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J Am Soc Nephrol. 2017 Jun;28(6):1898-1911. doi: 10.1681/ASN.2015111225. Epub 2017 Feb 1.

A Trial of Extending Hemodialysis Hours and Quality of Life.

Author information

1
The George Institute for Global Health, mjardine@georgeinstitute.org.au.
2
Department of Renal Medicine, Concord Repatriation General Hospital, Sydney, Australia.
3
Department of Nephrology, Peking University People's Hospital, Beijing, China.
4
Department of Renal Medicine, Nambour General Hospital, Nambour, Australia.
5
Sunshine Coast Clinical School, The University of Queensland, Brisbane, Australia.
6
Department of Nephrology, North Shore Hospital, University of Auckland, Auckland, New Zealand.
7
Division of Nephrology, University Health Network, Toronto, Canada.
8
The George Institute for Global Health.
9
Concord Clinical School.
10
Sydney Translational Imaging Laboratory, Charles Perkins Centre, Sydney Medical School, and.
11
Departments of Radiology, Cardiology, and.
12
Specialist Magnetic Resonance Imaging, Newtown, Australia.
13
First Affiliated Hospital of Dalian Medical University, Dalian, China.
14
Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia.
15
Department of Nephrology, China-Japan Friendship Hospital, Beijing, China.
16
Fourth Hospital Affiliated to Hebei Medical University, Shijiazhuang, China.
17
School of Public Health, University of Sydney, Sydney, Australia.
18
Institute for Choice, University of South Australia, Sydney, Australia.
19
Menzies School of Health Research, Charles Darwin University, Darwin, Australia; and.

Abstract

The relationship between increased hemodialysis hours and patient outcomes remains unclear. We randomized (1:1) 200 adult recipients of standard maintenance hemodialysis from in-center and home-based hemodialysis programs to extended weekly (≥24 hours) or standard (target 12-15 hours, maximum 18 hours) hemodialysis hours for 12 months. The primary outcome was change in quality of life from baseline assessed by the EuroQol 5 dimension instrument (3 level) (EQ-5D). Secondary outcomes included medication usage, clinical laboratory values, vascular access events, and change in left ventricular mass index. At 12 months, median weekly hemodialysis hours were 24.0 (interquartile range, 23.6-24.0) and 12.0 (interquartile range, 12.0-16.0) in the extended and standard groups, respectively. Change in EQ-5D score at study end did not differ between groups (mean difference, 0.04 [95% confidence interval, -0.03 to 0.11]; P=0.29). Extended hours were associated with lower phosphate and potassium levels and higher hemoglobin levels. Blood pressure (BP) did not differ between groups at study end. Extended hours were associated with fewer BP-lowering agents and phosphate-binding medications, but were not associated with erythropoietin dosing. In a substudy with 95 patients, we detected no difference between groups in left ventricular mass index (mean difference, -6.0 [95% confidence interval, -14.8 to 2.7] g/m2; P=0.18). Five deaths occurred in the extended group and two in the standard group (P=0.44); two participants in each group withdrew consent. Similar numbers of patients experienced vascular access events in the two groups. Thus, extending weekly hemodialysis hours did not alter overall EQ-5D quality of life score, but was associated with improvement in some laboratory parameters and reductions in medication burden. (Clinicaltrials.gov identifier: NCT00649298).

KEYWORDS:

extended dialysis; hemodialysis; left ventricular hypertrophy; quality of life; randomized controlled trials

PMID:
28151412
PMCID:
PMC5461782
DOI:
10.1681/ASN.2015111225
[Indexed for MEDLINE]
Free PMC Article

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