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PubMed ID:
26467779
Public Release Type:
Journal
Publication Year: 2016
Affiliation: Department of Medicine, Stanford University, Palo Alto, California; gchertow@stanford.edu.; Renal Research Institute, New York, New York;; Cleveland Clinic Foundation, Cleveland, Ohio;; University of Illinois, Chicago, Illinois;; National Institutes of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland;; Yale University, New Haven, Conneticut;; Cleveland Clinic Foundation, Cleveland, Ohio;; Wake Forest University, Winston-Slem, North Carolina; and.; Cleveland Clinic Foundation, Cleveland, Ohio; University of Utah, Salt Lake City, Utah.
DOI:
https://doi.org/10.1681/ASN.2015040426
Authors:
Chertow Glenn M, Levin Nathan W, Beck Gerald J, Daugirdas John T, Eggers Paul W, Kliger Alan S, Larive Brett, Rocco Michael V, Greene Tom
Request IDs:
20628
Studies:
Frequent Hemodialysis Network Daily Trial
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.
