The effect of frequent hemodialysis on nutrition and body composition: Frequent Hemodialysis Network Trial

• Published in: Kidney international Vol. 82; no. 1; pp. 90 - 99
• Main Authors: Kaysen, George A., Greene, Tom, Larive, Brett, Mehta, Ravindra L., Lindsay, Robert M., Depner, Tom A., Hall, Yoshio N., Daugirdas, John T., Chertow, Glenn M.
• Format: Journal Article
• Language: English
• Published: Basingstoke Elsevier Inc 01.07.2012; Nature Publishing Group; Elsevier Limited
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biomarkers - metabolism; Body Composition; Body Water - metabolism; Body Weight; chronic hemodialysis; daily hemodialysis; Dietary Proteins - metabolism; Electric Impedance; Emergency and intensive care: renal failure. Dialysis management; Female; Glomerular Filtration Rate; Humans; hypoalbuminemia; Intensive care medicine; Kidney - physiopathology; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - therapy; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; nutrition; Nutritional Status; Prospective Studies; randomized controlled trials; Renal Dialysis - adverse effects; Renal Dialysis - methods; Serum Albumin - metabolism; Time Factors; Treatment Outcome; United States; United States; nutrition; daily hemodialysis; randomized controlled trials; chronic hemodialysis; hypoalbuminemia; Nephrology; Nutrition; Hemodialysis; Albumin; Randomized controlled trial; Body composition; Urology; Feeding; Hypoalbuminemia; Extrarenal dialysis; Metabolic disorder; Chronic; Daily; Diet; Network; Clinical trial; Frequency
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1038/ki.2012.75

We investigated the effects of frequency of hemodialysis on nutritional status by analyzing the data in the Frequent Hemodialysis Network Trial. We compared changes in albumin, body weight, and composition among 245 patients randomized to six or three times per week in-center hemodialysis (Daily Trial) and 87 patients randomized to six times per week nocturnal or three times per week conventional hemodialysis, performed largely at home (Nocturnal Trial). In the Daily Trial, there were no significant differences between groups in changes in serum albumin or the equilibrated protein catabolic rate by 12 months. There was a significant relative decrease in predialysis body weight of 1.5±0.2kg in the six times per week group at 1 month, but this significantly rebounded by 1.3±0.5kg over the remaining 11 months. Extracellular water (ECW) decreased in the six times per week compared with the three per week hemodialysis group. There were no significant between-group differences in phase angle, intracellular water, or body cell mass (BCM). In the Nocturnal Trial, there were no significant between-group differences in any study parameter. Any gain in ‘dry’ body weight corresponded to increased adiposity rather than muscle mass but was not statistically significant. Thus, frequent in-center hemodialysis reduced ECW but did not increase serum albumin or BCM while frequent nocturnal hemodialysis yielded no net effect on parameters of nutritional status or body composition.