title: Scope and design of the Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements (FREEDOM) Study.
abstract: BACKGROUND
  Conventional thrice-weekly hemodialysis (HD) has limited the ability to generate further improvements in patient quality of life, morbidity, and mortality. Daily HD (DHD) offers the promise of providing clinical and economic benefits. The objectives of the Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements Study are to evaluate outcomes of DHD (6 times/wk) with the NxStage System One (NxStage Medical Inc, Lawrence, MA) device.
  
  
  METHODS
  Cohort study with matched control group.
  
  
  METHODS
  The DHD group will include up to 500 participants at 70 clinical sites, enrolling for 3 years with a minimum of 1-year follow-up. Study candidates include adult patients (age >or= 18 years) with end-stage renal disease who are considered suitable candidates for DHD with the NxStage System One device by the treating physician and who have Medicare as their primary insurance payer. The control group will consist of a matched thrice-weekly in-center HD cohort derived from the US Renal Data System database using a 10:1 ratio, totaling 5,000 patients.
  
  
  METHODS
  Treatment with DHD and "standard of care" thrice-weekly HD.
  
  
  METHODS
  The primary intent-to-treat analysis compares hospitalization days/patient-year between the DHD and thrice-weekly HD groups. Other outcomes recorded in both groups include non-treatment-related medical expenditures. In addition, in the DHD cohort, changes in quality-of-life measures (baseline, 4 and 12 months, and every 6 months thereafter); urea kinetics; parameters related to anemia, bone and mineral metabolism, and nutrition; vascular access interventions; and use of medications will be examined.
  
  
  CONCLUSIONS
  This study has the potential to elucidate the health and economic benefits of DHD and complement results of current clinical trials.
authors.affiliation: Tufts University School of Medicine, Boston, MA, USA. bertrand.jaber@caritaschristi.org
authors.forename: Bertrand L
authors.initials: BL
authors.lastname: Jaber
authors.forename: Fredric O
authors.initials: FO
authors.lastname: Finkelstein
authors.forename: Joel D
authors.initials: JD
authors.lastname: Glickman
authors.forename: Alan R
authors.initials: AR
authors.lastname: Hull
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kraus
authors.forename: John K
authors.initials: JK
authors.lastname: Leypoldt
authors.forename: Jiannong
authors.initials: J
authors.lastname: Liu
authors.forename: David
authors.initials: D
authors.lastname: Gilbertson
authors.forename: James
authors.initials: J
authors.lastname: McCarthy
authors.forename: Brent W
authors.initials: BW
authors.lastname: Miller
authors.forename: John
authors.initials: J
authors.lastname: Moran
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Collins
mesh_terms: D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D011788:Quality of Life; D006435:Renal Dialysis / Q000191:economics / Q000379:methods; D011795:Surveys and Questionnaires; D016896:Treatment Outcome