title: Long-Term Effects of Frequent In-Center Hemodialysis.
abstract: The Frequent Hemodialysis Network Daily Trial randomized 245 patients to receive six (frequent) or three (conventional) in-center hemodialysis sessions per week for 12 months. As reported previously, frequent in-center hemodialysis yielded favorable effects on the coprimary composite outcomes of death or change in left ventricular mass and death or change in self-reported physical health. Here, we determined the long-term effects of the 12-month frequent in-center hemodialysis intervention. We determined the vital status of patients over a median of 3.6 years (10%-90% range, 1.5-5.3 years) after randomization. Using an intention to treat analysis, we compared the mortality hazard in randomized groups. In a subset of patients from both groups, we reassessed left ventricular mass and self-reported physical health a year or more after completion of the intervention; 20 of 125 patients (16%) randomized to frequent hemodialysis died during the combined trial and post-trial observation periods in contrast to 34 of 120 patients (28%) randomized to conventional hemodialysis. The relative mortality hazard for frequent versus conventional hemodialysis was 0.54 (95% confidence interval, 0.31 to 0.93); with censoring of time after kidney transplantation, the relative hazard was 0.56 (95% confidence interval, 0.32 to 0.99). Bayesian analysis suggested a relatively high probability of clinically significant benefit and a very low probability of harm with frequent hemodialysis. In conclusion, a 12-month frequent in-center hemodialysis intervention significantly reduced long-term mortality, suggesting that frequent hemodialysis may benefit selected patients with ESRD.
authors.affiliation: Department of Medicine, Stanford University, Palo Alto, California; gchertow@stanford.edu.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.affiliation: Renal Research Institute, New York, New York;
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Levin
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio;
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Beck
authors.affiliation: University of Illinois, Chicago, Illinois;
authors.forename: John T
authors.initials: JT
authors.lastname: Daugirdas
authors.affiliation: National Institutes of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland;
authors.forename: Paul W
authors.initials: PW
authors.lastname: Eggers
authors.affiliation: Yale University, New Haven, Conneticut;
authors.forename: Alan S
authors.initials: AS
authors.lastname: Kliger
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio;
authors.forename: Brett
authors.initials: B
authors.lastname: Larive
authors.affiliation: Wake Forest University, Winston-Slem, North Carolina; and.
authors.forename: Michael V
authors.initials: MV
authors.lastname: Rocco
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio; University of Utah, Salt Lake City, Utah.
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
mesh_terms: D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D013997:Time Factors
keywords: clinical trial; end-stage renal disease; hemodialysis