A primer for the prescription of short‐daily and nocturnal hemodialysis

Abstract

More frequent and intensive hemodialysis (HD) schedules continue to garner interest internationally. Two dominant regimens have emerged, namely short-daily and nocturnal HD. A growing body of observational data suggests that these regimens allow more rigorous control of biochemical and physical parameters when compared with conventional HD. This review describes the methodology used in providing more frequent or sustained HD both in center and at home, and attempts to provide a physiological rationale for the practices described in the current literature.

Review: Differences in prescription between conventional and alternative haemodialysis

“…Although the type of dialysers for alternative HD regimens is similar to conventional HD (preferably being high‐flux), the dialysate concentration should vary between schedules 4,26 (Table 3). Initial dialysate composition for SDHD is similar to that for conventional HD (Table 3), but there are variations in NHD as listed below.…”

“…An increasing number of studies in haemodialysis (HD) patients show benefits of alternative HD regimens providing more effective treatment and improving surrogate end‐points and quality of life 1 . There has been growing interest in changes in HD prescription to facilitate these treatments; and alternative HD schedules have thus become an increasingly popular alternative to conventional thrice‐weekly HD (3.5–5 h per session) 2–5 . Alternative regimens provide greater flexibility and predominantly involve augmentation of the frequency and/or duration of HD.…”

“…1 There has been growing interest in changes in HD prescription to facilitate these treatments; and alternative HD schedules have thus become an increasingly popular alternative to conventional thrice-weekly HD (3.5-5 h per session). [2][3][4][5] Alternative regimens provide greater flexibility and predominantly involve augmentation of the frequency and/or duration of HD. In Australia, longer and more frequent HD is the commonest alternative regimen and is often undertaken in the home environment.…”

Dietary and Pharmacological Control of Calcium and Phosphate Metabolism in Dialysis Patients

“…However, this amount is inadequate to remove the phosphorus load on a weekly basis. Increasing the dosage of dialysis, preferably to lengthy three times per week dialysis, hemodiafiltration, or, even better, daily/nightly dialysis (not always a practicable option) may prevent phosphorus retention and even require no dietary phosphate restriction or the withdrawal of phosphate binders [84,85] . However, the data are limited and uncertainty remains as to a preferred dialysis regimen (http://www.kdigo.org).…”

Intensified hemodialysis

“…Verschiedene Verfahren werden beschrieben: F Verlängerung der Behandlungszeit/Sitzung bei gleich bleibender Frequenz (3-mal 7-8 h/Woche, in der Regel über Nacht); F Erhöhung der Frequenz bei gleich bleibender wöchentlicher Stundenzahl (statt 3-mal 4 h/Woche: 6-mal 2 h/ Woche, "short daily hemodialysis") sowie F Erhöhung von Dauer und Frequenz der Sitzungen (6-mal 7-8 h) während der Nacht zuhause ("nocturnal dialysis"). Das Dialyseregime bei der täglichen kurzen Hämodialyse entspricht in der Regel dem der konventionellen Dialyse, sowohl hinsichtlich der Dialysatzusammensetzung als auch des Blut-und Dialysatflusses [14]. In der Regel wird der Shunt mit zwei Nadeln punktiert.…”