Grant: Project Grant

People who have kidney failure require hemodialysis to stay alive. Hemodialysis cleans the blood of the toxins and fluids that build up when kidneys don't work. Most patients receive hemodialysis three times every week with each treatment lasting 4 hours. These patients spend 156 days per year receiving hemodialysis. This is a very large time burden which has a tremendous impact on well-being and life satisfaction. Our current approach of prescribing hemodialysis three times per week is not based on good studies and assumes that all people need the same number of hemodialysis treatments regardless of their age, frailty, life expectancy, values or other health conditions. Over time, increasingly more elderly people are starting hemodialysis. We have conducted a preliminary study that shows that patients over 70 years old do well receiving hemodialysis twice per week. In this study, receiving hemodialysis twice per week was no different than three times per week with regards to blood values and management of body fluid levels. We now propose to carry out a much larger study in many centers across Canada that will compare two times to three times per week hemodialysis in elderly patients who have reached kidney failure. We want to know if receiving hemodialysis twice per week increases the number of days that a patient is able to spend at home without increasing rates of hospitalization or death compared to receiving hemodialysis three times per week and whether any noted differences are impacted by patient frailty. We also want to know if this is better for people's quality of life, safe, less expensive for the health care system and friendlier to the environment. The results of this study will help elderly patients needing to start hemodialysis treatments, medical care teams who help make decisions about how many hemodialysis treatments per week are necessary as well as kidney organizations that oversee kidney care for patients in Canada and around the world.