PHILADELPHIA -- More dialysis may not be better when it comes to quality of life, researchers reported here.
In the ACTIVE trial, patients aiming for 24 hours per week of dialysis saw no improvements in quality of life compared with those who did a standard number of hours per week, Meg Jardine, MD, of the George Institute for Global Health in Australia, and colleagues reported during a late-breaking trials session at Kidney Week.
"They did manage to have twice as much dialysis, but there was still no difference in quality of life," Jardine told MedPage Today.
Observational studies have suggested a relationship between increased dialysis hours and better clinical outcomes. But Jardine explained that these studies couldn't show whether it's the extra dialysis that confers the benefit -- versus something else about the population that dialyzes more.
To assess the impact of extended weekly dialysis hours on quality of life and clinical outcomes, Jardine and colleagues randomized 200 patients, mean age 52, to extended or standard dialysis for 1 year. Extended dialysis involved a target of 24 hours per week, while standard dialysis was targeted to 12 to 15 hours per week.
The primary outcome was the difference in change in quality of life betweeen baseline and 1 year using the EQ-5D questionnaire.
The mean hours achieved each week were 22.1 for the extended dialysis group compared with 14.2 hours per week in the standard care group.
Jardine reported that by the end of the trial, quality of life scores were similar between groups, and there were no differences in systolic blood pressure between groups.
Patients in the extended-hours group were, however, taking fewer blood pressure-lowering drugs than those on standard dialysis (mean difference -0.35 agents, P=0.01).
Doing longer dialysis was also associated with higher hemoglobin, lower potassium, and lower phosphate levels compared with standard care during follow-up (expressed as the mean difference from the standard dialysis group):
- Hemoglobin: 3.51 g/L, P=0.037
- Potassium: -0.28 mmol/L, P=0.0001
- Phosphate: -0.17 mmol/L, P=0.002
Jardine said these may turn into longer-term improvements, but further research is required.
She and her team also found that the number of patients with vascular access events was similar in both groups -- a difference from previous trials, Jardine said: "We did not find evidence of excess harm. We didn't see extra infections or clotting."
They concluded that extending weekly dialysis hours for a year doesn't appear to improve quality of life, but may be a boon to some laboratory parameters and reduced blood pressure medication requriements.
Jardine said the big problem with results from the aforementioned observational studies is that they don't necessarily capture the typical dialysis patient. Patients who do extended dialysis -- which is typically done at home -- tend to be healthier, younger, and have less severe disease.
It is possible, she said, that 1 year isn't long enough to see a difference between groups, so she and her team will continue to study this population for 5 years.
But in the meantime, she said the conclusion to be drawn from the results is that "maybe treatment options need to be personalized. You cant say to all patients that [extended dialysis] is the golden bullet. You can't give a one-size-fits-all recommendation."
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