Benefit of more frequent dialysis on dialysis recovery time in nursing home patients with ESRD

Background: Dialysis patients admitted to a skilled nursing facility (SNF) are characterized by advanced age, frailty, and multiple comorbidities. Based on prior studies which demonstrated shortened dialysis recovery time (DRT) with more frequent dialysis (MFD) in populations aged ∼50s living at home (FREEDOM Study 2010, FHN trial 2006), it was postulated that dialysis patients in a SNF would benefit from MFD. Methods: Patients studied were admitted to SNFs in OH, TX, FL, NY, and PA from November-December 2019 (pre-COVID) and could reliably answer questions about DRT. 80% were undergoing subacute rehabilitation and 20% were permanent residents of the SNF. Patients received NxStage on-site staff assisted MFD 5x (80%) or 4x (20%) per week. StdKt/V was ≥2.1. At every dialysis, patients were asked by their RN caregiver How long did it take you to recover from your last? HD session Responses were deemed unreliable if a patient had cognitive impairment. Reliable responses were used for outcome analysis. In the present study, DRT data was collected by a caregiver nurse, differing from the methodology of the FREEDOM/FHN studies which collected DRT data via KDQOL form or phone interview. The implications of these differences in data collection methods are currently unknown. Results: 485 unique patients were included in the study. Demographics included 53% males, mean age 67.5 +/-13 years, African American 19%, Caucasian 25%, Hispanic 5%, Asian 0.4%, unknown or other 51%. Mean DRT was 1.5 +/-2.6 hours. Mean DRT was calculated using the midpoint recovery time for intervals, or 18 hours when DRT was the next morning or beyond. In 69%, DRT was < 2 hours. Conclusions: In the FREEDOM and FHN conventional HD 3x per week study arms, DRT averaged 6-8 hours. MFD reduced DRT to ∼1.0 hour in those relatively young patients living at home. In our study, HD patients residing in a SNF and receiving MFD experienced DRT of 1.5 hours. Age, frailty and comorbid conditions therefore do not prevent DRT benefits of MFD. DRT benefits could stem from more effective, gentler fluid management by MFD. Further studies are needed to fully explore the impact of shortened DRT on rehabilitation scores, hospitalizations and deaths in elderly patients residing in SNFs.