Patients receiving frequent hemodialysis have better health-related quality of life compared to patients receiving conventional hemodialysis

Abstract

Most patients with end-stage kidney disease value their health-related quality of life (HRQoL) and want to know how it will be affected by their dialysis modality. We extended the findings of two prior clinical trial reports to estimate the effects of frequent compared to conventional hemodialysis on additional measures of HRQoL. The Daily Trial randomly assigned 245 patients to receive frequent (six times per week) or conventional (three times per week) in-center hemodialysis. The Nocturnal Trial randomly assigned 87 patients to receive frequent nocturnal (six times per week) or conventional (three times per week) home hemodialysis. All patients were on conventional hemodialysis prior to randomization, with an average feeling thermometer score of 70 to 75 (a visual analog scale from 0 to 100 where 100 is perfect health), an average general health scale score of 40 to 47 (a score from 0 to 100 where 100 is perfect health), and an average dialysis session recovery time of 2 to 3 hours. Outcomes are reported as the between-treatment group differences in one-year change in HRQoL measures and analyzed using linear mixed effects models. After one year in the Daily Trial, patients assigned to frequent in-center hemodialysis reported a higher feeling thermometer score, better general health, and a shorter recovery time after a dialysis session compared to standard thrice-weekly dialysis. After one year in the Nocturnal Trial, patients assigned to frequent home hemodialysis also reported a shorter recovery time after a dialysis session, but no statistical difference in their feeling thermometer or general health scores compared to standard home dialysis schedules. Thus, patients receiving day or nocturnal hemodialysis on average recovered approximately one hour earlier from a frequent compared to conventional hemodialysis session. Patients treated in an in-center dialysis facility reported better HRQoL with frequent compared to conventional hemodialysis.

Trial registration: ClinicalTrials.gov NCT00264758 NCT00271999.

Keywords: clinical trial; daily hemodialysis; health-related quality of life; nocturnal hemodialysis.

Figure 1

a. Flow diagram for Daily Trial showing the number of patients enrolled and assigned to each study am (intervention/control), and number of patients who completed the baseline and 12-month HRQoL measures, including reasons for drop-out. *Two patients received transplants late during follow-up and were included in the analyses for 12-month changes for the HUI3, General Health subscore and the Health Thermometer. One of the two transplanted patients also contributed to the analysis for 12-month changes in post-dialysis recovery time. b. Flow diagram for Nocturnal Trial showing the number of patients enrolled and assigned to each study am (intervention/control), and number of patients who completed the baseline and 12-month HRQoL measures, including reasons for drop-out. *One patient received a transplant late during follow-up and was included in the analyses for 12-month changes for the HUI3, General Health subscore and post-dialysis recovery time.

Figure 1

a. Flow diagram for Daily Trial showing the number of patients enrolled and assigned to each study am (intervention/control), and number of patients who completed the baseline and 12-month HRQoL measures, including reasons for drop-out. *Two patients received transplants late during follow-up and were included in the analyses for 12-month changes for the HUI3, General Health subscore and the Health Thermometer. One of the two transplanted patients also contributed to the analysis for 12-month changes in post-dialysis recovery time. b. Flow diagram for Nocturnal Trial showing the number of patients enrolled and assigned to each study am (intervention/control), and number of patients who completed the baseline and 12-month HRQoL measures, including reasons for drop-out. *One patient received a transplant late during follow-up and was included in the analyses for 12-month changes for the HUI3, General Health subscore and post-dialysis recovery time.

Figure 2