Patients with end-stage renal disease experience improved health-related quality of life (HRQoL) when they undergo hemodialysis (HD) 6 times a week rather than conventional thrice-weekly HD, according to a new study.
After a conventional in-center HD session, which lasts 3.5 to 4.5 hours, many patients feel fatigued and not themselves for the next 2 to 3 hours, and sometimes longer after their dialysis treatment, explained lead investigator Amit X. Garg, MD, PhD, of Western University in London, Ontario. With frequent HD, patients dialyze for about 2 to 2.5 hours a day for 5 or 6 days a week with daily HD and about 8 hours a night for most nights with nocturnal HD.
In an analysis of 2 randomized controlled trials, the Daily Trial and the Nocturnal Trial, “we found patients recovered on average approximately 1 hour earlier from frequent compared to conventional hemodialysis,” said Dr Garg, who practices nephrology at the London Health Sciences Centre. This was true for in-center HD in the Daily Trial or at home HD in the Nocturnal Trial, he said.
“These data can be used to inform patients about a potential benefit of frequent hemodialysis, particularly if they have important responsibilities soon after their hemodialysis session such as childcare or work,” Dr Garg told Renal & Urology News. “While a patient receives more hours of hemodialysis a week with the frequent hemodialysis regimen than conventional hemodialysis, he or she actually experiences more hours during which he or she feels more normal, and less ‘washed out’ after their dialysis treatments. Frequent in-center hemodialysis also yielded statistically significant and clinically important changes in general measures of health-related quality of life compared to the alternative of conventional hemodialysis.”
The Daily Trial included 245 patients randomly assigned to receive frequent (6 times a week) or conventional (3 times per week) in-center HD. The Nocturnal Trial included 87 patients randomly assigned to receive frequent nocturnal or conventional home HD. The investigators evaluated HRQoL using the feeling thermometer and a general health scale. The feeling thermometer consists of a single question that asks patients to rate their own health on a visual analog scale from 0 to 100 (perfect health). A 5- to 8-point change in score is considered clinically important. A general health scale is scored from 0 to 100, with a low score reflecting poor health that is likely to worsen and a high score indicating excellent health. A 3- to 5-point change in score is considered clinically important.
All patients had been on conventional HD prior to randomization. At the beginning of the trial, they had an average feeling thermometer score of 70 to 75 and an average general health scale score of 40 to 47, and an average dialysis recovery time of 2 to 3 hours.
After 1 year, Daily Trial patients assigned to frequent in-center HD reported higher feeling thermometer and general health scores and a shorter recovery time after a dialysis session compared with standard thrice-weekly HD, Dr Garg and colleagues reported online ahead of print in Kidney International. “Patients assigned to frequent HD reported a 6-point improvement in their feeling thermometer score and a 6-point improvement in their general health scale score. The scores on both measures remained similar in patients assigned to conventional HD. Among patients assigned to frequent HD, the median recovery time from a dialysis session decreased from 150 minutes at baseline to 60 minutes at 12 months; in the conventional HD arm, median recovery time was 120 minutes at baseline and 150 minutes at 12 months. The mean between-treatment group difference in the change in recovery time over 1 year was −84 minutes.
In Nocturnal Trial, the recovery time after a dialysis session decreased from 180 minutes at baseline to 30 minutes at 12 months among patients assigned to frequent home HD and decreased from 180 to 120 minutes in the conventional HD group. The between-treatment group difference in the change in score by 1 year was −60 minutes. Results showed no statistical difference in feeling thermometer or general health scores between the frequent and standard home HD schedules, according to the investigators.
1. Garg AX, Suri RS, Eggers P, et al. Patients receiving frequent hemodialysis have better health-related quality of life compared to patients receiving conventional hemodialysis. Kidney Int 2017; published online ahead of print.