ACTIVE Dialysis - A clinical trial of intensive dialysis

Many people take for granted how well their body is able to clean their blood, eliminate waste and function without much interference with their daily lives. But for patients with kidney disease, this essential task of cleaning the body of impurities is not simple and radically changes the way they live their lives. Patients undergo up to 18 hours every week of dialysis, a process where a machine cleans the body of toxins. That usually means three days per week of being hooked up to a machine. That is three days per week of not doing the things they love, not working, or not spending time with their friends and family. But at the same time, people on dialysis feel tired and washed out, and don’t live as long as people with normal kidney function. Studies in the past have suggested that more hours dialysis might actually help them to feel better and live longer. But we don’t know if more time on dialysis is worth it? Does this extra time on the machine make people feel better?

The Active Dialysis study tested whether or not intensive dialysis of 24 hours per week is better than 12 to 18 hours per week in terms of making people feel better and have better tests of body function. To answer this question, we enrolled 200 people on dialysis from China, Australia, New Zealand and Canada. At random, we assigned 100 to standard dialysis of 12-18 hours per week, and the other 100 were assigned to intensive dialysis of 24 hours per week.

After one year, we saw that the people who did intensive dialysis were taking fewer tablets and had better blood levels of some toxins (eg. phosphate). However, we also found that there were no major differences in the way that people felt or their quality of life. Overall, this important study has shown us that, for many people, they may not feel any better or worse with intensive dialysis compared to standard dialysis. This does not mean that some people benefit from more hours of dialysis, but it does mean that it is not something that we need to recommend for everyone.

List of publications:

Smyth B, Zuo L, Gray NA, Chan CT, de Zoysa JR, Hong D, Rogers K, Wang J, Cass A, Gallagher M, Perkovic V, Jardine M. No evidence of a legacy effect on survival following randomization to extended hours dialysis in the ACTIVE Dialysis trial. Nephrology. 2020 Jun 5.

Smyth B, Chan CT, Grieve SM, Puranik R, Zuo L, Hong D, Gray NA, de Zoysa JR, Scaria A, Gallagher M, Perkovic V, Jardine M. Predictors of change in left-ventricular structure and function in a trial of extended hours hemodialysis. J Card Fail. 2020 Apr 14. pii: S1071-9164(19)31786-5.

Smyth B, van den Broek-Best O, Hong D, Howard K, Rogers K, Zuo L, Gray NA, de Zoysa JR, Chan CT, Lin H, Zhang L, Xu J, Cass A, Gallagher M, Perkovic V, Jardine M. Varying Association of Extended Hours Dialysis with Quality of Life. Clin J Am Soc Nephrol. 2019;14(12):1751-1762.

Zhan Z, Smyth B, Toussaint ND, Gray NA, Zuo L, de Zoysa JR, Chan CT, Jin C, Scaria A, Hawley CM, Perkovic V, Jardine MJ, Zhang L. Effect of extended hours dialysis on markers of chronic kidney disease-mineral and bone disorder in the ACTIVE Dialysis study. BMC Nephrol. 2019;20(1):258.

Gray NA, Zuo L, Hong D, Smyth B, Min J, De Zoysa J, Vo K, Howard K, Wang J, Lu C, Liu Z, Cass A, Perkovic V, Jardine M. Quality of life in caregivers compared with dialysis recipients: the Co-ACTIVE sub-study of the ACTIVE Dialysis trial. Nephrology. 2019 Feb 5. doi: 10.1111/nep.13530

Liao JL, van den Broek-Best O, Smyth B, Hong D, Vo K, Zuo L, Gray NG, Chan CT, de Zoysa J, Perkovic V, Jiang L, Jardine M. The effect of extended hours dialysis on sleep quality in a randomised trial. Nephrology. 2018 Feb 9. doi: 10.1111/nep.13236

Meg J Jardine, Li Zuo, Nicholas A Gray, Janak R de Zoysa, Christopher T Chan, Martin P Gallagher, Helen Monaghan, Stuart M Grieve, Rajesh Puranik, Hongli Lin, Josette M Eris, Ling Zhang, Jinsheng Xu, Kirsten Howard, Serigne Lo , Alan Cass, Vlado Perkovic. A Trial of Extending Hemodialysis Hours and Quality of Life. J Am Soc Nephrol. 2017 Jun;28(6):1898-1911. doi: 10.1681/ASN.2015111225. Epub 2017 Feb 1.