Frequent Dialysis Does Not Markedly Improve Physical Health

A new study suggests that frequent hemodialysis treatments, which are time-consuming and take a considerable toll on patients, do not markedly improve the patients' actual health.

Researchers at the University of Washington (Seattle, USA) conducted a study involving participants in both the Frequent Hemodialysis Network (FHN) Daily (245 patients) and Nocturnal (87 patients) trials to examine changes in physical performance and self-reported physical health and functioning among subjects randomized to frequent (six times per week) compared with conventional (three times per week) hemodialysis. The main outcome measures were adjusted change over 12 months on the short physical performance battery (SPPB),the RAND 36-item health survey physical health composite (PHC), and the physical functioning subscale (PF) scores, based on the intention to treat principle.

The results showed that among the 245 patients in the Daily Trial, patients randomized to frequent compared with conventional dialysis experienced no significant change in physical performance, but they reported that they felt that their physical health and functioning had improved. Among the 87 patients in the Nocturnal Trial, patients who received frequent dialysis did not demonstrate better physical performance or report better physical health and functioning compared with patients who received conventional dialysis. Patients in both groups experienced improved physical health and functioning over the course of the year, though the researchers suggest this might be due to the switch from clinical to home-based treatments. The study was published ahead of print on March 15, 2012, in the Clinical Journal of the American Society of Nephrology (CJASN).

“Frequent hemodialysis as currently practiced may improve the lives of some, but is not a cost-effective or practical solution to improving the physical health of most patients with end-stage kidney disease,” said lead author Yoshio Hall, MD. “Faced with rising numbers of persons with progressive chronic kidney disease worldwide, we need to broadly consider innovative strategies beyond manipulating the dose of dialysis to substantially improve or preserve the physical capacity of patients with end-stage kidney disease.”

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