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Kidney Week

Abstract: FR-PO498

The Relationship of Frequency of Hemodialysis Treatments per Week to Improved Clinical Outcomes in Patients in Skilled Nursing Facilities

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kaufman, Allen, Dialyze Direct, Brooklyn, New York, United States
  • Levin, Nathan W., Dialyze Direct, Brooklyn, New York, United States
Background

Dialysis patients residing in a skilled nursing facility (SNF) are characterized by advanced age, frailty, and hemodynamic instability, with multiple comorbid conditions. Based on previous increased frequency studies it was postulated that SNF residents could benefit from frequent hemodialysis (HD) when compared to conventional therapy. Given the potential for less traumatic treatments we compared the effects of HD performed 5 times per week (MFD5) with 4 times per week (MFD4) on mortality and hospitalization rates for patients in skilled nursing facilities.

Methods

We studied patients enrolled in Dialyze Direct staff-assisted, on-site SNF home HD programs in five states: OH, TX, FL, NY, PN, analyzing 1177 patients under care for 260 patient-years. 83% were dialyzed MFD5 (77,745 patient-days) and 17% (15,545 patient-days) were dialyzed) using NxStage technology for approximately 2.7 and 3.1 hrs per treatment respectively.

Results

Patient characteristics of MFD4 vs MFD5 were comparable with respect to age (69y vs 70y), gender (49% F vs 45% F), HD vintage (3.14 vs 2.79 yrs), and mean blood pressure upon program entrance (135 vs. 130 mmHg). Weekly time on HD differed (3.1 vs 2.7 hrs => 12.2 vs 13.4 hours per week). Patients were divided into length of stay quartiles: 15, 33, 90, and 1127 days. Mortality: relative risk in MFD5 patients was lower for per patient-year (0.25 vs 0.54 p<0.05); significant differences were present in quartile one (0.15 vs 0.28) and four (0.07 vs 0.21). Hospitalizations: relative risk in MFD5 was lower per patient year (2.64 vs 4.88 p<0.05); a significant difference in hospitalization was present in quartile one (1.78 vs 4.25). Blood Pressure: MFD5 and MFD4 pre-hemodialysis systolic blood pressure were (136 vs 132 mmHg); for both groups pre-HD.

Conclusion

Five times a week dialysis significantly reduces mortality and hospitalization rates in patients confined to nursing homes, possibly related to more effective and gentler fluid management strategy, that with better blood pressure control and fewer episodes of intradialytic hypotension may have protected organ systems. Its success in this frail population confirms the importance of volume control.

Funding

  • Private Foundation Support