What was the frequent hemodialysis network trials?
Frequent hemodialysis network trials are the largest to-date prospective randomized controlled trials to study the safety, feasibility, and efficacy of frequent in-center (Daily Trial) and frequent home-based nocturnal (Nocturnal Trial) hemodialysis.
The first arm (FHN-Daily Trial) randomized 245 patients from 10 regional centers to receive six (frequent) or three (conventional) in-center hemodialysis sessions per week for 12 months.
The second arm (FHN-Nocturnal Trial) randomized 87 patients from 9 regional centers to 12 months of 6 times per week (frequent) home nocturnal hemodialysis versus 3 times a week (conventional) HHD. All patients were receiving conventional thrice-weekly in-center dialysis prior to the time of randomization.
What is learnt from these FHN trials?
The coprimary composite outcomes examined in both daily and nocturnal trials were (1) death or change in LV mass death or (2) change in physical health composite (PHC) score. Secondary outcomes analyzed were cognitive performance, self-reported depression, laboratory markers of nutrition, mineral metabolism and anemia, blood pressure and rates of hospitalization, and vascular access interventions. The FHN-Daily Trial showed a statistically significant benefit of more frequent hemodialysis (HD) for both coprimary composite outcomes (death/LV mass or death/PHC). The FHN-Nocturnal Trial (HHD patients) did not show a definitive benefit of more frequent nocturnal HD for either co-primary outcome. Both arms showed improvement in phosphorus and systolic blood pressure control. Neither trial showed significant benefit among the other main secondary outcomes. Long-term survival (median 3.6 years follow-up) was significantly better in the group of patients who were initially randomized to the frequent dialysis arm of the FHN-Daily trial. In contrast, long-term survival (median 3.7 years follow-up) was worse for the frequent dialysis HHD patients in the FHN-nocturnal trial.