Title | Short, frequent, 5-days-per-week, in-center hemodialysis versus 3-days-per week treatment: a randomized crossover pilot trial through the Midwest Pediatric Nephrology Consortium. |
Publication Type | Journal Article |
Year of Publication | 2017 |
Authors | Laskin BL, Huang G, King E, Geary DF, Licht C, Metlay JP, Furth SL, Kimball T, Mitsnefes M |
Journal | Pediatr Nephrol |
Volume | 32 |
Issue | 8 |
Pagination | 1423-1432 |
Date Published | 2017 Aug |
ISSN | 1432-198X |
Keywords | Adolescent, Antihypertensive Agents, Blood Pressure Determination, Cross-Over Studies, Feasibility Studies, Female, Humans, Hypertension, Insurance, Health, Reimbursement, Kidney Failure, Chronic, Male, Midwestern United States, Nephrology, Pilot Projects, Renal Dialysis, Time Factors, Treatment Outcome |
Abstract | BACKGROUND: No controlled trials in children with end-stage kidney disease have assessed the benefits of more frequently administered hemodialysis (HD). METHODS: We conducted a multicenter, crossover pilot trial to determine if short, more frequent (5 days per week) in-center HD was feasible and associated with improvements in blood pressure compared with three conventional HD treatments per week. Because adult studies have not controlled for the weekly duration of dialysis, we fixed the total treatment time at 12 h a week of dialysis during two 3-month study periods; only frequency varied from 5 to 3 days per week between study periods. RESULTS: Eight children (median age 16.7 years) consented at three children's hospitals. The prespecified primary composite outcome was a sustained 10% decrease in systolic blood pressure and/or a decrease in antihypertensive medications relative to each study period's baseline. Among the six patients completing both study periods, five (83.3%) experienced the primary outcome during HD performed 5 days per week but not 3 days per week; one of the six (16.7%) achieved that outcome during 3-day but not 5-day (p = 0.22) per week HD. During 5-day HD, all patients had significantly more treatments during which their pre-HD systolic (p = 0.01) or diastolic (p = 0.01) blood pressure was 10% lower than baseline. CONCLUSIONS: We observed that more frequent HD sessions per week was feasible and associated with improved blood pressure control, but barriers to changing thrice-weekly standard of care include financial reimbursement and the time demands associated with more frequent treatments. |
DOI | 10.1007/s00467-017-3656-x |
Alternate Journal | Pediatr. Nephrol. |
PubMed ID | 28389745 |
PubMed Central ID | PMC5485844 |
Grant List | K23 DK101600 / DK / NIDDK NIH HHS / United States KM1 CA156715 / CA / NCI NIH HHS / United States K24 DK090070 / DK / NIDDK NIH HHS / United States UL1 TR000003 / TR / NCATS NIH HHS / United States UL1 RR026314 / RR / NCRR NIH HHS / United States UL1 RR024134 / RR / NCRR NIH HHS / United States |
Submitted by kej2006 on June 6, 2018 - 4:12pm