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Abstract: TH-PO239

The Impact of Extended Hours Haemodialysis on Quality of Life, Vascular Access, Mortality, and Residual Renal Function: Systematic Review and Meta-Analysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Hull, Katherine Leigh, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
  • March, Daniel Scott, University of Leicester, Leicester, United Kingdom
  • Churchward, Darren R., University of Leicester, Leicester, United Kingdom
  • Graham-Brown, Matthew P.M., University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
  • Burton, James, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
Background

Patients with end-stage renal failure on conventional haemodialysis (CHD) experience significant morbidity and mortality. There is increasing evidence that extending weekly haemodialysis (HD) time is associated with improvements in quality of life (QoL), biochemical and cardiovascular parameters, and mortality. However, there is concern that increasing HD duration or frequency accelerates the loss of residual renal function (RRF) and increases vascular access adverse events. This systematic review aims to determine the impact of extended HD in comparison to CHD on QoL, vascular access events, mortality and RRF.

Methods

Randomised and non-randomised controlled trials of adult prevalent HD patients comparing extended hours HD (> 12 hours of HD in 1 week) to CHD were eligible. Outcomes of interest were quantitative measures of QoL, vascular access adverse events, all-cause mortality and RRF. Data from randomised and non-randomised trials were pooled separately using a random-effects model.

Results

476 patients from 6 trials were eligible. The number of trials available for meta-analysis varied for each outcome. There was no significant change in QoL when comparing extended HD to CHD (SF-36 PCS standardised mean difference 0.61, 95% CI -0.10 to 1.31, P=0.09, SF-36 MCS standardised mean difference -0.04, 95% CI -0.61 to 0.54, P=0.90). There was no significant change in vascular access adverse events (relative risk ratio 1.25, 95% CI 0.88 to 1.77, P=0.21) or mortality (relative risk ratio 2.29, 95% CI 0.60 to 8.71, P=0.22). RRF was only assessed in one report which demonstrated a potential reduction over 12 months with extended HD, however, RRF was not a pre-specified secondary outcome. All trials had a high risk of bias.

Conclusion

In this systematic review, we demonstrated no significant difference between extended HD and CHD on QoL, adverse vascular access events and mortality. There was only a single trial with data regarding the changes in RRF. The majority of the included trials were either low or very low in quality. This supports the need for further adequately powered randomised controlled trials.

Funding

  • Government Support - Non-U.S.