Depressive symptoms and the time taken to recover from dialysis can be decreased in patients with chronic kidney disease (CKD) by switching to treatment with daily hemodialysis. “The initiation of daily hemodialysis in the home setting resulted in a sustained and clinically meaningful improvement in depressive symptoms and postdialysis recovery time,” says lead author Bertrand Jaber.

Long-term maintenance hemodialysis can have a negative influence on the mental health and well-being of patients with CKD. Nearly one-third of patients on hemodialysis are believed to experience depressive symptoms during treatment, which have been associated with adverse outcomes. Moreover, many patients on dialysis report that 'postdialysis fatigue' (a feeling of malaise) can limit their normal activities for many hours after dialysis.

Jaber and colleagues now present an interim report from the ongoing FREEDOM study and describe the effect of frequent hemodialysis on depressive symptoms and postdialysis fatigue in patients with CKD.

239 participants from 28 sites across the USA were enrolled in the study and 128 of these patients completed the 12-month follow-up period. Patients switched from thrice weekly in-center hemodialysis treatment to at-home 'daily dialysis' (6 days per week). Depressive symptoms (as measured by the Beck Depression Inventory [BDI] survey) and postdialysis recovery time (as determined using a previously validated questionnaire) were monitored at 0, 4 and 12 months.

Jaber and colleagues found that the percentage of patients on daily dialysis with mild or moderate to severe depressive symptoms (BDI score >10) dropped from 41% at baseline to 27% after 12 months; the marked improvement in BDI score could be seen even after adjusting for antidepressant use. The BDI score was almost halved in patients with severe depressive symptoms (BDI score >15). Furthermore, a substantial decrease in the postdialysis recovery time (by 413 min) was observed after 12 months in the 128 patients that completed the study. Moreover, the percentage of patients that experienced a prolonged postdialysis recovery time (≥60 min) decreased by more than twofold.

Jaber adds that further research will examine the impact of daily dialysis on other quality-of-life indicators.