title: In-center hemodialysis six times per week versus three times per week.
abstract: BACKGROUND
  In this randomized clinical trial, we aimed to determine whether increasing the frequency of in-center hemodialysis would result in beneficial changes in left ventricular mass, self-reported physical health, and other intermediate outcomes among patients undergoing maintenance hemodialysis.
  
  
  METHODS
  Patients were randomly assigned to undergo hemodialysis six times per week (frequent hemodialysis, 125 patients) or three times per week (conventional hemodialysis, 120 patients) for 12 months. The two coprimary composite outcomes were death or change (from baseline to 12 months) in left ventricular mass, as assessed by cardiac magnetic resonance imaging, and death or change in the physical-health composite score of the RAND 36-item health survey. Secondary outcomes included cognitive performance; self-reported depression; laboratory markers of nutrition, mineral metabolism, and anemia; blood pressure; and rates of hospitalization and of interventions related to vascular access.
  
  
  RESULTS
  Patients in the frequent-hemodialysis group averaged 5.2 sessions per week; the weekly standard Kt/V(urea) (the product of the urea clearance and the duration of the dialysis session normalized to the volume of distribution of urea) was significantly higher in the frequent-hemodialysis group than in the conventional-hemodialysis group (3.54±0.56 vs. 2.49±0.27). Frequent hemodialysis was associated with significant benefits with respect to both coprimary composite outcomes (hazard ratio for death or increase in left ventricular mass, 0.61; 95% confidence interval [CI], 0.46 to 0.82; hazard ratio for death or a decrease in the physical-health composite score, 0.70; 95% CI, 0.53 to 0.92). Patients randomly assigned to frequent hemodialysis were more likely to undergo interventions related to vascular access than were patients assigned to conventional hemodialysis (hazard ratio, 1.71; 95% CI, 1.08 to 2.73). Frequent hemodialysis was associated with improved control of hypertension and hyperphosphatemia. There were no significant effects of frequent hemodialysis on cognitive performance, self-reported depression, serum albumin concentration, or use of erythropoiesis-stimulating agents.
  
  
  CONCLUSIONS
  Frequent hemodialysis, as compared with conventional hemodialysis, was associated with favorable results with respect to the composite outcomes of death or change in left ventricular mass and death or change in a physical-health composite score but prompted more frequent interventions related to vascular access. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; ClinicalTrials.gov number, NCT00264758.).
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Levin
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Beck
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Depner
authors.forename: Paul W
authors.initials: PW
authors.lastname: Eggers
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Gassman
authors.forename: Irina
authors.initials: I
authors.lastname: Gorodetskaya
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.forename: Sam
authors.initials: S
authors.lastname: James
authors.forename: Brett
authors.initials: B
authors.lastname: Larive
authors.forename: Robert M
authors.initials: RM
authors.lastname: Lindsay
authors.forename: Ravindra L
authors.initials: RL
authors.lastname: Mehta
authors.forename: Brent
authors.initials: B
authors.lastname: Miller
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Ornt
authors.forename: Sanjay
authors.initials: S
authors.lastname: Rajagopalan
authors.forename: Anjay
authors.initials: A
authors.lastname: Rastogi
authors.forename: Michael V
authors.initials: MV
authors.lastname: Rocco
authors.forename: Brigitte
authors.initials: B
authors.lastname: Schiller
authors.forename: Olga
authors.initials: O
authors.lastname: Sergeyeva
authors.forename: Gerald
authors.initials: G
authors.lastname: Schulman
authors.forename: George O
authors.initials: GO
authors.lastname: Ting
authors.forename: Mark L
authors.initials: ML
authors.lastname: Unruh
authors.forename: Robert A
authors.initials: RA
authors.lastname: Star
authors.forename: Alan S
authors.initials: AS
authors.lastname: Kliger
mesh_terms: D000328:Adult; D000368:Aged; D003863:Depression / Q000453:epidemiology; D005260:Female; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D054559:Hyperphosphatemia / Q000517:prevention & control; D006973:Hypertension / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods* / Q000523:psychology; D016896:Treatment Outcome