End-stage renal disease in the medicare population: frequency and duration of hemodialysis and quality of life assessment
The SOE was low that more frequent and longer hemodialysis compared to usual hemodialysis: improved blood pressure; and shortened time to recovery after hemodialysis; The SOE was low that vascular access complications were more frequent with either more frequent or more frequent and longer hemodialy...
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| Corporate Authors: | , |
| Format: | eBook |
| Language: | English |
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Rockville (MD)
Agency for Healthcare Research and Quality (US)
July 14, 2020, 2020
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | The SOE was low that more frequent and longer hemodialysis compared to usual hemodialysis: improved blood pressure; and shortened time to recovery after hemodialysis; The SOE was low that vascular access complications were more frequent with either more frequent or more frequent and longer hemodialysis, compared to usual care. We identified 125 QOL or symptom measure tools used in 165 studies. Ten tools were designed for use in, and validated in dialysis populations. Six tools were not designed for dialysis populations but were validated in that population. COSMIN assessments were good in four or more domains for the Kidney Disease Quality of Life instrument, and Pediatric Quality of Life Inventory. CONCLUSIONS: More frequent in-center hemodialysis may improve clinical outcomes, mortality, and quality of life or patient-reported symptom measures. The trial populations were younger, healthier, and had a longer life-expectancy than the broader U.S. OBJECTIVE: To study effects of more frequent or longer hemodialysis on clinical outcomes, quality of life (QOL), and symptoms in end-stage renal disease (ESRD) patients. DATA SOURCES: We searched through October 21, 2019 for studies in PubMed, Embase(r), and other sources. METHODS: We focused on studies assessing the frequency or duration of hemodialysis using a comparison group and at least 6 months of followup. We defined usual care as hemodialysis three times per week with less than 4 hours per treatment, more frequent hemodialysis as four or more treatments per week, and longer hemodialysis as 4 or more hours per treatment. We considered study limitations, directness, consistency, and precision to grade strength of evidence (SOE). We included studies assessing QOL in ESRD patients receiving dialysis and evaluated QOL tools using the COnsensus-based Standards for selection of health status Measurement Instruments (COSMIN). dialysis population, limiting applicability to patients with similar characteristics. Further research may increase our confidence in the findings RESULTS: We found 17 studies (3 randomized controlled trials (RCTs), one non-randomized trial, and 13 observational studies) reported in 39 articles that addressed the impacts of increased frequency or duration of hemodialysis. Compared to the U.S. hemodialysis population, study populations were younger, healthier, and had a longer life expectancy. The SOE was low that more frequent hemodialysis compared to usual care: lowered mortality, the composite outcome of risk of death or increase in left ventricular (LV) mass, and risk of death or decrease in physical health; lowered LV mass and heart rate variability; and improved quality of life and patient reported symptom measures, blood pressure, and metabolic measures. |
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| Physical Description: | 1 PDF file (xiii, 4, 111 pages) illustrations |