Table 1.
Summary of Comparative Studies Evaluating Patient Outcomes in with Twice vs Thrice weekly hemodialysis
| Author | Year | Study Design | Study Duration (years) | Twice-weekly N | Thrice-weekly N | RKF Metric | Results | ||
|---|---|---|---|---|---|---|---|---|---|
| RKF | Mortality | Other | |||||||
| Hanson9 | 1999 | Retrospective Cohort | 3 | 570 | 14497 | eGFR | Lower mortality for twice weekly group (RR=0.76, p=0.02), but when adjusted for eGFR at time of dialysis start, mortality was similar between two groups (RR 0.85, p=0.31) | ||
| Supasyndh79 | 2009 | Cross-sectional study | N/A | 82 | 60 | Nutritional status similar in both groups measured by bio-impedance | |||
| Lin54 | 2009 | Prospective Cohort | 8 | 23 | 51 | UOP and residual GFR* | Twice weekly group had higher mean urine output than thrice weekly group (1.7L vs 0.61L; p=0.001) and residual GFR (1.9mL/min vs 0.71mL/min; p=0.001) | -Less frequent hospitalization in twice weekly group (63% vs 33%; p=0.012 -No difference in nutrition or inflammation indices between groups |
|
| Stankuviene80 | 2010 | Retrospective Cohort | 8 | Total cohort N=2428 58.5% 3x week 36.2% 2x week 5.3% 1x week |
Higher mortality in twice weekly group (RR 1.98 (95% CI 1.64, 2.40; p<0.001) | ||||
| Lin81 | 2012 | 1041 | 1531 | Similar survival in both groups (RR 0.78; 95% CI 0.55,1.09; p=0.145) | |||||
| Elamin82 | 2012 | Prospective Cohort | 2 | Total cohort N=1011 74.8% 2x week |
Similar one year mortality in twice weekly group (85% vs 89%, p=0.06) | ||||
| Fernandez-Lucas83 | 2012 | Prospective Cohort | 5 | 41 | 54 | loss of UOP/24 hours | -loss of UOP/24 hours was greater in thrice weekly group compared to twice weekly group (206mL/month vs 91mL/month | -Survival greater in twice weekly group (log-rank 3.96; p-0.04) | |
| Zhang55 | 2014 | Prospective Cohort | 1 | 30 | 55 | RKF loss, defined as < 200mL/day of urine output | RKF loss reported in 60% (n=18) in twice weekly vs 82% (n=45) in thrice weekly group | ||
| Caria56 | 2014 | Prospective Cohort^ | 2 | 38 (with very low protein diet) | 30 | GFR* loss per month | -GFR loss of −0.13mL/min/month in twice weekly vs −1.53mL/min/month in thrice weekly group weekly group (p=NS). | -Survival 95% vs 87% in twice vs thrice | -Hospitalization in 24 months was 3.7 days/patient in twice weekly vs 6.1 days/patient in thrice weekly group |
| Obi28 | 2016 | Retrospective Cohort | 4 | 351 | 8068 | UOP and KRU | - Slower RKF decline over time in twice vs thrice weekly group (UOP to ≤ 600mL/day RR 1.15 (95% CI, 1.02–1.30, p<0.001) | -Similar overall survival between groups (HR1.11; 95% CI, 0.89–1.38; P=0.3). | |
| Hwang84 | 2016 | Prospective Cohort | 3 | 113 | 572 | KRU corrected for 1.73m2 body surface area | -RKF at 36 months 2.9mL/min in twice weekly vs 1.0 mL/min in thrice weekly; p<0.001) | -Higher mortality in twice weekly group compared to thrice weekly group (HR 4.2; 95% CI 1.02–17.32; p0.04) | |
| Mathew58 | 2016 | Retrospective Cohort | 5 | 434 | 50162 | -Similar survival between groups (HR 0.88, 95% CI 0.72, 1.08), after adjustment for RKF | |||
^
includes once-weekly and twice weekly HD patients, 5.3% and 36.2% of total cohort, respectively
*
calculated as arithmetic mean of residual urea and creatinine clearances
Abbreviations: RKF=residual kidney function; eGFR=estimated glomerular filtration rate; UOP=urine output; KRU=residual urea clearance; GFR=glomerular filtration rate; RR=relative risk; CI=confidence interval