A trial of extending hemodialysis hours and quality of life

Meg J. Jardine, Li Zuo, Nicholas A. Gray, Janak R. De Zoysa, Christopher T Chan, Martin P. Gallagher, Helen Monaghan, Stuart M. Grieve, Rajesh Puranik, Hongli Lin, Josette M. Eris, Ling Zhang, Jinsheng Xu, Kirsten Howard, Serigne Lo, Alan Cass, Vlado Perkovic

    Research output: Contribution to journalArticle

    Abstract

    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 extendedweekly ($24 hours) or standard (target 12-15 hours, maximum18 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 ventricularmass index. At 12months, 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, 20.03 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 hourswere associatedwith fewer BP-lowering agents and phosphate-bindingmedications, but were not associated with erythropoietin dosing. In a substudy with 95 patients,wedetected no differencebetween groups in left ventricularmass index (meandifference,26.0 [95%confidenceinterval,214.8 to 2.7]g/m2;P=0.18).Fivedeaths 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 twogroups. Thus, extendingweekly 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).

    Original languageEnglish
    Pages (from-to)1898-1911
    Number of pages14
    JournalJournal of the American Society of Nephrology : JASN
    Volume28
    Issue number6
    DOIs
    Publication statusPublished - Jun 2017

    Fingerprint Dive into the research topics of 'A trial of extending hemodialysis hours and quality of life'. Together they form a unique fingerprint.

  • Cite this

    Jardine, M. J., Zuo, L., Gray, N. A., De Zoysa, J. R., Chan, C. T., Gallagher, M. P., Monaghan, H., Grieve, S. M., Puranik, R., Lin, H., Eris, J. M., Zhang, L., Xu, J., Howard, K., Lo, S., Cass, A., & Perkovic, V. (2017). A trial of extending hemodialysis hours and quality of life. Journal of the American Society of Nephrology : JASN, 28(6), 1898-1911. https://doi.org/10.1681/ASN.2015111225