Twice vs Thrice Weekly Hemodialysis: Clinical Outcomes and Quality of Life

Thrice-weekly maintenance hemodialysis is the conventional schedule. Twice-weekly hemodialysis is used selectively in patients with residual kidney function. Local prospective comparative data in Egypt are limited.

This observational study will include adults with end-stage kidney disease receiving established twice-weekly or thrice-weekly in-center maintenance hemodialysis. Patients will be followed according to their prescribed schedule without research-driven changes. Health-related quality of life will be assessed using the Arabic KDQOL-36 at baseline, 3 months, and 6 months. Clinical outcomes including adequacy, residual kidney function, hospitalization, and mortality will be recorded.

Inclusion criteria

• - Age 18 years or older
• Established end-stage kidney disease requiring maintenance hemodialysis
• Receiving in-center maintenance hemodialysis at Assiut University Hospitals
• On maintenance hemodialysis for at least one month before enrollment
• Established twice-weekly or thrice-weekly schedule prescribed by the treating team
• Clinically stable at recruitment
• Able to understand and respond to the questionnaire
• Written informed consent

Exclusion criteria

• - Acute kidney injury without established end-stage kidney disease
• Hemodialysis for less than one month
• Peritoneal dialysis or kidney transplantation during follow-up
• Acute severe illness requiring intensive care at recruitment
• Severe cognitive, psychiatric or neurological impairment preventing reliable questionnaire responses
• Active malignancy with expected survival too short to complete follow-up
• Temporary dialysis solely for an acute indication
• Refusal to participate
• Permanent transfer to another dialysis center during follow-up