A Trial of Extending Hemodialysis Hours and Quality of Life.
The relationship between increased hemodialysis hours and patient outcomes remains unclear. We randomized (1:1) 200 adult recipients of standard maintenance hemodialysis from in-center and home-based hemodialysis programs to extended weekly (≥24 hours) or standard (target 12-15 hours, maximum 18 hours) hemodialysis hours for 12 months. The primary outcome was change in quality of life from baseline assessed by the EuroQol 5 dimension instrument (3 level) (EQ-5D). Secondary outcomes included medication usage, clinical laboratory values, vascular access events, and change in left ventricular mass index. At 12 months, median weekly hemodialysis hours were 24.0 (interquartile range, 23.6-24.0) and 12.0 (interquartile range, 12.0-16.0) in the extended and standard groups, respectively. Change in EQ-5D score at study end did not differ between groups (mean difference, 0.04 [95% confidence interval, -0.03 to 0.11];P=0.29). Extended hours were associated with lower phosphate and potassium levels and higher hemoglobin levels. Blood pressure (BP) did not differ between groups at study end. Extended hours were associated with fewer BP-lowering agents and phosphate-binding medications, but were not associated with erythropoietin dosing. In a substudy with 95 patients, we detected no difference between groups in left ventricular mass index (mean difference, -6.0 [95% confidence interval, -14.8 to 2.7] g/m2;P=0.18). Five deaths occurred in the extended group and two in the standard group (P=0.44); two participants in each group withdrew consent. Similar numbers of patients experienced vascular access events in the two groups. Thus, extending weekly hemodialysis hours did not alter overall EQ-5D quality of life score, but was associated with improvement in some laboratory parameters and reductions in medication burden. (Clinicaltrials.gov identifier: NCT00649298).
The George Institute for Global Health, mjardine@georgeinstitute.org.au.|Department of Renal Medicine, Concord Repatriation General Hospital, Sydney, Australia.
Meg J
MJ
Jardine
Department of Nephrology, Peking University People's Hospital, Beijing, China.
Li
L
Zuo
Department of Renal Medicine, Nambour General Hospital, Nambour, Australia.|Sunshine Coast Clinical School, The University of Queensland, Brisbane, Australia.
Nicholas A
NA
Gray
Department of Nephrology, North Shore Hospital, University of Auckland, Auckland, New Zealand.
Janak R
JR
de Zoysa
Division of Nephrology, University Health Network, Toronto, Canada.
Christopher T
CT
Chan
The George Institute for Global Health.|Concord Clinical School.
Martin P
MP
Gallagher
The George Institute for Global Health.
Helen
H
Monaghan
Sydney Translational Imaging Laboratory, Charles Perkins Centre, Sydney Medical School, and.|Departments of Radiology, Cardiology, and.
Stuart M
SM
Grieve
Sunshine Coast Clinical School, The University of Queensland, Brisbane, Australia.|Specialist Magnetic Resonance Imaging, Newtown, Australia.
Rajesh
R
Puranik
First Affiliated Hospital of Dalian Medical University, Dalian, China.
Hongli
H
Lin
Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia.
Josette M
JM
Eris
Department of Nephrology, China-Japan Friendship Hospital, Beijing, China.
Ling
L
Zhang
Fourth Hospital Affiliated to Hebei Medical University, Shijiazhuang, China.
Jinsheng
J
Xu
School of Public Health, University of Sydney, Sydney, Australia.|Institute for Choice, University of South Australia, Sydney, Australia.
Kirsten
K
Howard
The George Institute for Global Health.
Serigne
S
Lo
Menzies School of Health Research, Charles Darwin University, Darwin, Australia; and.
Alan
A
Cass
The George Institute for Global Health.|Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia.
Vlado
V
Perkovic
D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis / Q000379:methods*; D013997:Time Factors
extended dialysis; hemodialysis; left ventricular hypertrophy; quality of life; randomized controlled trials