The Effect of Increasing Dialysis Dose in Overweight Hemodialysis Patients on Quality of Life: A 6-Week Randomized Crossover Trial

Background

Using standard hemodialysis regimens, overweight patients often do not reach Kidney Disease Outcomes Quality Initiatives (KDOQI) Kt/V targets, and this has been associated with lower health-related quality of life (HRQL). Whether increasing dialysis adequacy in large patients not achieving KDOQI targets improves HRQL is unknown.

Study Design

Randomized blinded crossover study.

Setting & Participants

Overweight (>80 kg) underdialyzed patients from 6 dialysis units in 2 Canadian dialysis programs.

Interventions

Six-week treatment periods with a standard dialysis regimen (4 hours 3 times weekly) and 3 augmented regimens: 4.5 hours of hemodialysis, 4 hours of hemodialysis with increased dialysate flow, and 4 hours of hemodialysis with 2 dialyzers in parallel.

Outcomes & Measurements

The End-Stage Renal Disease Symptom domain of the Kidney Disease Quality-of-Life Short-Form questionnaire (primary outcome) and the Health Utilities Index Mark 2 (secondary outcome).

Results

We enrolled 18 patients (mean weight, 109.7 ± 16.2 [SD] kg); 12 completed all 4 regimens. Mean Kt/Vs during the study were 1.27 (95% confidence interval [CI], 1.19 to 1.35), 1.41 (95% CI, 1.32 to 1.50), 1.31 (95% CI, 1.22 to 1.39), and 1.41 (95% CI, 1.33 to 1.49) for patients receiving standard dialysis, 4.5 hours of hemodialysis, hemodialysis with increased dialysate flow, and hemodialysis with 2 dialyzers, respectively. Kidney Disease Quality-of-Life End-Stage Renal Disease Symptom domain and Health Utilities Index Mark 2 scores were 75.9 (95% CI, 70.7 to 81.2) and 0.69 (95% CI, 0.56 to 0.81) for patients receiving standard dialysis, respectively. These did not differ when patients received the 3 augmented dialysis regimens (P = 0.2 and P = 0.5, respectively).

Limitations

Small sample size and inability to fully blind patients to the treatment they were receiving.

Conclusion

Improving hemodialysis adequacy for large underdialyzed patients did not lead to improved HRQL. Our findings suggest that augmentation of the dialysis regimen is not required for these patients in the absence of overt uremic symptoms.

Index Words: Overweight, dialysis adequacy, 2 dialyzers in parallel, Health Utilities Index Mark 2 (HUI2), Kidney Disease Quality of Life Short Form (KDQOL-SF)