02653nas a2200301   4500000000100000008004100001100001700042700001400059700001400073700001900087700001100106700001800117700001900135700002100154700001900175700001800194700001900212700001500231700001700246700001500263700001600278700001500294700003900309700001900348245006500367520190500432022001402337       2017                            d1 aGallagher M.1 aCass Alan1 aJardine M1 aHoward Kirsten1 aZuo Li1 aGray Nicholas1 ade Zoysa Janak1 aChan Christopher1 aMonaghan Helen1 aGrieve Stuart1 aPuranik Rajesh1 aLin Hongli1 aEris Josette1 aZhang Ling1 aXu Jinsheng1 aLo Serigne1 aACTIVE Dialysis Steering Committee1 aPerkovic Vlado00aA Trial of Extending Hemodialysis Hours and Quality of Life.3 a<p>
The relationship between increased hemodialysis hours and patient outcomes remains unclear. We randomized (1:1) 200 adult recipients of standard maintenance hemodialysis from in-center and home-based hemodialysis programs to extended weekly (≥24 hours) or standard (target 12-15 hours, maximum 18 hours) hemodialysis hours for 12 months. The primary outcome was change in quality of life from baseline assessed by the EuroQol 5 dimension instrument (3 level) (EQ-5D). Secondary outcomes included medication usage, clinical laboratory values, vascular access events, and change in left ventricular mass index. At 12 months, median weekly hemodialysis hours were 24.0 (interquartile range, 23.6-24.0) and 12.0 (interquartile range, 12.0-16.0) in the extended and standard groups, respectively. Change in EQ-5D score at study end did not differ between groups (mean difference, 0.04 [95% confidence interval, -0.03 to 0.11]; P=0.29). Extended hours were associated with lower phosphate and potassium levels and higher hemoglobin levels. Blood pressure (BP) did not differ between groups at study end. Extended hours were associated with fewer BP-lowering agents and phosphate-binding medications, but were not associated with erythropoietin dosing. In a substudy with 95 patients, we detected no difference between groups in left ventricular mass index (mean difference, -6.0 [95% confidence interval, -14.8 to 2.7] g/m(2); P=0.18). Five deaths occurred in the extended group and two in the standard group (P=0.44); two participants in each group withdrew consent. Similar numbers of patients experienced vascular access events in the two groups. Thus, extending weekly hemodialysis hours did not alter overall EQ-5D quality of life score, but was associated with improvement in some laboratory parameters and reductions in medication burden. (Clinicaltrials.gov identifier: NCT00649298).
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