B SMYTH1,2, O VAN DEN BROEK-BEST3, D HONG4,5, K HOWARD1, K ROGERS2, NA GRAY7,8, JR DE ZOYSA9,10, CT CHAN11, H LIN12, L ZHENG13, J XU14, A CASS15, M GALLAGHER2,3,16, V PERKOVIC2, M JARDINE2,16
1Sydney School of Public Health, University of Sydney, Sydney, Australia, 2The George Institute For Global Health, UNSW, Sydney, Australia, 3Sydney Medical School, University of Sydney, Sydney, Australia, 4Renal Department, Sichuan Provincial People’s Hospital, Chengdu, China, 5University of Electronic Science and Technology of China Medical School, Chengdu, China, 6Peking University People’s Hospital, Beijing, China, 7Sunshine Coast University Hospital, Birtinya, Australia, 8Sunshine Coast Clinical School, University of Queensland, , Australia, 9North Shore Hospital, Auckland, New Zealand, 10Department of Medicine, University of Auckland, Auckland, New Zealand, 11University Health Network, Toronto, Canada, 12First Affiliated Hospital of Dalian Medical University, Dalian, China, 13China-Japan Friendship Hospital, Beijing, China, 14Fourth Hospital Affiliated to Hebei Medical University, Shijiazhuang, China, 15Menzies School of Health Research, Charles Darwin University, Darwin, Australia, 16Renal Unit, Concord Repatriation General Hospital, Sydney, Australia
Aim: To determine if the effect of extended hours dialysis on quality of life (QOL) in the ACTIVE Dialysis trial differed according to pre-specified subgroups.
Background: The ACTIVE Dialysis trial of extended hours (≥24 hours per week) versus standard hours (≤18 hours per week) haemodialysis demonstrated a significant improvement in QOL as measured by Short Form-36 (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS).
Methods: The ACTIVE Dialysis trial was an open-label randomised, blinded endpoint assessment trial. Two hundred participants were enrolled from four countries and randomised to 12 months of standard or extended hours dialysis. The SF-36 was administered by a blinded interviewer at 3-month intervals. Mean difference between extended and standard arms was assessed by mixed linear regression. The overall effect sizes (Cohen’s d: where 0.2-0.5 is a small effect, 0.5-0.8 a moderate effect and >0.8 a large effect) were calculated as the ratio of mean difference to standard deviation. Subgroup variables were added to the regression model with an interaction with treatment group to test for effect modification.
Results: Extended hours dialysis was associated with significant improvement in PCS (2.30 [95% CI 0.55-4.06]; p=0.010) and MCS (2.54 [95% CI 0.48-4.60]; p=0.016). The effect size on both measures was small (PCS 0.24 [95%CI 0.06-0.42; p=0.010], MCS 0.24 [95%CI 0.04-0.43; p=0.016]). The effect of extended hours dialysis did not vary significantly by baseline score, region (China vs Australia, Canada, New Zealand), dialysis location (home vs in-centre/satellite) or dialysis vintage (≤6 months vs >6 months).
Conclusions: Extended hours dialysis leads to a small improvement in physical and mental QOL. These effects did not differ significantly between key demographic and clinical subgroups.
Dr Smyth is a nphrologist and PhD candidate at The George Institute for Global Health. His research interests include dialysis, especially randomised controlled trial methodology and evidence as well as patient reported outcomes in dialysis patients.