Physical Activity in Short Daily Home Dialysis vs to In-Center HD

BACKGROUND: Short Daily Home Dialysis (SDHD) has been proposed as a patient-centered alternative to conventional in-center hemodialysis (ICHD). METHODS: The multicenter Self-convecTive Evaluation of short daily home dialysis (SDHD) on Physical Activity (STEP-HD) observational and prospective cohort compared SDHD with ICHD over 12 months in France and Belgium. The primary endpoint was average daily step count, assessed using wearable activity trackers. Secondary outcomes included sleep, sedentary time, recovery after dialysis, laboratory parameters, quality of life, and treatment burden. RESULTS: A total of 152 patients were enrolled (82 SDHD, 70 ICHD). At baseline, SDHD patients demonstrated 28% higher activity levels (6,673 vs 4,768 steps/day), a difference sustained throughout follow-up. Physical activity in ICHD patients was significantly lower on dialysis days, while SDHD patients maintained stable patterns. Sleep duration was greater un SDHD (up to 405 minutes/day) and lower in ICHD (to 202 minutes/day). Sedentary time remained consistently lower and recovery time tended to be shorter in SDHD (60 vs 120 minutes). Laboratory analyses showed lower predialysis β2-microglobulin and preserved nutritional markers in SDHD, despite similar anemia and metabolic control. CONCLUSIONS: Compared with ICHD, SDHD was associated with sustained preservation of physical activity, better post-dialysis recovery, improved sleep, and reduced sedentary burden, supporting its use as a safe and patient-centered modality.