Format

Send to

Choose Destination
J Am Soc Nephrol. 2016 Jun;27(6):1830-6. doi: 10.1681/ASN.2015040426. Epub 2015 Oct 14.

Long-Term Effects of Frequent In-Center Hemodialysis.

Author information

1
Department of Medicine, Stanford University, Palo Alto, California; gchertow@stanford.edu.
2
Renal Research Institute, New York, New York;
3
Cleveland Clinic Foundation, Cleveland, Ohio;
4
University of Illinois, Chicago, Illinois;
5
National Institutes of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland;
6
Yale University, New Haven, Conneticut;
7
Wake Forest University, Winston-Slem, North Carolina; and.
8
Cleveland Clinic Foundation, Cleveland, Ohio; University of Utah, Salt Lake City, Utah.

Abstract

The Frequent Hemodialysis Network Daily Trial randomized 245 patients to receive six (frequent) or three (conventional) in-center hemodialysis sessions per week for 12 months. As reported previously, frequent in-center hemodialysis yielded favorable effects on the coprimary composite outcomes of death or change in left ventricular mass and death or change in self-reported physical health. Here, we determined the long-term effects of the 12-month frequent in-center hemodialysis intervention. We determined the vital status of patients over a median of 3.6 years (10%-90% range, 1.5-5.3 years) after randomization. Using an intention to treat analysis, we compared the mortality hazard in randomized groups. In a subset of patients from both groups, we reassessed left ventricular mass and self-reported physical health a year or more after completion of the intervention; 20 of 125 patients (16%) randomized to frequent hemodialysis died during the combined trial and post-trial observation periods in contrast to 34 of 120 patients (28%) randomized to conventional hemodialysis. The relative mortality hazard for frequent versus conventional hemodialysis was 0.54 (95% confidence interval, 0.31 to 0.93); with censoring of time after kidney transplantation, the relative hazard was 0.56 (95% confidence interval, 0.32 to 0.99). Bayesian analysis suggested a relatively high probability of clinically significant benefit and a very low probability of harm with frequent hemodialysis. In conclusion, a 12-month frequent in-center hemodialysis intervention significantly reduced long-term mortality, suggesting that frequent hemodialysis may benefit selected patients with ESRD.

KEYWORDS:

clinical trial; end-stage renal disease; hemodialysis

PMID:
26467779
PMCID:
PMC4884113
DOI:
10.1681/ASN.2015040426
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center