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The following is a summary of “Twice against thrice-weekly hemodialysis (TATH): a multicenter nonrandomized trial,” published in the April 2025 issue of BMC Nephrology by Aoun et al. 

The ideal frequency for maintenance hemodialysis is still unclear. Twice-weekly sessions remain common in many regions. The study assessed survival and potential risks over a 2-year period. Researchers conducted a retrospective study to compare outcomes between twice-weekly and thrice-weekly hemodialysis.  

They included adults with CKD stage 5 starting hemodialysis from Jan 2018 to Aug 2021 in a prospective, multicenter, nonrandomized trial. Patients were assigned to twice- or thrice-weekly regimens and monitored at 1, 3, 6, 12, and 24 months. The trial ended early after recruiting 25% of the planned sample due to COVID-19 and economic issues. They used multiple imputation for missing baseline data, followed by logistic regression to estimate propensity scores. The primary outcome was 2-year survival using Cox regression adjusted for propensity scores and residual urine output. Secondary outcomes were hospitalization, uncontrolled hypertension, and erythropoietin dose at 2 years, analyzed using regression models with the same adjustments. Analyses followed an intention-to-treat approach. 

The results showed 132 patients on thrice-weekly and 71 on twice-weekly hemodialysis were included. Mean age was 67 ± 15 years; median eGFR was 6 (4,8) mL/min/1.73 m². At 1 year, the twice-weekly group had higher residual urine output. At 2 years, no significant differences were seen in survival (HR = 0.84; 95% CI: 0.37, 1.90), hospitalization (P = 0.515), or uncontrolled hypertension (P = 0.442). The twice-weekly group showed a trend toward higher erythropoietin use (P = 0.08) and had higher serum potassium and more antihypertensive medications. 

Investigators found that twice-weekly hemodialysis had comparable 2-year survival to thrice-weekly. They noted it was viable in the first year but required close monitoring afterward. 

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-025-04105-3