Effects of 6-times-weekly versus 3-times-weekly hemodialysis on depressive symptoms and self-reported mental health: Frequent Hemodialysis Network (FHN) Trials
Mark L Unruh, Brett Larive, Glenn M Chertow, Paul W Eggers, Amit X Garg, Jennifer Gassman, Maria Tarallo, Fredric O Finkelstein, Paul L Kimmel, FHN Trials Group, S Achinger, S Anderson, L Appel, R Apruzzes, J Atwal, B Augustine, J Ayus, J Bardsley, W Bay, S Beach, G Beck, B Bharti, J Briggs, R Bullas, J Burkart, J Burrowes, E Cabezon, J Callegari, M Carter, J Champagne, C Chan, W Chan, J Chang, G Chertow, A Cheung, M Copland, N Coplon, A Coppley, J Daugirdas, S Dellagrottaglie, T Depner, A Derse, A Dominguez, S Doss, P Eggers, G Eknoyan, R Escalada, A Fensterer, F Finkelstein, Y Fofie, B Franzwa, R Frome, Z Fu, A Garg, J Gassman, P Gayda, N Geller, R Geronemus, W Goodman, I Gorodetskaya, F Gotch, T Greene, R Greenwood, R Grimm, M Gutierrez, Y Hall, G Handelman, L Henderson, A Hernandez, H Higgins, A Hilkin, T Hostetter, C Hoy, M Humphreys, L Hunsicker, S James, M Kariisa, A Kaufman, T Kaufman, G Kaysen, S Ke, R Keene, P Kimmel, A Kliger, P Kotanko, C Kramer, M Kuhlmann, S Kwan, S Kwok, E Lacson, B Larive, E Leavell, D Lemus, A Levin, N Levin, M Li, K Lilli, R Lindsay, R Lockridge, J Luan, J MacKrell, R Manaster, O Mandaci, R Mathew, V Mauck, A Mazzorato, C McCulloch, M McGrath-Chong, S McLeroy, R Mehta, I Meisels, B Miller, P Mohr, S Moossavi, A Nabali, A Narva, A Nissenson, D Ornt, P Painter, J Pepas, C Peterson, A Pierratos, M Pipkin, S Prichard, S Rajagopalan, R Ramos, M Rashid, A Rastogi, K Regozo, J Riley, M Rivas, M Rocco, R Rodriquez, E Roecker, D Roger, J Rogers, I Salusky, G Sanz, J Sanz, B Schiller-Moran, J Schlarb, R Schuessler, G Schulman, S Schweitzer, O Sergeyeva, S Shah, S Sherer, M Sika, L Sioson, R Skelton, M Smith, C Snell, D Somers, J Sonico, E Spanner, R Star, D Steigerwald, J Stokes, R Suri, M Suter, M Tamura, M Tarallo, M Tichy, G Ting, T Tran, D Ulloa, M Unruh, J Vassalotti, W Wallace, E Waterman, J Wei, B Weiss, J West, K Wiggins, J Winchester, Mark L Unruh, Brett Larive, Glenn M Chertow, Paul W Eggers, Amit X Garg, Jennifer Gassman, Maria Tarallo, Fredric O Finkelstein, Paul L Kimmel, FHN Trials Group, S Achinger, S Anderson, L Appel, R Apruzzes, J Atwal, B Augustine, J Ayus, J Bardsley, W Bay, S Beach, G Beck, B Bharti, J Briggs, R Bullas, J Burkart, J Burrowes, E Cabezon, J Callegari, M Carter, J Champagne, C Chan, W Chan, J Chang, G Chertow, A Cheung, M Copland, N Coplon, A Coppley, J Daugirdas, S Dellagrottaglie, T Depner, A Derse, A Dominguez, S Doss, P Eggers, G Eknoyan, R Escalada, A Fensterer, F Finkelstein, Y Fofie, B Franzwa, R Frome, Z Fu, A Garg, J Gassman, P Gayda, N Geller, R Geronemus, W Goodman, I Gorodetskaya, F Gotch, T Greene, R Greenwood, R Grimm, M Gutierrez, Y Hall, G Handelman, L Henderson, A Hernandez, H Higgins, A Hilkin, T Hostetter, C Hoy, M Humphreys, L Hunsicker, S James, M Kariisa, A Kaufman, T Kaufman, G Kaysen, S Ke, R Keene, P Kimmel, A Kliger, P Kotanko, C Kramer, M Kuhlmann, S Kwan, S Kwok, E Lacson, B Larive, E Leavell, D Lemus, A Levin, N Levin, M Li, K Lilli, R Lindsay, R Lockridge, J Luan, J MacKrell, R Manaster, O Mandaci, R Mathew, V Mauck, A Mazzorato, C McCulloch, M McGrath-Chong, S McLeroy, R Mehta, I Meisels, B Miller, P Mohr, S Moossavi, A Nabali, A Narva, A Nissenson, D Ornt, P Painter, J Pepas, C Peterson, A Pierratos, M Pipkin, S Prichard, S Rajagopalan, R Ramos, M Rashid, A Rastogi, K Regozo, J Riley, M Rivas, M Rocco, R Rodriquez, E Roecker, D Roger, J Rogers, I Salusky, G Sanz, J Sanz, B Schiller-Moran, J Schlarb, R Schuessler, G Schulman, S Schweitzer, O Sergeyeva, S Shah, S Sherer, M Sika, L Sioson, R Skelton, M Smith, C Snell, D Somers, J Sonico, E Spanner, R Star, D Steigerwald, J Stokes, R Suri, M Suter, M Tamura, M Tarallo, M Tichy, G Ting, T Tran, D Ulloa, M Unruh, J Vassalotti, W Wallace, E Waterman, J Wei, B Weiss, J West, K Wiggins, J Winchester
Abstract
Background: Patients undergoing maintenance hemodialysis frequently exhibit poor mental health. We studied the effects of frequent in-center and nocturnal hemodialysis on depressive symptoms and self-reported mental health.
Study design: 1-year randomized controlled clinical trials.
Setting & participants: Hemodialysis centers in the United States and Canada. 332 patients were randomly assigned to frequent (6-times-weekly) compared with conventional (3-times-weekly) hemodialysis in the Frequent Hemodialysis Network (FHN) Daily (n = 245) and Nocturnal (n = 87) Trials.
Intervention: The Daily Trial was a trial of frequent (6-times-weekly) compared with conventional (3-times-weekly) in-center hemodialysis. The Nocturnal Trial assigned patients to either frequent nocturnal (6-times-weekly) hemodialysis or conventional (3-times-weekly) hemodialysis.
Outcomes: Self-reported depressive symptoms and mental health.
Measurements: Beck Depression Inventory and the mental health composite score and emotional subscale of the RAND 36-Item Health Survey at baseline and 4 and 12 months. The mental health composite score is derived by summarizing these domains of the RAND 36-Item Health Survey: emotional, role emotional, energy/fatigue, and social functioning scales.
Results: In the Daily Trial, participants randomly assigned to frequent compared with conventional in-center hemodialysis showed no significant change over 12 months in adjusted mean Beck Depression Inventory score (-1.9 ± 0.7 vs -0.6 ± 0.7; P = 0.2), but experienced clinically significant improvements in adjusted mean mental health composite (3.7 ± 0.9 vs 0.2 ± 1.0; P = 0.007) and emotional subscale (5.2 ± 1.6 vs -0.3 ± 1.7; P = 0.01) scores. In the Nocturnal Trial, there were no significant changes in the same metrics in participants randomly assigned to nocturnal compared with conventional hemodialysis.
Limitations: Trial interventions were not blinded.
Conclusions: Frequent in-center hemodialysis, as compared with conventional in-center hemodialysis, improved self-reported general mental health. Changes in self-reported depressive symptoms were not statistically significant. We were unable to conclude whether nocturnal hemodialysis yielded similar effects.
Trial registration: ClinicalTrials.gov NCT00264758 NCT00271999.
Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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Source: PubMed