More Is Not Better When It Comes to Dialysis

Twenty-four hours per week of dialysis saw no improvements in quality of life compared to those who did a standard number of hours per week….

Previous studies have suggested a relationship between increased dialysis hours and better clinical outcomes. However, these studies cannot show whether the outcomes are attributed to the extra hours of dialysis or something else about the population that dialyzes more. Also, these studies do not capture the typical dialysis patient.

To assess the impacts of extended weekly dialysis hours on quality of life and clinical outcomes, Dr. Meg J. Jardine and colleagues from the George Institute for Global Health in Australia randomized 200 patients, with a mean age of 52 to extended or standard dialysis for 1 year. Extended dialysis involved a target of 24 hours per week, while the standard dialysis was targeted to 12 to 15 hours per week. The primary outcome was the difference in quality of life between baseline and 1 year using the Q-5D questionnaire.

Jardine reported that by the end of the trial, the quality of life scores were similar between groups, but there were differences in systolic blood pressure. Patients in the extended arm of the study were taking fewer blood pressure lowering medications than those on standard dialysis (mean difference -0.35 agents, P=0.01).

Those in the extended dialysis arm also experienced higher hemoglobin, lower potassium and lower phosphate levels compared to those in the standard group. (Hemoglobin: 3.51 g/L, P=0.037, Potassium: -0.28 mmol/L, P=0.0001, Phosphate: -0.17 mmol/L, P=0.002).

Dr. Jardine stated that these may turn into long-term improvements, but further research is needed. The researchers concluded that extending weekly dialysis hours for a one-year time period year doesn’t appear to improve quality of life, but may be an advantage to some laboratory parameters and reduced blood pressure medication requirements.

Practice Pearls:

• The results conclude extending weekly dialysis hours for a year doesn’t appear to improve quality of life
• Extending weekly dialysis hours may benefit laboratory parameters (hemoglobin, potassium and phosphate)
• Extending weekly dialysis hours may reduce blood pressure medication requirements

Jardine MJ, et al "Impact of extended weekly hemodialysis hours on quality of life and clinical outcomes: The ACTIVE dialysis multinational trial" Kidney Week2014; Late-Breaking Trial. 18 Nov 2014. Web 18 Nov 2014.