title: Patients receiving frequent hemodialysis have better health-related quality of life compared to patients receiving conventional hemodialysis.
abstract: Most patients with end-stage kidney disease value their health-related quality of life (HRQoL) and want to know how it will be affected by their dialysis modality. We extended the findings of two prior clinical trial reports to estimate the effects of frequent compared to conventional hemodialysis on additional measures of HRQoL. The Daily Trial randomly assigned 245 patients to receive frequent (six times per week) or conventional (three times per week) in-center hemodialysis. The Nocturnal Trial randomly assigned 87 patients to receive frequent nocturnal (six times per week) or conventional (three times per week) home hemodialysis. All patients were on conventional hemodialysis prior to randomization, with an average feeling thermometer score of 70 to 75 (a visual analog scale from 0 to 100 where 100 is perfect health), an average general health scale score of 40 to 47 (a score from 0 to 100 where 100 is perfect health), and an average dialysis session recovery time of 2 to 3 hours. Outcomes are reported as the between-treatment group differences in one-year change in HRQoL measures and analyzed using linear mixed effects models. After one year in the Daily Trial, patients assigned to frequent in-center hemodialysis reported a higher feeling thermometer score, better general health, and a shorter recovery time after a dialysis session compared to standard thrice-weekly dialysis. After one year in the Nocturnal Trial, patients assigned to frequent home hemodialysis also reported a shorter recovery time after a dialysis session, but no statistical difference in their feeling thermometer or general health scores compared to standard home dialysis schedules. Thus, patients receiving day or nocturnal hemodialysis on average recovered approximately one hour earlier from a frequent compared to conventional hemodialysis session. Patients treated in an in-center dialysis facility reported better HRQoL with frequent compared to conventional hemodialysis.
authors.affiliation: Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada. Electronic address: amit.garg@lhsc.on.ca.
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.affiliation: Department of Medicine, Section of Nephrology, Centre de Recherche, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
authors.forename: Rita S
authors.initials: RS
authors.lastname: Suri
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Eggers
authors.affiliation: Yale School of Medicine and Yale New Haven Health System, New Haven, Connecticut, USA.
authors.forename: Fredric O
authors.initials: FO
authors.lastname: Finkelstein
authors.affiliation: University of Utah Medical Center, Salt Lake City, Utah, USA.
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.affiliation: Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Kimmel
authors.affiliation: Yale School of Medicine and Yale New Haven Health System, New Haven, Connecticut, USA.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Kliger
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Larive
authors.affiliation: Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Lindsay
authors.affiliation: Humber River Hospital, University of Toronto, Toronto, Canada.
authors.forename: Andreas
authors.initials: A
authors.lastname: Pierratos
authors.affiliation: Department of Internal Medicine, Division of Nephrology, University of New Mexico, Albuquerque, New Mexico, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Unruh
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: clinical trial; daily hemodialysis; health-related quality of life; nocturnal hemodialysis