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Long-Term Effects of Frequent In-Center Hemodialysis
#MMPMID26467779
Chertow GM
; Levin NW
; Beck GJ
; Daugirdas JT
; Eggers PW
; Kliger AS
; Larive B
; Rocco MV
; Greene T
J Am Soc Nephrol
2016[Jun]; 27
(6
): 1830-6
PMID26467779
show ga
The Frequent Hemodialysis Network Daily Trial randomized 245 patients to receive
six (frequent) or three (conventional) in-center hemodialysis sessions per week
for 12 months. As reported previously, frequent in-center hemodialysis yielded
favorable effects on the coprimary composite outcomes of death or change in left
ventricular mass and death or change in self-reported physical health. Here, we
determined the long-term effects of the 12-month frequent in-center hemodialysis
intervention. We determined the vital status of patients over a median of 3.6
years (10%-90% range, 1.5-5.3 years) after randomization. Using an intention to
treat analysis, we compared the mortality hazard in randomized groups. In a
subset of patients from both groups, we reassessed left ventricular mass and
self-reported physical health a year or more after completion of the
intervention; 20 of 125 patients (16%) randomized to frequent hemodialysis died
during the combined trial and post-trial observation periods in contrast to 34 of
120 patients (28%) randomized to conventional hemodialysis. The relative
mortality hazard for frequent versus conventional hemodialysis was 0.54 (95%
confidence interval, 0.31 to 0.93); with censoring of time after kidney
transplantation, the relative hazard was 0.56 (95% confidence interval, 0.32 to
0.99). Bayesian analysis suggested a relatively high probability of clinically
significant benefit and a very low probability of harm with frequent
hemodialysis. In conclusion, a 12-month frequent in-center hemodialysis
intervention significantly reduced long-term mortality, suggesting that frequent
hemodialysis may benefit selected patients with ESRD.
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