Varying Association of Extended Hours Dialysis with Quality of Life.

Smyth, B; van den Broek-Best, O; Hong, D; Howard, K; Rogers, K; Zuo, L; Gray, NA; de Zoysa, JR; Chan, CT; Lin, H; Zhang, L; Xu, J; Cass, A; Gallagher, M; Perkovic, V; Jardine, M

Varying Association of Extended Hours Dialysis with Quality of Life.

Smyth, B van den Broek-Best, O Hong, D Howard, K Rogers, K

Zuo, L Gray, NA de Zoysa, JR Chan, CT Lin, H Zhang, L Xu, J Cass, A Gallagher, M Perkovic, V Jardine, M

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Publisher:: American Society of Nephrology (ASN)
Publication Type:: Journal Article
Citation:: Clinical journal of the American Society of Nephrology : CJASN, 2019, 14, (12), pp. 1751-1762
Issue Date:: 2019-12

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Field	Value	Language
dc.contributor.author	Smyth, B
dc.contributor.author	van den Broek-Best, O
dc.contributor.author	Hong, D
dc.contributor.author	Howard, K
dc.contributor.author	Rogers, K https://orcid.org/0000-0001-5497-4298
dc.contributor.author	Zuo, L
dc.contributor.author	Gray, NA
dc.contributor.author	de Zoysa, JR
dc.contributor.author	Chan, CT
dc.contributor.author	Lin, H
dc.contributor.author	Zhang, L
dc.contributor.author	Xu, J
dc.contributor.author	Cass, A
dc.contributor.author	Gallagher, M
dc.contributor.author	Perkovic, V
dc.contributor.author	Jardine, M
dc.date.accessioned	2020-05-22T05:43:46Z
dc.date.available	2019-09-17
dc.date.available	2020-05-22T05:43:46Z
dc.date.issued	2019-12
dc.identifier.citation	Clinical journal of the American Society of Nephrology : CJASN, 2019, 14, (12), pp. 1751-1762
dc.identifier.issn	1555-9041
dc.identifier.issn	1555-905X
dc.identifier.uri	http://hdl.handle.net/10453/140889
dc.description.abstract	BACKGROUND AND OBJECTIVES:Little is known about the effect of changes in dialysis hours on patient-reported outcome measures. We report the effect of doubling dialysis hours on a range of patient-reported outcome measures in a randomized trial, overall and separately for important subgroups. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:The A Clinical Trial of IntensiVE Dialysis trial randomized 200 participants to extended or standard weekly hours hemodialysis for 12 months. Patient-reported outcome measures included two health utility scores (EuroQOL-5 Dimensions-3 Level, Short Form-6 Dimension) and their derived quality-adjusted life year estimates, two generic health scores (Short Form-36 Physical Component Summary, Mental Component Summary), and a disease-specific score (Kidney Disease Component Score). Outcomes were assessed as the mean difference from baseline using linear mixed effects models adjusted for time point and baseline score, with interaction terms added for subgroup analyses. Prespecified subgroups were dialysis location (home- versus institution-based), dialysis vintage (≤6 months versus >6 months), region (China versus Australia, New Zealand, Canada), and baseline score (lowest, middle, highest tertile). Multiplicity-adjusted P values (Holm-Bonferroni) were calculated for the main analyses. RESULTS:Extended dialysis hours was associated with improvement in Short Form-6 Dimension (mean difference, 0.027; 95% confidence interval [95% CI], 0.00 to 0.05; P=0.03) which was not significant after adjustment for multiple comparisons (Padjusted =0.05). There were no significant differences in EuroQOL-5 Dimensions-3 Level health utility (mean difference, 0.036; 95% CI, -0.02 to 0.09; P=0.2; Padjusted =0.2) or in quality-adjusted life years. There were small positive differences in generic and disease-specific quality of life: Physical Component Summary (mean difference, 2.3; 95% CI, 0.6 to 4.1; P=0.01; Padjusted =0.04), Mental Component Summary (mean difference, 2.5; 95% CI, 0.5 to 4.6; P=0.02; Padjusted =0.05) and Kidney Disease Component Score (mean difference, 3.5; 95% CI, 1.5 to 5.5; P=0.001; Padjusted =0.005). The results did not differ among predefined subgroups or by baseline score. CONCLUSIONS:The effect of extended hours hemodialysis on patient-reported outcome measures reached statistical significance in some but not all measures. Within each measure the effect was consistent across predefined subgroups. The clinical importance of these differences is unclear.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	American Society of Nephrology (ASN)
dc.relation.ispartof	Clinical journal of the American Society of Nephrology : CJASN
dc.relation.isbasedon	10.2215/cjn.06800619
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	1103 Clinical Sciences
dc.subject.classification	Urology & Nephrology
dc.title	Varying Association of Extended Hours Dialysis with Quality of Life.
dc.type	Journal Article
utslib.citation.volume	14
utslib.location.activity	United States
utslib.for	1103 Clinical Sciences
pubs.organisational-group	/University of Technology Sydney/Graduate School of Health
pubs.organisational-group	/University of Technology Sydney
utslib.copyright.status	closed_access	*
dc.date.updated	2020-05-22T05:43:42Z
pubs.issue	12
pubs.publication-status	Published
pubs.volume	14
utslib.start-page	1751
utslib.citation.issue	12

Abstract:

BACKGROUND AND OBJECTIVES:Little is known about the effect of changes in dialysis hours on patient-reported outcome measures. We report the effect of doubling dialysis hours on a range of patient-reported outcome measures in a randomized trial, overall and separately for important subgroups. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:The A Clinical Trial of IntensiVE Dialysis trial randomized 200 participants to extended or standard weekly hours hemodialysis for 12 months. Patient-reported outcome measures included two health utility scores (EuroQOL-5 Dimensions-3 Level, Short Form-6 Dimension) and their derived quality-adjusted life year estimates, two generic health scores (Short Form-36 Physical Component Summary, Mental Component Summary), and a disease-specific score (Kidney Disease Component Score). Outcomes were assessed as the mean difference from baseline using linear mixed effects models adjusted for time point and baseline score, with interaction terms added for subgroup analyses. Prespecified subgroups were dialysis location (home- versus institution-based), dialysis vintage (≤6 months versus >6 months), region (China versus Australia, New Zealand, Canada), and baseline score (lowest, middle, highest tertile). Multiplicity-adjusted P values (Holm-Bonferroni) were calculated for the main analyses. RESULTS:Extended dialysis hours was associated with improvement in Short Form-6 Dimension (mean difference, 0.027; 95% confidence interval [95% CI], 0.00 to 0.05; P=0.03) which was not significant after adjustment for multiple comparisons (Padjusted =0.05). There were no significant differences in EuroQOL-5 Dimensions-3 Level health utility (mean difference, 0.036; 95% CI, -0.02 to 0.09; P=0.2; Padjusted =0.2) or in quality-adjusted life years. There were small positive differences in generic and disease-specific quality of life: Physical Component Summary (mean difference, 2.3; 95% CI, 0.6 to 4.1; P=0.01; Padjusted =0.04), Mental Component Summary (mean difference, 2.5; 95% CI, 0.5 to 4.6; P=0.02; Padjusted =0.05) and Kidney Disease Component Score (mean difference, 3.5; 95% CI, 1.5 to 5.5; P=0.001; Padjusted =0.005). The results did not differ among predefined subgroups or by baseline score. CONCLUSIONS:The effect of extended hours hemodialysis on patient-reported outcome measures reached statistical significance in some but not all measures. Within each measure the effect was consistent across predefined subgroups. The clinical importance of these differences is unclear.

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http://hdl.handle.net/10453/140889