More Is Not Always Better: Frequent Dialysis Does Not Markedly Improve Physical

[okarol]

More Is Not Always Better: Frequent Dialysis Does Not Markedly Improve Physical Health
Released: 3/9/2012 9:00 AM EST
Embargo expired: 3/15/2012 5:00 PM EDT   
Source: American Society of Nephrology (ASN)
Other efforts needed to boost kidney failure patients’ low physical capacity
Highlights
•   Patients with kidney failure have relatively poor physical health.
•   Frequent dialysis does not markedly improve kidney failure patients’ overall physical capacity compared with conventional dialysis.
Kidney failure is on the rise and currently afflicts 2 million people worldwide.

Newswise — Washington, DC (March 15, 2012) — 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 treatments—which are time-consuming and take a considerable toll on patients—do 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).
Kidney failure, or end-stage kidney disease, afflicts more than 2 million people worldwide. Many of these individuals are on long-term hemodialysis and suffer from relatively poor physical health.
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.
“Frequent hemodialysis as currently practiced may improve the lives of some but is not a cost-effective or practical solution to improving the physical health of most patients with end-stage kidney disease,” said Dr. Hall. “Faced with rising numbers of persons with progressive chronic kidney disease worldwide, we need to broadly consider innovative strategies beyond manipulating the dose of dialysis to substantially improve or preserve the physical capacity of patients with end-stage kidney disease,” he added.
Study co-authors include Brett Larive (Cleveland Clinic Foundation); Patricia Painter, PhD (University of Utah, Salt Lake City); George Kaysen, MD, PhD (University of California, Davis); Robert Lindsay, MD (University of Western Ontario and London Health Sciences Center, in Canada); Allen Nissenson, MD (DaVita, Inc.); Mark Unruh, MD (University of
Pittsburgh); Michael Rocco, MD (Wake Forest University School of Medicine); Glenn Chertow, MD (Stanford University School of Medicine); and the Frequent Hemodialysis Network Trial Group.
Disclosures: The Frequent Hemodialysis Network trials were supported by the National Institutes of Health (NIH), National Institutes of Diabetes and Digestive and Kidney Diseases, the Centers for Medicare and Medicaid Services, and the NIH Research Foundation. Contributors to the NIH Foundation in support of the Frequent Hemodialysis Network trials included Amgen, Baxter and Dialysis Clinics. Additional support was provided by DaVita, Dialysis Clinics, Fresenius Medical Care, Renal Advantage, Renal Research Institute, and Satellite Healthcare. Dr. Hall has received research support from Satellite Healthcare’s Norman Coplon extramural grant program. Dr. Kaysen has received research support from Dialysis Clinics, Inc. Dr. Nissenson is employed by DaVita, Inc. Dr. Unruh has received research support from Satellite Healthcare’s Norman Coplon extramural grant program, Dialysis Clinics, Inc. and Baxter Healthcare and has consulted for Merck, Sigma-Tau and Baxter Healthcare. Dr. Rocco has consulted for Amgen, Inc. and DaVita, Inc. Dr. Chertow is a member of the Board of Directors of Satellite Healthcare and the Scientific Advisory Board of DaVita, Inc. and has consulted for Amgen, Inc.
The article, entitled “Effects of Six versus Three Times per Week Hemodialysis on Physical Performance, Health, and Functioning: Frequent Hemodialysis Network (FHN) Randomized Trials,” will appear online at http://cjasn.asnjournals.org/ on March 15, 2012, doi: 10.2215/CJN.10601011.
The content of these articles does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 13,500 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

http://www.newswise.com/articles/view/586581/?sc=rsmn

[big777bill]

 I've only been on 5x weekly for 3 weeks now but I know I feel better than I did in center.    Now let's see if it continues that way.

[Desert Dancer]

Additional support was provided by DaVita, Dialysis Clinics, Fresenius Medical Care, Renal Advantage, Renal Research Institute, and Satellite Healthcare. Dr. Hall has received research support from Satellite Healthcare’s Norman Coplon extramural grant program. Dr. Kaysen has received research support from Dialysis Clinics, Inc. Dr. Nissenson is employed by DaVita, Inc. Dr. Unruh has received research support from Satellite Healthcare’s Norman Coplon extramural grant program, Dialysis Clinics, Inc. and Baxter Healthcare and has consulted for Merck, Sigma-Tau and Baxter Healthcare. Dr. Rocco has consulted for Amgen, Inc. and DaVita, Inc. Dr. Chertow is a member of the Board of Directors of Satellite Healthcare and the Scientific Advisory Board of DaVita, Inc. and has consulted for Amgen, Inc.

Sorry, but based on the above I don't think I'll be giving this study any credence whatsoever.

[lmunchkin]

I know I wont be paying any attention, AT ALL!!!!

lmunchkin

[amanda100wilson]

I'm with you both there.

[SooMK]

I was sad to see this article and like others here I'm skeptical. I was thinking about this: "Frequent dialysis does not markedly improve kidney failure patients’ overall physical capacity compared with conventional dialysis." Made me wonder if this is some semantic game. You can feel a lot better without necessarily being any stronger physically or in better health. The study reports patients "...experienced no significant change in physical performance, but they reported that they felt that their physical health and functioning had improved". What did they ask them to do--pushups? Even though patients said they felt better that was given no value and the increased dialysis was said not to be cost effective. Maybe it's not the results of the study that are bogus but the carefully crafted conclusions that fit in nicely with the preferred outcome of the sponsors.

[plugger]

I'm thinking the above group of doctors ought to talk to the following group of doctors who stated the following:

Results of daily dialysis
"Disappearance of postdialysis fatigue, better dialysis adequacy, a higher removal of middle and large molecules, a reduction of phosphate binders, improvement of status nutritional, and an important reduction of cardiovascular risk factors were observed."
http://www.ncbi.nlm.nih.gov/pubmed/12787423

And I don't imagine any of the companies mentioned would happen to have a financial reason to favor short, fast, infrequent dialysis would they now? 

"Short hemodialysis sessions have great appeal only to the uninformed dialysis patient and to for-profit dialysis centers."
http://www.therenalnetwork.org/qi/resources/HDP.pdf (Of course what would Dr. Belding Scribner, inventor of the Scribner shunt and founder of Northwest Kidney Centers know, compared to some good company underlings)

And I'm sure the following group of doctors must also be mistaken:
"By incorporating dialysis frequency, the HDP takes into account the very positive results that have been obtained with more frequent dialysis by De Palma, Buoncristiani,  Bonomini, Pierratos, and Lockridge."  (same Dr. Scribner article as above)

[iketchum]

It is easy to suspect the big companies of preferring the shorted treatments, but wouldn't they be getting more money in the long run? They must figure their hourly rate being better with 5 hours than with 4, or are their bean counters useing some other math?

[amanda100wilson]

I suspect that longer, more frequent dialysis equates to less bums on the chairs, which equals less money.

Funny how my physical health improvement is demonstrated by the fact that I am now well enough to work out in the gym on a consistent basis since I've been doing NxStage, yet last year I often felt too ill to do so even when I was doing a combination of haemo and PD as preparation for my switch to NxStage.  Not only that, my fitness instructor is increasing repas and weights (obviously not for arms because of the fistula), and in the past month ot two I have gained a pound of muscle and lost a pound of fat.. I make sure she assesses me at my dry weight so that hopefully, I am not weighing water.  I have felt better than I have in the last four years of PD, which has been shown to have no better mortality rates than in unit HD, and I am not entirely sure that I don't feel nearly as good as I did when I had a good functioning transplant.  My energy level has gone through the roof to the point that I find it difficult to go to sleep at night but wakemuch more easily in the morning despite this.  Saying that, I am still on high doses of sensipar and binders, and NxStage really cuts into my life.  Before when I was on PD using a cycler I had the time to do things but not the energy, now I have the energy but not the time which I why I want to do nocturnal (just in case my dr.reads this and thinks that there is mo reason for me to do nocturnal  ).