More is not always better: Frequent dialysis does not markedly improve physical health
Some recent observational studies suggest that more frequent hemodialysis may prolong kidney failure patients' lives compared with conventional dialysis. If it does, what's the quality of that extra life? The additional treatmentswhich are time-consuming and take a considerable toll on patientsdo not markedly improve patients' physical health, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN).
Researchers and clinicians have wondered whether increasing the frequency of dialysis treatments can improve or at least preserve kidney failure patients' overall physical capacity by reducing excess body fluid, improving their exercise ability, providing a better balance of nutrition, and preserving muscle mass, among other things.
To test this, Yoshio Hall, MD (University of Washington, Seattle) and his colleagues examined changes in physical health among patients enrolled in two studies: the Frequent Hemodialysis Network Daily and Nocturnal Trials, which randomized patients to receive either frequent (six times per week) or conventional (three times per week) dialysis for one year. All patients in the Daily Trial received treatments in a clinic while nearly all of those in the Nocturnal Trial received them at home, while they slept.
Among the major findings:
- Among the 245 patients in the Daily Trial, patients randomized to frequent compared with conventional dialysis experienced no significant change in physical performance, but they reported that they felt that their physical health and functioning had improved.
- Among the 87 patients in the Nocturnal Trial, patients who received frequent dialysis did not demonstrate better physical performance or report better physical health and functioning compared with patients who received conventional dialysis. Patients in both groups experienced improved physical health and functioning over the course of the year, though, perhaps due to the switch from clinical to home-based treatments.