Abstract: FR-OR050

Reduction in Post-Dialysis Recovery Time in the FREEDOM Study of Frequent Home Hemodialysis

Session Information

  • Home Hemodialysis
    November 03, 2017 | Location: Room 295, Morial Convention Center
    Abstract Time: 04:54 PM - 05:06 PM

Category: Dialysis

  • 604 Home and Frequent Dialysis

Authors

  • Jaber, Bertrand L., St. Elizabeth's Medical Center, Boston, Massachusetts, United States
  • Weinhandl, Eric D., NxStage Medical, Inc., Victoria, Minnesota, United States
  • Collins, Allan J., NxStage Medical, Inc., Victoria, Minnesota, United States
  • Finkelstein, Fredric O., Yale University, New Haven, Connecticut, United States
Background

Long post-dialysis recovery time (RT) is associated with higher risk of death and lower quality of life. Increasing treatment frequency reduced RT in the Frequent Hemodialysis Network trials. The FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study was a 12-month prospective cohort study of short daily home hemodialysis (SDHHD). Interim analysis of the FREEDOM Study indicated that SDHHD led to decreased RT. We sought to confirm these findings in a final analysis.

Methods

We analyzed RT, as elicited by the question, "How long does it take you to recover from a dialysis session and resume your normal, usual activities?", in intention-to-treat (ITT), conditional ITT (cITT), and as-treated (AT) cohorts. The ITT, cITT, and AT cohorts comprised all patients who initiated SDHHD, those who completed 2 months of follow-up, and those who completed 12 months of follow-up, respectively. RT was measured at baseline, 4 months (if the patient remained on SDHHD), and 12 months (if the patient remained on SDHHD). Patients were censored at death or kidney transplantation. We used mixed models to analyze changes in RT, with adjustments for demographics and comorbidity.

Results

The ITT, cITT, and AT cohorts included 487, 407, and 247 patients, respectively. In the ITT cohort, mean RT decreased from 494 minutes (min) at baseline to 227 and 198 min at 4 and 12 months, respectively, while median RT decreased from 180 min at baseline to 60 and 45 min at 4 and 12 months. In the AT cohort, mean RT decreased from 512 min at baseline to 132 and 96 min at 4 and 12 months, while median RT decreased from 180 min at baseline to 30 min at both 4 and 12 months. Adjusted differences in mean RT between baseline and 4 months were -263 min, -306 min, and -380 min in the ITT, cITT, and AT cohorts, respectively, and corresponding adjusted differences between baseline and 12 months were -287 min, -339 min, and -416 minutes (P < 0.001 for all differences).

Conclusion

In a 12-month prospective cohort study, SDHHD was associated with large reductions in mean and median post-dialysis recovery time. Reductions were evident after 4 months on SDHHD and sustained after 12 months. Increasing treatment frequency likely reduces recovery time, but the physiologic mechanisms underlying this effect remain uncertain and merit further research.