Scope and design of the Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements (FREEDOM) Study.
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.
Jaber
Bertrand L
BL
Tufts University School of Medicine, Boston, MA, USA. bertrand.jaber@caritaschristi.org
Finkelstein
Fredric O
FO
Glickman
Joel D
JD
Hull
Alan R
AR
Kraus
Michael A
MA
Leypoldt
John K
JK
Liu
Jiannong
J
Gilbertson
David
D
McCarthy
James
J
Miller
Brent W
BW
Moran
John
J
Collins
Allan J
AJ
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