The effect of frequent hemodialysis on nutrition and body composition: Frequent Hemodialysis Network Trial

Kaysen, George A.; Greene, Tom; Larive, Brett; Mehta, Ravindra L.; Lindsay, Robert M.; Depner, Tom; Hall, Yoshio N.; Daugirdas, John T.; Chertow, Glenn M.

doi:10.1038/ki.2012.75

Cited by 71 publications

(85 citation statements)

References 32 publications

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“…The recently published Frequent Hemodialysis Network (FHN) Trial failed to demonstrate beneficial effects of frequent NHD on body composition, nutritional parameters and extracellular fluid volume [25]. In the Nocturnal Trial part of the study, serum albumin increased by 0.20 ± 0.05 g/dl in the nocturnal arm, similarly to previous studies [5,11,14].…”

Section: Discussionsupporting

confidence: 67%

Effects of Three Times Weekly Eight-Hour Nocturnal Hemodialysis on Volume and Nutritional Status

Demirci¹,

Özkahya

Demirci

et al. 2013

Am J Nephrol

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Background: This prospective cohort study compared the changes in body water composition and nutritional parameters measured with multifrequency bioimpedance analysis between 8-hour three times weekly nocturnal hemodialysis (NHD) and 4-hour conventional hemodialysis (CHD) patients. Patients and Methods: 55 patients on CHD and 57 patients on NHD were included in the study. Multifrequency bioimpedance analysis was performed at baseline and at the 12th month. The primary outcomes of the study were changes in extracellular water (ECW), fat mass, dry lean mass and phase angle. Secondary outcomes of the study included changes in blood pressure and biochemical parameters related to nutrition and inflammation. Results: ECW/height values decreased in the NHD group, while they increased in the CHD group. Fat mass, dry lean mass, and serum albumin increased and high sensitive CRP decreased in the NHD group but did not change in the CHD group. When changes in parameters from baseline to the 12th month between the groups were compared, NHD was associated with improvement in volume parameter including ECW/height (difference -0.44 l/m, p < 0.001). Change in blood pressure was not different between the groups, however requirement for antihypertensive medication decreased from 26.5 to 8.5% in the NHD group (p = 0.002). NHD was also associated with increases in fat mass (difference 1.8 kg, p < 0.001), dry lean mass (difference 0.6 kg, p = 0.006), serum albumin (difference 0.19 g/dl, p < 0.001) and cholesterol (difference 18.8 mg, p < 0.001). Phase angle values decreased in the CHD group but did not change in the NHD group (difference between the groups 0.37°, p = 0.04). Conclusion: This study revealed that longer HD facilitates volume control and improves nutritional status.

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Section: Discussionsupporting

confidence: 67%

Effects of Three Times Weekly Eight-Hour Nocturnal Hemodialysis on Volume and Nutritional Status

Demirci¹,

Özkahya

Demirci

et al. 2013

Am J Nephrol

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“…Trial design, 9 baseline characteristics, 14 primary results, 10 and the effects of the intervention on several secondary outcomes [15][16][17][18][19][20][21][22] have been published.…”

Section: Concise Methodsmentioning

confidence: 99%

Long-Term Effects of Frequent In–Center Hemodialysis

Chertow

Levin

Beck

et al. 2015

JASN

Self Cite

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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 incenter 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. Nearly 400,000 persons in the United States and .2 million worldwide are dialysis dependent; of these, .90% in the United States and 70% in Canada receive hemodialysis, typically delivered thrice weekly. 1 Mortality rates in the hemodialysis population remain high (approximately 15%-20% per year overall and .30% in patients over 65 years old), 1 and health-related quality of life (HRQoL) for most patients is quite poor. 2 A large randomized clinical trial (the Hemodialysis Study) compared high-dose versus conventional-dose thrice weekly hemodialysis (target equilibrated Kt/V urea [eKt/ V urea ] of 1.45 versus 1.05) and showed no benefit on mortality, cardiovascular events, or HRQoL. 3,4 Small, uncontrolled studies showed that patients treated with frequent hemodialysis enjoyed favorable changes in multiple biochemical parameters, improved control of hypertension, and in many studies, improved HRQoL. 5-8 These preliminary results justified and informed the design and implementation of the Frequent Hemodialysis Network (FHN) randomized clinical trials. 9 Given the expense of frequent hemodialysis and other feasibility concerns, we chose to examine an array of intermediate outcomes measured at baseline and

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“…Several factors, including energy-protein malnutrition, increase in the parathyroid hormone (PTH), abnormalities in vitamin D activity, uremic myopathy and protein catabolism cause impairment in the physical and functional capacity of patients undergoing hemodialysis (HD) treatment (1)(2)(3)(4)(5)(6)(7)(8) . Moreover, studies have shown that changes occur in the morphological and histochemical aspects of muscles, such as the reduced cross-sectional area of the fiber, atrophy and reduction in size of fiber type I and type II, infiltration and degeneration of muscle fiber, production of actin fragments of 14kD (kiloDalton) and reduction in the synthesis of mitochondrial proteins and inside the oxidative capacity of muscle cells, further decreasing muscle capillary density (7)(8)(9) .…”

Section: Introductionmentioning

confidence: 99%

Inspiratory muscle training improves strength and health-related quality of life in hemodialysis patients

Soares¹,

Oliveira‐Silva²,

Silva³

et al. 2020

mtprehabjournal

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Background: Patients undergone hemodialysis (HD) suffer with energy-protein malnutrition, uremic myopathy and protein catabolism reducing their functional capacity, tolerance to exercise and aspects related to quality of life. Objective: The aim of this study was to evaluate the effects of the two protocols of inspiratory muscle training (IMT) on muscle strength, pulmonary function and related-health quality of life on male HD patients. Methods: Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), peak expiratory flow (PEF), forced expiratory volume in first second (FEV 1 ), forced vital capacity (FVC) and the FEV 1 /FVC ratio and quality of life were evaluated pre and post six months of IMT in HD patients. IMT was performed by one group using a specific training (Power breathe) device (T-IMT, n=19) and by the other with incentive spirometry (I-IMT, n= 15). Results: Following the inspiratory training, muscle strength improved in both groups. The group that used incentive spirometry had increments in MIP larger (39.8%, p<0.001) than the group that trained with the specific training device (28.3%, p=0.001). The KDQOL-SF dimensions showed significant difference in the T-IMT group in cognitive function (p=0.03), sexual function (p=0.009) and social function dimensions (p=0.04) and in the I-IMT group in the physical function dimension (p=0.03). Conclusion: It was proved that IMT improved muscle strength and I-IMT promoted increments significantly larger in MIP. Aspects of health-related quality of life of HD male patients improved significantly with T-IMT (sexual, social and cognitive functions), while I-IMT ameliorated only physical function.

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The effect of frequent hemodialysis on nutrition and body composition: Frequent Hemodialysis Network Trial

Cited by 71 publications

References 32 publications

Effects of Three Times Weekly Eight-Hour Nocturnal Hemodialysis on Volume and Nutritional Status

Effects of Three Times Weekly Eight-Hour Nocturnal Hemodialysis on Volume and Nutritional Status

Long-Term Effects of Frequent In–Center Hemodialysis

Inspiratory muscle training improves strength and health-related quality of life in hemodialysis patients

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