Effects of 6-Times-Weekly Versus 3-Times-Weekly Hemodialysis on Depressive Symptoms and Self-reported Mental Health: Frequent Hemodialysis Network (FHN) Trials

Abstract

Background Patients undergoing maintenance hemodialysis frequently exhibit poor mental health. We studied the effects of frequent in-center and nocturnal hemodialysis on depressive symptoms and self-reported mental health. Study Design 1-year randomized-controlled clinical trials. Setting & Participants Hemodialysis centers in the United States and Canada. A total of 332 patients were randomized to frequent (six times per week) as compared with conventional (three times per week) hemodialysis in the Frequent Hemodialysis Network (FHN) Daily (n=245) and Nocturnal (n=87) Trials. Intervention Daily Trial was a trial of frequent (six times per week), as compared with conventional (three times per week) in-center hemodialysis. The Nocturnal Trial assigned patients to either frequent nocturnal hemodialysis (six times per week) or conventional hemodialysis (three times per week). Outcomes Self-reported depressive symptoms and mental health. Measurements Beck Depression Inventory (BDI) and the mental health composite (MHC) score and emotional subscale of the RAND 36-Item Health Survey at baseline, 4 and 12 months. The MHC score is derived by summarizing these domains of the RAND 36-Item Health Survey: emotional, role emotional, energy/fatigue, and social functioning scales. Results In the Daily Trial, subjects randomized to frequent as compared with conventional in-center hemodialysis demonstrated no significant change over 12 months in adjusted mean BDI (−1.9 ± 0.7 vs. −0.6 ± 0.7; p=0.2), but experienced clinically significant improvements in adjusted mean MHC (3.7 ± 0.9 vs. 0.2 ± 1.0; P<0.01) and the emotional subscale (5.2 ± 1.6 vs. −0.3 ± 1.7; p=0.01). In the Nocturnal Trial, there were no significant changes among subjects randomized to nocturnal as compared with conventional hemodialysis on the same metrics. Limitations The trial interventions were not blinded. Conclusions Frequent in-center hemodialysis, as compared with conventional in-center hemodialysis, improved self-reported general mental health. Changes in self-reported depressive symptoms were not statistically significant. We were unable to conclude whether nocturnal hemodialysis yielded similar effects.

Survival by Dialysis Modality—Who Cares?

“…There is sufficient cumulative evidence that PD and conventional HD survival are similar enough (Figure 1; 8,21,29) that what our patients will need to guide them in choosing a modality are studies of the quality of life on different modalities and how that quality of life can be improved. The CHOICE, Netherlands Cooperative Study on the Adequacy of Dialysis, Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements, Frequent Hemodialysis Network, and other studies reported on quality of life in relation to dialysis modality but did not address the question of how to maximize quality of life within the constraints of the expected survival on a given modality (30)(31)(32)(33)(34)(35)(36)(37). Patients, policymakers, and even physicians believe and hope that longer survival will mean better quality of life, but this is often not the case.…”

Caregiver Burden and Hemodialysis

“…Other findings are as follows: participants assigned to frequent compared with conventional in-center hemodialysis show no significant change over 12 months in adjusted mean Beck Depression Inventory scores, whereas they experience clinically significant improvements in adjusted mean mental health composite and emotional subscale scores (6). Executive function and global cognition are not improved, although enhanced performance was found on tests of memory and verbal fluency (7).…”

Ev Hemodiyalizinde Çocuk Hasta Deneyimi: Olgu Sunumu

“…Daha yavaş kan akım hızı ve uzun süreli uygulamalar sayesinde hastalarda kas krampları, halsizlik ve hipotansiyon gibi bulgular daha az oranlarda rapor edilmektedir. Farklı çalışmalarda, nokturnal veya daha sık aralıklarla yapılan diyalizin sıvı fazlalığının kontrolü, üremik toksinlerin temizlenmesi ve diyaliz yeterliliği üzerindeki güçlü ve olumlu etkisinin üzerinde sıklıkla durulmaktadır (14)(15)(16)(17). Ev HD' nin aynı zamanda SDBY' ne bağlı gelişen anemide iyileşme, eritropoetin ve demir ihtiyacında azalma, sol ventrikül kitle indeksinde anlamlı düzelmeler sağladığı da ifade edilmektedir (18)(19)(20).…”

“…Ev HD' nin aynı zamanda SDBY' ne bağlı gelişen anemide iyileşme, eritropoetin ve demir ihtiyacında azalma, sol ventrikül kitle indeksinde anlamlı düzelmeler sağladığı da ifade edilmektedir (18)(19)(20). Dahası, bu yöntem ile fosforun daha yüksek oranda uzaklaştırıldığı, fosfor bağlayıcı kullanımında anlamlı düşüş olduğu, buna bağlı olarak kemik mineral metabolizmasında görülen bozukluklarda iyileşme ve fibroblast büyüme faktörü 23'te azalma olduğu da saptanmıştır (17,21). Tüm bunlara ek olarak, egzersiz kapasitesinde, beslenme durumundaki iyileşmeler de dikkati çekmektedir (17,22,23).…”

“…Dahası, bu yöntem ile fosforun daha yüksek oranda uzaklaştırıldığı, fosfor bağlayıcı kullanımında anlamlı düşüş olduğu, buna bağlı olarak kemik mineral metabolizmasında görülen bozukluklarda iyileşme ve fibroblast büyüme faktörü 23'te azalma olduğu da saptanmıştır (17,21). Tüm bunlara ek olarak, egzersiz kapasitesinde, beslenme durumundaki iyileşmeler de dikkati çekmektedir (17,22,23). Ev HD ile tedavisi bireyselleştirilen hastalarda, haftada üç seans merkezde HD uygulayan hastalara göre uzun dönem mortalite, hastaneye yatış oranlarında azalma, yaşam-uyku kalitesinde artış saptandığı da ifade edilmektedir (24).…”