Impact of Expanded Hemodialysis Using Medium Cut-off Dialyzer on Quality of Life: Application of Dynamic Patient-Reported Outcome Measurement Tool

Penny, Jarrin D; Jarosz, Patricia A.; Salerno, Fabio; Lemoine, Sandrine; McIntyre, Christopher W.

doi:10.1016/j.xkme.2021.05.010

Cited by 3 publications

(2 citation statements)

References 27 publications

(78 reference statements)

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“…Based on these findings, we surmise that the timing of questionnaire administration should be an important consideration in the design of future, larger clinical trials. Prior studies pointed to multidimensional features of patient-reported quality of life measures that vary over time, emphasizing the need for serial assessments [ 9 , 34 , 35 ]. For a clinical trial of twice-weekly HD start vs thrice-weekly HD, eliciting patient-reported symptoms after conversion from twice-weekly to thrice-weekly HD will miss the opportunity to properly characterize patient-reported outcomes by different schedules of HD treatment.…”

Section: Discussionmentioning

confidence: 99%

Patient-reported outcomes in a pilot clinical trial of twice-weekly hemodialysis start with adjuvant pharmacotherapy and transition to thrice-weekly hemodialysis vs conventional hemodialysis

et al. 2022

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Background Physical and emotional symptoms are prevalent in patients with kidney-dysfunction requiring dialysis (KDRD) and the rigors of thrice-weekly hemodialysis (HD) may contribute to deteriorated health-related quality of life. Less intensive HD schedules might be associated with lower symptom and/or emotional burden. Methods The TWOPLUS Pilot study was an individually-randomized trial conducted at 14 dialysis units, with the primary goal to assess feasibility and safety. Patients with incident KDRD and residual kidney function were assigned to incremental HD start (twice-weekly HD for 6 weeks followed by thrice-weekly HD) vs conventional HD (thrice-weekly HD). In exploratory analyses, we compared the two treatment groups with respect to three patient-reported outcomes measures. We analyzed the change from baseline in the score on Dialysis Symptom Index (DSI, range 0–150), Generalized Anxiety Disorder-7 (GAD-7, range 0–21), and Patient Health Questionnaire-9 (PHQ-9, range 0–27) at 6 (n = 20 in each treatment group) and 12 weeks (n = 21); with lower scores denoting lower symptom burden. Analyses were adjusted for age, race, gender, baseline urine volume, diabetes mellitus, and malignancy. Participants’ views on the intervention were sought using a Patient Feedback Questionnaire (n = 14 in incremental and n = 15 in conventional group). Results The change from baseline to week 6 in estimated mean score (standard error; P value) in the incremental and conventional group was − 9.7 (4.8; P = 0.05) and − 13.8 (5.0; P = 0.009) for DSI; − 1.9 (1.0; P = 0.07) and − 1.5 (1.4; P = 0.31) for GAD-7; and − 2.5 (1.1; P = 0.03) and − 3.5 (1.5; P = 0.02) for PHQ-9, respectively. Corresponding changes from week 6 to week 12 were − 3.1 (3.2; P = 0.34) and − 2.4 (5.5; P = 0.67) in DSI score; 0.5 (0.6; P = 0.46) and 0.1 (0.6; P = 0.87) in GAD-7 score; and − 0.3 (0.6; P = 0.70) and − 0.5 (0.6; P = 0.47) in PHQ-9 score, respectively. Majority of respondents felt their healthcare was not jeopardized and expressed their motivation for study participation was to help advance the care of patients with KDRD. Conclusions This study suggests a possible mitigating effect of twice-weekly HD start on symptoms of anxiety and depression at transition from pre-dialysis to KDRD. Larger clinical trials are required to rigorously test clinically-matched incrementally-prescribed HD across diverse organizations and patient populations. Trial registration Registered at ClinicalTrials.gov with study identifier NCT03740048, registration date 14/11/2018.

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Section: Discussionmentioning

confidence: 99%

Patient-reported outcomes in a pilot clinical trial of twice-weekly hemodialysis start with adjuvant pharmacotherapy and transition to thrice-weekly hemodialysis vs conventional hemodialysis

et al. 2022

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“…Expanded Hemodialysis Therapy: From the Rational to the Delivery DOI: http://dx.doi.org /10.5772/intechopen.110262 Several studies aimed to compare the use of HDx with conventional hemodialysis or HDF in improving QOL parameters, using several scores (LEVIL, KDQOL -SF 36, PROM POS-S Renal Symptom questionnaire and the "Recovery time from last dialysis session) [43,44]. The major items assessed were dialysis symptom index, restless legs syndrome, sleep, energy, and well-being.…”

Section: Quality Of Lifementioning

confidence: 99%

Expanded Hemodialysis Therapy: From the Rational to the Delivery

Kabbali¹,

Chouhani²

2023

Updates on Hemodialysis

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Expanded hemodialysis therapy is a new concept in blood purification technology using a specific membrane with a steep sieving curve characterized by medium membrane cutoff and high retention onset values that are close to but lower than those of albumin. Expanded hemodialysis therapy thereby targets an important pathophysiologic link to many of the sequelae of end-stage renal disease, by improving the clearance of medium to larger-size solutes. The significant internal filtration achieved in these hemodialyzers provides a remarkable convective clearance of medium to high solutes. This therapy does not need specific software or additional complex technology, making its application possible in every setting once the quality of the dialysis fluid is guaranteed to ensure the safe conduct of the dialysis session. The present chapter reviews the rationale for expanded hemodialysis therapy, the potential benefits, and the considerations for prescription and delivery.

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Introductory Chapter: Updates on Hemodialysis

Karkar

2023

Updates on Hemodialysis

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monitoring, HD-related complications, hypertension in HD, errors in HD practices, and psychological status of HD patients, management and innovation of vascular access techniques, resistance to erythropoietin and its prescription, and extracorporeal management of liver failure. "Updates on Hemodialysis" book has also focused on the recent innovation in dialysis membranes/dialyzers, particularly the medium off membrane and its ability to remove the larger-size uremic toxins more efficiently in a HD modality known as expanded hemodialysis (HDx).

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Impact of Expanded Hemodialysis Using Medium Cut-off Dialyzer on Quality of Life: Application of Dynamic Patient-Reported Outcome Measurement Tool

Cited by 3 publications

References 27 publications

Patient-reported outcomes in a pilot clinical trial of twice-weekly hemodialysis start with adjuvant pharmacotherapy and transition to thrice-weekly hemodialysis vs conventional hemodialysis

Patient-reported outcomes in a pilot clinical trial of twice-weekly hemodialysis start with adjuvant pharmacotherapy and transition to thrice-weekly hemodialysis vs conventional hemodialysis

Expanded Hemodialysis Therapy: From the Rational to the Delivery

Introductory Chapter: Updates on Hemodialysis

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