Gihad E. Nesrallah, MD
Does increasing the frequency of treatment reduce adverse clinical outcomes in patients undergoing maintenance hemodialysis (HD)?
Randomized controlled trial (Frequent Hemodialysis Network [FHN] Trial). ClinicalTrials.gov NCT00264758.
Blinded (outcome adjudicators).†
65 university- and community-based HD facilities in North America.
245 patients ≥ 13 years of age (mean age 50 y, 62% men) with end-stage renal disease requiring long-term renal replacement therapy. Exclusion criteria included weight < 30 kg, mean eKt/V < 1.0 for the last 2 baseline dialysis sessions, need for dialysis > 3 times per week, expectation that native kidneys would recover, and residual renal clearance > 3 mL/min/35 L.
Frequent in-center HD 6 times per week with target equilibrated Kt/Vn 0.9 and length of session 1.5 to 2.75 hours (n = 125), or usual in-center HD 3 times per week with minimum target equilibrated Kt/Vurea 1.1 and session length 2.5 to 4.0 hours (n = 120). Kt/Vn and Kt/Vurea are clearance targets based on urea removal and estimated urea volume of distribution.
A composite of death or change in left ventricular mass and a composite of death or change in the physical health composite score from the RAND 36-item health survey. Other outcomes included time to first vascular access intervention.
81% for composite of death or change in left ventricular mass and 86% for composite of death or change in the RAND-36 physical health composite score (intention-to-treat analysis).
The frequent HD group had more treatments per week (mean 5.2 vs 2.9, P < 0.001) and more total dialysis time (mean 12.7 vs 10.4 h/wk, P < 0.001) than the usual HD group. Frequent dialysis reduced both coprimary endpoints and time to first vascular access intervention compared with usual HD (Table).
Increasing the frequency of treatment reduced some adverse clinical outcomes in patients undergoing maintenance dialysis.
Frequent vs usual dialysis in patients with end-stage renal disease undergoing maintenance dialysis†
†CI defined in Glossary. Death (4.0% vs 7.5%, difference 3.5%, 95% CI −2.6 to 10 ), change in left ventricular mass from baseline to 12 mo (−16.3 g vs −2.4 g, P < 0.001), change in RAND-36 physical health composite from baseline to 12 mo (3.3 vs 0.1, P = 0.004; scores range from 0 to 100, with higher scores indicating better health status).
Nesrallah GE. Increased frequency of hemodialysis reduced adverse clinical outcomes. Ann Intern Med. ;154:JC4–6. doi: 10.7326/0003-4819-154-8-201104190-02006
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Published: Ann Intern Med. 2011;154(8):JC4-6.
Nephrology, Renal Replacement Therapy.
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