Pilot Randomized Trial of Dialysis Less Frequently in the Elderly: The DLITE Study
A pilot randomized trial in incident haemodialysis patients aged 70 and older found that starting with twice-weekly rather than thrice-weekly dialysis was feasible and safe over 9 months, setting the stage for a larger trial powered for quality-of-life and survival outcomes.
Background
Older adults are the fastest-growing group with end-stage kidney disease, yet the haemodialysis prescription that best serves this population—who have reduced life expectancy and high symptom burden—is unknown. Incremental (less frequent) dialysis is an appealing but unproven strategy.
Study design
DLITE was a single-centre open randomized controlled pilot trial enrolling patients aged 70 or older on incident haemodialysis, randomized to twice-weekly (n=20) versus thrice-weekly (n=20) dialysis and followed for 9 months, with no residual kidney function trigger for escalation. Primary outcomes were feasibility and safety; secondary outcomes included quality of life, hyperkalaemia, and mortality.
Key findings
Recruitment was 1.1 patients/month with a 77% consent rate; adherence was at least 99%, 96% of quality-of-life surveys were completed, and 78% of patients completed the study. Pre-dialysis normokalaemia rates were 89% (twice-weekly) versus 90% (thrice-weekly), and urgent dialysis treatments, hospitalizations, and deaths were infrequent in both arms.
Clinical implications
The intervention was feasible and safe, and these results are intended to inform the design of a multicentre RCT with quality-of-life, economic, morbidity, and mortality endpoints. Findings should not yet change practice on their own.
Category
Research
Source
Kidney International Reports
More from ASNRT News
Browse the latest news, society announcements, KDIGO guideline updates, and AJNT issue releases on the ASNRT newsroom.