title: Short, frequent, 5-days-per-week, in-center hemodialysis versus 3-days-per week treatment: a randomized crossover pilot trial through the Midwest Pediatric Nephrology Consortium.
abstract: BACKGROUND
  No controlled trials in children with end-stage kidney disease have assessed the benefits of more frequently administered hemodialysis (HD).
  
  
  METHODS
  We conducted a multicenter, crossover pilot trial to determine if short, more frequent (5 days per week) in-center HD was feasible and associated with improvements in blood pressure compared with three conventional HD treatments per week. Because adult studies have not controlled for the weekly duration of dialysis, we fixed the total treatment time at 12 h a week of dialysis during two 3-month study periods; only frequency varied from 5 to 3 days per week between study periods.
  
  
  RESULTS
  Eight children (median age 16.7 years) consented at three children's hospitals. The prespecified primary composite outcome was a sustained 10% decrease in systolic blood pressure and/or a decrease in antihypertensive medications relative to each study period's baseline. Among the six patients completing both study periods, five (83.3%) experienced the primary outcome during HD performed 5 days per week but not 3 days per week; one of the six (16.7%) achieved that outcome during 3-day but not 5-day (p = 0.22) per week HD. During 5-day HD, all patients had significantly more treatments during which their pre-HD systolic (p = 0.01) or diastolic (p = 0.01) blood pressure was 10% lower than baseline.
  
  
  CONCLUSIONS
  We observed that more frequent HD sessions per week was feasible and associated with improved blood pressure control, but barriers to changing thrice-weekly standard of care include financial reimbursement and the time demands associated with more frequent treatments.
authors.affiliation: Division of Nephrology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA. laskinb@email.chop.edu.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Laskin
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Guixia
authors.initials: G
authors.lastname: Huang
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Eileen
authors.initials: E
authors.lastname: King
authors.affiliation: Sidra Medical and Research Center, Doha, Qatar.
authors.forename: Denis F
authors.initials: DF
authors.lastname: Geary
authors.affiliation: Division of Nephrology, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Christoph
authors.initials: C
authors.lastname: Licht
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Metlay
authors.affiliation: Division of Nephrology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA.|Department of Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Furth
authors.affiliation: Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Tom
authors.initials: T
authors.lastname: Kimball
authors.affiliation: Division Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Mitsnefes
mesh_terms: D000293:Adolescent; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001795:Blood Pressure Determination; D018592:Cross-Over Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D007349:Insurance, Health, Reimbursement; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D015146:Midwestern United States; D009398:Nephrology; D010865:Pilot Projects; D006435:Renal Dialysis / Q000191:economics* / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: Children; End-stage kidney disease; Hypertension; More frequent hemodialysis