间 4 小时的治疗方案。所描述的提高生存率和生活质量、减少液体限制的需要以及避免额外的通路并发症都与选择更长或更频繁的治疗方案显着相关。年龄较小、疲劳、既往有血管通路并发症的经历、无心力衰竭以及前往透析中心的时间较短与每周 4 次治疗的偏好相关。患者表示愿意牺牲长达 2 年的生命，以避免每周 4 次治疗或出现并发症。应用现有文献估计的治疗益处和危害后，完全调整的模型显示，27.1% 的人会选择每周 3 次的较长治疗方案，34.3% 的人会选择每周 4 次、4 小时的治疗方案。居住在单位附近的年轻疲劳患者的类似估计分别为 23.5% 和 62.5%。

局限性

估计是基于陈述的偏好而不是观察到的行为。治疗方案的预测接受度来自于治疗益处和危害的数据，这些数据主要来自观察性研究。

结论

预计对更长时间和更频繁的血液透析方案的接受程度大大超过了其在当前临床实践中的使用。这些发现强调需要获得关于这些更强化治疗方案的临床有效性的可靠数据，并在选择透析方案时更广泛地考虑患者的选择。