Prognostic Value of the Delivery Dialysis Dose on Twice-Weekly Hemodialysis Patients.
BACKGROUND
Few studies have evaluated the prognostic value of dialysis dose in twice-weekly hemodialysis (HD). A single-pool Kt/V (spKt/V) over 1.70 may benefit patients receiving twice-weekly maintenance HD.


METHODS
This is a multicenter randomized controlled trial performed on 163 patients from 17 dialysis centers in Shanghai who were allocated to high- (n = 98) and standard-dose groups (n = 65) and followed through 96 weeks of study period. Therapeutic approaches were given to increase spKt/V to over 1.70 in the high-dose group. Data were collected every 12-24 weeks. The primary outcomes were all-cause mortality and major adverse cardio-cerebrovascular events (MACEs) occurrence, and secondary outcomes included residual kidney function (RKF) and health-related quality of life (HR-QOL).


RESULTS
The spKt/V in high-dose and standard-dose groups were 1.80 ± 0.23 and 1.55 ± 0.19, respectively, after an 8-week intervention (p < 0.001). At the end of the study, SF-36 physical function and total score in high-dose group were 82 (69-90) and 74 (47-84), respectively, both of which were higher than those in the standard-dose group. Decline in urine volume was observed in both groups with no significant difference (p = 0.431). No difference was found in overall survival between the 2 groups (p = 0.580). The 1-year MACE-free survival for high-dose group was 84.49%, better than 76.72% for standard-dose group (p = 0.029).


CONCLUSIONS
Higher spKt/V is also associated with MACE-free survival and better HR-QOL, especially in physical function aspect for twice-weekly dialysis patients. Increasing spKt/V over 1.70 in twice-weekly HD population does not cause loss of RKF.
Division of Nephrology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Qichen
Q
Fan
Yucheng
Y
Yan
Leyi
L
Gu
Liqun
L
He
Nan
N
Chen
Gengru
G
Jiang
Li
L
Yuan
Jun
J
Xue
Yun
Y
Zhang
Jun
J
Ma
Huimin
H
Jin
Weijie
W
Yuan
Zhiyong
Z
Guo
Lili
L
Guo
Niansong
N
Wang
Wei
W
Zhang
Zhibin
Z
Ye
Peiju
P
Mao
Xiaoling
X
Pi
Renhua
R
Lu
Mingli
M
Zhu
Weiming
W
Zhang
Zhaohui
Z
Ni
Jiaqi
J
Qian
Huihua
H
Pang
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome