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

Benjamin L. Laskin, Guixia Huang, Eileen King, Denis F. Geary, Christoph Licht, Joshua P. Metlay, Susan L. Furth, Tom Kimball, Mark Mitsnefes

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalPediatric Nephrology
DOIs
StateAccepted/In press - Apr 8 2017
Externally publishedYes

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Nephrology
Cross-Over Studies
Renal Dialysis
Pediatrics
Blood Pressure
Therapeutics
Dialysis
Standard of Care
Antihypertensive Agents
Chronic Kidney Failure

Keywords

  • Children
  • End-stage kidney disease
  • Hypertension
  • More frequent hemodialysis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

Cite this

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. / Laskin, Benjamin L.; Huang, Guixia; King, Eileen; Geary, Denis F.; Licht, Christoph; Metlay, Joshua P.; Furth, Susan L.; Kimball, Tom; Mitsnefes, Mark.

In: Pediatric Nephrology, 08.04.2017, p. 1-10.

Research output: Contribution to journalArticle

Laskin, Benjamin L. ; Huang, Guixia ; King, Eileen ; Geary, Denis F. ; Licht, Christoph ; Metlay, Joshua P. ; Furth, Susan L. ; Kimball, Tom ; Mitsnefes, Mark. / 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. In: Pediatric Nephrology. 2017 ; pp. 1-10.
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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.",
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AU - King, Eileen

AU - Geary, Denis F.

AU - Licht, Christoph

AU - Metlay, Joshua P.

AU - Furth, Susan L.

AU - Kimball, Tom

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