Pilot Randomized Trial of Dialysis Less Frequently in the Elderly: The DLITE Study

Area of Science:

• Nephrology
• Geriatrics

Background:

• Elderly patients are the fastest-growing demographic with end-stage kidney disease (ESKD).
• Optimal hemodialysis (HD) prescription for this population remains undetermined.
• The DLITE pilot trial investigated the feasibility and safety of comparing twice-weekly versus thrice-weekly HD in elderly patients.

Purpose of the Study:

• To assess the feasibility and safety of a clinical trial comparing twice-weekly versus thrice-weekly HD.
• To evaluate the impact of different HD frequencies on quality of life (QOL) and clinical outcomes in elderly patients.

Main Methods:

• A pilot single-center, open-label, randomized controlled trial (RCT) was conducted.
• Seventy elderly patients (≥70 years) on incident HD were randomized to twice-weekly (n=20) or thrice-weekly (n=20) HD for 9 months.
• Primary outcomes were feasibility and safety; secondary outcomes included QOL, hyperkalemia, mortality, and urgent HD needs.

Main Results:

• The study achieved a recruitment rate of 1.1 patients/month with a high consent rate (77%) and adherence (≥99%).
• High completion rates for QOL surveys (96%) and study participation (78%) were observed.
• Both HD groups showed comparable, infrequent rates of hyperkalemia, urgent HD, hospitalizations, and mortality.

Conclusions:

• Twice-weekly HD in elderly patients with ESKD is feasible and safe.
• Findings support the design of a larger multicenter RCT to definitively assess QOL, economic, morbidity, and mortality endpoints.