Effects of Six versus Three Times per Week Hemodialysis on Physical Performance, Health, and Functioning

Abstract

SummaryBackground and objectives Relatively little is known about the effects of hemodialysis frequency on the disability of patients with ESRD.Design, setting, participants, & measurements This study examined changes in physical performance and selfreported physical health and functioning among subjects randomized to frequent (six times per week) compared with conventional (three times per week) hemodialysis in both the Frequent Hemodialysis Network daily (n=245) and nocturnal (n=87) trials. The main outcome measures were adjusted change in scores over 12 months on the short physical performance battery (SPPB), RAND 36-item health survey physical health composite (PHC), and physical functioning subscale (PF) based on the intention to treat principle.Results Overall scores for SPPB, PHC, and PF were poor relative to population norms and in line with other studies in ESRD. In the Daily Trial, subjects randomized to frequent compared with conventional in-center hemodialysis experienced no significant change in SPPB (adjusted mean change of 20.2060.19 versus 20.4160.21, P=0.45) but experienced significant improvement in PHC (3.460.8 versus 0.460.8, P=0.009) and a relatively large change in PF that did not reach statistical significance. In the Nocturnal Trial, there were no significant differences among subjects randomized to frequent compared with conventional hemodialysis in SPPB ( Conclusions Frequent in-center hemodialysis compared with conventional in-center hemodialysis improved self-reported physical health and functioning but had no significant effect on objective physical performance. There were no significant effects of frequent nocturnal hemodialysis on the same physical metrics.

How to Overcome Barriers and Establish a Successful Home HD Program

“…In this context, one study demonstrated no significant difference in HRQOL of patients treated with nocturnal HD or peritoneal dialysis (PD), both of which were performed at home (50). Nevertheless, the short-daily in-center FHN trial suggests that selected HRQOL measures, such as the physical health composite score of the Short-Form 36, improved significantly, even though objective measurements of exercise tolerance did not improve (51). Of note, however, sustained improvements in patient-reported outcomes have been demonstrated in a variety of measures, including sleep, restless legs, depressive symptoms, time to recovery after an HD session, and almost all domains on the Short-Form 36 (34,35,52).…”

Caregiver Burden and Hemodialysis

“…Executive function and global cognition are not improved, although enhanced performance was found on tests of memory and verbal fluency (7). Self-reported physical health and functioning were improved but had no significant effect on objective physical performance (8). The FHN Group also reported on cardiac function (9,10), anemia (11), residual kidney function (12), and nutrition (13).…”

Frequent Hemodialysis

“…As secondary outcomes, the FHN trial assessed the effect of frequent hemodialysis on physical performance, health, and functioning. The results are presented in this issue of CJASN by Hall et al (11).…”