Structured Abstract

Contents

• Preface
• Acknowledgments
• Key Informants
• Technical Expert Panel
• Peer Reviewers
• Evidence Summary
  • Main Points
  • Background and Purpose
  • Methods
  • Results
  • Limitations
  • Implications and Conclusions
  • References
• Introduction
  • Background
  • Decisional Dilemma Regarding the Frequency and Duration of Hemodialysis
  • Key Questions (KQ)s and Scope of the Review
• Methods
  • Literature Search Strategy
  • Process for Study Selection
  • Data Extraction and Data Management
  • Risk of Bias Assessment
  • Data Synthesis
  • Grading the Body of Evidence for Each Key Question
  • Peer Review and Public Commentary
• Results
  • Results of the Literature Search
  • Key Question 1. In studies of frequency and duration of hemodialysis in non-institutionalized individuals, what are the characteristics of the patients and hemodialysis modality (including home or hemodialysis center setting and flow rate)? What is the length of followup on patients in the studies? How does this compare to the general population of patients on hemodialysis?
  • Key Question 2. In hemodialysis patients, does more frequent hemodialysis (more than three times a week) improve objective outcomes (including hypertension control, mortality, and QOL) over the long term (more than 6 months) compared with usual hemodialysis frequency (three times a week)? What is the impact of patient characteristics and modality of hemodialysis used in the studies on outcomes?
  • Key Question 3. Does extended hemodialysis duration (daytime, 4 or more hours per treatment, or nocturnal, overnight) improve objective outcomes over the long term (more than six months) compared with usual length hemodialysis duration (less than 4 hours)?
  • Key Questions 2 and 3 Combined. Does more frequent and extended hemodialysis duration (greater than three times per week and daytime, 4 or more hours per treatment, or nocturnal, overnight) improve objective outcomes over the long term (more than six months) compared with usual hemodialysis frequency and duration (three times per week and less than 4 hours)?
  • Key Question 4. What instruments have been used to measure QOL and symptoms in studies of people with ESRD treated by dialysis?
• Discussion
  • Key Findings
  • Limitations of Evidence
  • Limitations of the Systematic Review Process
  • Research Recommendations
  • Conclusions
• References
• List of Acronyms
• Glossary
• Appendixes
  • Appendix A. Main Outcomes of Interest
  • Appendix B. Detailed Search Strategy
  • Appendix C. Screening and Data Abstraction Forms
  • Appendix D. Included and Excluded Articles
  • Appendix E. Evidence Tables
  • Appendix F. Evidence Tables: Quality of Life and Symptom Measure
• Evidence-based Practice Center Systematic Review Protocol
• Technology Assessment Disposition of Comments Report

Suggested citation:

Shafi T, Wilson RF, Greer R, Zhang A, Sozio S, Tan M, Bass EB. End-stage Renal Disease in the Medicare Population: Frequency and Duration of Hemodialysis and Quality of Life Assessment. Technology Assessment Program Project ID No. JHE51000. (Prepared by the Johns Hopkins University Evidence-based Practice Center under contract number HHSA 290-2015-00006I) Rockville, MD: Agency for Healthcare Research and Quality. July 2020. Available at: http://www.ahrq.gov/research/findings/ta/index.html.

This report is based on research conducted by the Johns Hopkins University Evidence-based Practice Center (EPC), under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA 290-2015-00006-I). The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services.

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