Frequent Dialysis Relieves Depression and Fatigue

Frequent Dialysis Relieves Depression and Fatigue
Reuters Health • The Doctor's Channel Daily Newscast
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Posted: August 12, 2010
NEW YORK (Reuters Health) – When end-stage renal disease patients receive hemodialysis six times a week, their depressive symptoms and the “vexing problem” of postdialysis fatigue are ameliorated, according to interim findings from the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) study.

Writing in a July 29th online issue of the American Journal of Kidney Diseases, Dr. Bertrand L. Jaber, from Tufts University School of Medicine, and colleagues note that patients on maintenance hemodialysis are often depressed, and that malaise following dialysis frequently limits them for hours after treatment.

The FREEDOM trial is an ongoing investigation of the benefits of daily dialysis, with a planned interim look at the effects on depressive symptoms and postdialysis fatigue.

Initially, 239 patients began the study and were switched from thrice-weekly hemodialysis to 6 days per week using the NxStage System One device in the home setting. Just 128 patients remained in the study for at least 1 year, while 111 discontinued for a variety of reasons -- such as kidney transplantation, transfer from the participating center, death, or being off the device for more than 6 weeks.

In the per-protocol analysis of the 128 patients who completed the study, the mean score on the Beck Depression Inventory fell from 11.2 at baseline to 7.8 at 1 year (p<0.001). “These findings were attenuated, but remained robust,” in the intention-to-treat analysis (ITT) of the whole cohort, the authors report.

As for postdialysis recovery time, it fell from 476 minutes at baseline to 63 minutes at 1 year in the per-protocol group (p<0.001), with a similar attenuation in the ITT group.

The researchers say that, overall, “the results are internally valid because they remained robust in both the per-protocol and ITT analyses.”

Dr. Jaber and colleagues comment that treatment of depression in dialysis patients is challenging. “Few studies have shown interventions that result in amelioration of depressive symptoms. The significant improvement in BDI scores observed in our study therefore is of particular importance.”

However, they add, “Whether this improvement translates into improved clinical outcomes in terms of hospitalization and mortality remains to be determined.”

Reference:
Effect of Daily Hemodialysis on Depressive Symptoms and Postdialysis Recovery Time: Interim Report From the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study
Am J Kidney Dis 2010.