Effects of 6-times-weekly versus 3-times-weekly hemodialysis on depressive symptoms and self-reported mental health: Frequent Hemodialysis Network (FHN) Trials

Abstract

Background: Patients undergoing maintenance hemodialysis frequently exhibit poor mental health. We studied the effects of frequent in-center and nocturnal hemodialysis on depressive symptoms and self-reported mental health.

Study design: 1-year randomized controlled clinical trials.

Setting & participants: Hemodialysis centers in the United States and Canada. 332 patients were randomly assigned to frequent (6-times-weekly) compared with conventional (3-times-weekly) hemodialysis in the Frequent Hemodialysis Network (FHN) Daily (n = 245) and Nocturnal (n = 87) Trials.

Intervention: The Daily Trial was a trial of frequent (6-times-weekly) compared with conventional (3-times-weekly) in-center hemodialysis. The Nocturnal Trial assigned patients to either frequent nocturnal (6-times-weekly) hemodialysis or conventional (3-times-weekly) hemodialysis.

Outcomes: Self-reported depressive symptoms and mental health.

Measurements: Beck Depression Inventory and the mental health composite score and emotional subscale of the RAND 36-Item Health Survey at baseline and 4 and 12 months. The mental health composite score is derived by summarizing these domains of the RAND 36-Item Health Survey: emotional, role emotional, energy/fatigue, and social functioning scales.

Results: In the Daily Trial, participants randomly assigned to frequent compared with conventional in-center hemodialysis showed no significant change over 12 months in adjusted mean Beck Depression Inventory score (-1.9 ± 0.7 vs -0.6 ± 0.7; P = 0.2), but experienced clinically significant improvements in adjusted mean mental health composite (3.7 ± 0.9 vs 0.2 ± 1.0; P = 0.007) and emotional subscale (5.2 ± 1.6 vs -0.3 ± 1.7; P = 0.01) scores. In the Nocturnal Trial, there were no significant changes in the same metrics in participants randomly assigned to nocturnal compared with conventional hemodialysis.

Limitations: Trial interventions were not blinded.

Conclusions: Frequent in-center hemodialysis, as compared with conventional in-center hemodialysis, improved self-reported general mental health. Changes in self-reported depressive symptoms were not statistically significant. We were unable to conclude whether nocturnal hemodialysis yielded similar effects.

Trial registration: ClinicalTrials.gov NCT00264758 NCT00271999.

Figure 1

Flow diagrams for (1) Daily Trial and (B) Nocturnal Trial showing the number of subjects enrolled, assigned to each study arm, and with baseline and 12-month ascertainment of each metric. *Two patients received kidney transplants late during follow-up and were included in the 12-month change in MHC and BDI analyses

Figure 2

A. Fraction of subjects who had a BDI Score >15 (Daily and Nocturnal Trials). B. Fraction of subjects who had a score <43 on the RAND-36 Mental Health Composite (Daily and Nocturnal Trials).

Figure 2

A. Fraction of subjects who had a BDI Score >15 (Daily and Nocturnal Trials). B. Fraction of subjects who had a score <43 on the RAND-36 Mental Health Composite (Daily and Nocturnal Trials).