Long-Term Effects of Frequent In-Center Hemodialysis

Area of Science:

• Nephrology
• Clinical Trials
• Public Health

Background:

• End-stage renal disease (ESRD) affects millions globally, necessitating renal replacement therapy.
• Hemodialysis is a common treatment, with varying session frequencies.
• Previous studies indicated short-term benefits of frequent hemodialysis.

Purpose of the Study:

• To determine the long-term effects of a 12-month frequent in-center hemodialysis intervention.
• To assess the impact of frequent hemodialysis on mortality and patient-reported outcomes beyond the initial trial period.

Main Methods:

• The Frequent Hemodialysis Network Daily Trial randomized 245 patients to six (frequent) or three (conventional) in-center hemodialysis sessions weekly for 12 months.
• Long-term vital status was tracked for a median of 3.6 years post-randomization.
• Intention-to-treat analysis compared mortality hazards; left ventricular mass and physical health were reassessed in a subset.

Main Results:

• During the combined trial and post-trial periods, 20/125 (16%) patients on frequent hemodialysis died versus 34/120 (28%) on conventional hemodialysis.
• The relative mortality hazard for frequent versus conventional hemodialysis was 0.54 (95% CI, 0.31-0.93), and 0.56 (95% CI, 0.32-0.99) when censoring for kidney transplantation.
• Bayesian analysis indicated a high probability of benefit and low probability of harm with frequent hemodialysis.

Conclusions:

• A 12-month frequent in-center hemodialysis intervention significantly reduced long-term mortality in ESRD patients.
• Frequent hemodialysis may offer a clinically significant survival benefit for selected patients with end-stage renal disease.
• The findings support exploring more frequent hemodialysis regimens for improved long-term outcomes.