title: Intensive Hemodialysis and Health-Related Quality of Life.
abstract: Diminished health-related quality of life (HRQoL) is common in dialysis patients and associated with increased risks for morbidity and mortality. Patients may present limitations in both physical and mental HRQoL. Poor physical HRQoL may be defined by limited physical function, role limitations due to physical health, dissatisfaction with physical ability, and impaired mobility. Sleep disorders such as obstructive sleep apnea, restless legs, and fatigue are typical manifestations of poor physical HRQoL in dialysis patients. Poor mental HRQoL may be defined by depressive thinking, lack of positive affect, anxiety, and feelings of social isolation. The prevalence of depression is high in dialysis patients. Intensive hemodialysis (HD) can positively address HRQoL. In 3 randomized clinical trials, relative to conventional HD, intensive HD increased physical and mental component summary scores from the 36-Item Short-Form Health Survey (SF-36), although individual treatment effects of daily nocturnal HD were not statistically significant. In another large prospective study, initiation of short daily HD therapy was followed after 12 months by improvements in all SF-36 domains, sleep quality, and restless legs symptoms. In a small study of nocturnal HD, apnea and hypopnea episodes per hour decreased by almost 70% after conversion from conventional HD. Intensive HD is also associated with a large reduction in postdialysis recovery time. In contrast, 2 randomized clinical trials failed to demonstrate statistically significant effects of intensive HD on the Beck Depression Inventory score despite a significant decrease in Beck Depression Inventory score in the prospective study of short daily HD. Furthermore, intensive HD may not improve objective physical performance and can increase burden on caregivers in the home setting. In conclusion, intensive HD potentially can address both physical and mental aspects of poor HRQoL relative to conventional HD. However, more studies are needed to understand the effects of intensive HD, including specific schedules, on HRQoL.
authors: Indiana University Medical School, Indianapolis, IN.
authors: Michael A
authors: MA
authors: Kraus
authors: Department of Renal Medicine, Royal Derby Hospital, Derby, United Kingdom.
authors: Richard J
authors: RJ
authors: Fluck
authors: Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN. Electronic address: wein0205@umn.edu.
authors: Eric D
authors: ED
authors: Weinhandl
authors: Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH.
authors: Sheru
authors: S
authors: Kansal
authors: Division of Nephrology, University of British Columbia, Vancouver, Canada.
authors: Michael
authors: M
authors: Copland
authors: Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Seven Oaks General Hospital Renal Program, Winnipeg, Canada.
authors: Paul
authors: P
authors: Komenda
authors: Yale University School of Medicine, New Haven, CT.
authors: Fredric O
authors: FO
authors: Finkelstein
mesh_terms: D003863:Depression / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D012893:Sleep Wake Disorders / Q000209:etiology
keywords: Caregiver; Frequent Hemodialysis Network; chronic kidney disease; daily dialysis; depression; end stage renal disease (ESRD); fatigue; home dialysis; intensive hemodialysis; nocturnal hemodialysis; quality of life; restless legs syndrome; review; short daily hemodialysis; sleep apnea