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Randomized Controlled Trial
. 2012 May;7(5):782-94.
doi: 10.2215/CJN.10601011. Epub 2012 Mar 15.

Effects of six versus three times per week hemodialysis on physical performance, health, and functioning: Frequent Hemodialysis Network (FHN) randomized trials

Yoshio N Hall  1 , Brett Larive, Patricia Painter, George A Kaysen, Robert M Lindsay, Allen R Nissenson, Mark L Unruh, Michael V Rocco, Glenn M Chertow; Frequent Hemodialysis Network Trial Group
Collaborators, Affiliations
Randomized Controlled Trial

Effects of six versus three times per week hemodialysis on physical performance, health, and functioning: Frequent Hemodialysis Network (FHN) randomized trials

Yoshio N Hall et al. Clin J Am Soc Nephrol. 2012 May.

Abstract

Background and objectives: Relatively little is known about the effects of hemodialysis frequency on the disability of patients with ESRD.

Design, setting, participants, & measurements: This study examined changes in physical performance and self-reported physical health and functioning among subjects randomized to frequent (six times per week) compared with conventional (three times per week) hemodialysis in both the Frequent Hemodialysis Network daily (n=245) and nocturnal (n=87) trials. The main outcome measures were adjusted change in scores over 12 months on the short physical performance battery (SPPB), RAND 36-item health survey physical health composite (PHC), and physical functioning subscale (PF) based on the intention to treat principle.

Results: Overall scores for SPPB, PHC, and PF were poor relative to population norms and in line with other studies in ESRD. In the Daily Trial, subjects randomized to frequent compared with conventional in-center hemodialysis experienced no significant change in SPPB (adjusted mean change of -0.20±0.19 versus -0.41±0.21, P=0.45) but experienced significant improvement in PHC (3.4±0.8 versus 0.4±0.8, P=0.009) and a relatively large change in PF that did not reach statistical significance. In the Nocturnal Trial, there were no significant differences among subjects randomized to frequent compared with conventional hemodialysis in SPPB (adjusted mean change of -0.92±0.44 versus -0.41±0.43, P=0.41), PHC (2.7±1.4 versus 2.1±1.5, P=0.75), or PF (-3.1±3.5 versus 1.1±3.6, P=0.40).

Conclusions: Frequent in-center hemodialysis compared with conventional in-center hemodialysis improved self-reported physical health and functioning but had no significant effect on objective physical performance. There were no significant effects of frequent nocturnal hemodialysis on the same physical metrics.

Trial registration: ClinicalTrials.gov NCT00264758 NCT00271999.

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Figures

Figure 1.
Figure 1.
Flow diagrams showing the number of subjects enrolled and assigned to each study arm (intervention/control) and number of subjects analyzed with baseline and 12-month ascertainment of each physical metric including reasons for drop-out. (A) Daily Trial. (B) Nocturnal Trial.
Figure 1.
Figure 1.
Flow diagrams showing the number of subjects enrolled and assigned to each study arm (intervention/control) and number of subjects analyzed with baseline and 12-month ascertainment of each physical metric including reasons for drop-out. (A) Daily Trial. (B) Nocturnal Trial.
Figure 2.
Figure 2.
Forrest plots showing the effects of six versus three times per week hemodialysis on physical measures in in the Daily and Nocturnal Trials. (A) Physical performance (Short Physical Performance Battery). (B) Physical health (RAND-36 Physical Health Composite) and physical functioning (RAND-36 Physical Functioning subscale).
Figure 3.
Figure 3.
Correlational plots showing correlation of 12-month changes from baseline in physical performance (Short Physical Performance Battery) and physical health (RAND-36 Physical Health Composite) by treatment group. (A) Daily Trial. (B) Nocturnal Trial.
Figure 4.
Figure 4.
Correlational plots showing correlation of 12-month changes from baseline in physical performance (Short Physical Performance Battery) and physical functioning (RAND-36 Physical Functioning subscale) by treatment group. (A) Daily Trial. (B) Nocturnal Trial.
See this image and copyright information in PMC

Comment in

References

    1. Kurella Tamura M, Covinsky KE, Chertow GM, Yaffe K, Landefeld CS, McCulloch CE: Functional status of elderly adults before and after initiation of dialysis. N Engl J Med 361: 1539–1547, 2009 - PMC - PubMed
    1. Evans RW, Manninen DL, Garrison LP, Jr, Hart LG, Blagg CR, Gutman RA, Hull AR, Lowrie EG: The quality of life of patients with end-stage renal disease. N Engl J Med 312: 553–559, 1985 - PubMed
    1. Cook WL, Jassal SV: Functional dependencies among the elderly on hemodialysis. Kidney Int 73: 1289–1295, 2008 - PubMed
    1. Kaysen GA, Larive B, Painter P, Craig A, Lindsay RM, Rocco MV, Daugirdas JT, Schulman G, Chertow GM, FHN Trial Group : Baseline physical performance, health, and functioning of participants in the Frequent Hemodialysis Network (FHN) trial. Am J Kidney Dis 57: 101–112, 2011 - PMC - PubMed
    1. Unruh M, Benz R, Greene T, Yan G, Beddhu S, DeVita M, Dwyer JT, Kimmel PL, Kusek JW, Martin A, Rehm-McGillicuddy J, Teehan BP, Meyer KB, HEMO Study Group : Effects of hemodialysis dose and membrane flux on health-related quality of life in the HEMO Study. Kidney Int 66: 355–366, 2004 - PubMed

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