Dialysis frequency versus dialysis time, that is the question

Abstract

We reviewed a number of prospective randomized and multiple retrospective cohort studies of different dialysis prescriptions: longer dialysis time, at a frequency of at least three times a week, or a frequency of daily hemodialysis with a shorter dialysis time. Interestingly, the retrospective analyses have generally found significant survival benefits in the intensive dialysis groups, whereas more modest effects were observed in the prospective randomized controlled trials. The reason for this discrepancy may be related to the retrospective nature of the studies and possible selection bias; for example, the patients who were prescribed more frequent dialysis may have had more difficulties with volume control or high blood pressure. In contrast, the randomized controlled trials of increased dialysis frequency, which have shown indirect and modest benefits in complex coprimary end points, have small sample sizes and are plagued with difficulties in recruitment and compliance with the randomly allocated more frequent dialysis. This review, which attempts to balance the potential benefits of more frequent dialysis with the burden on the patient's lifestyle, an increased risk of access malfunction, as well as societal costs of such intensive dialysis prescriptions, concludes in favor of the conventional three times per week dialysis (at a minimum) but at longer dialysis times than is currently prescribed based on the Kt/Vurea metric alone.

Clinical, patient-related, and economic outcomes of home-based high-dose hemodialysis versus conventional in-center hemodialysis

“…15,96 Furthermore, addressing transition from twice-to thrice-weekly regimens as proposed 93,94 can be difficult from a patient perspective, potentially leading to suboptimal outcomes. 96,97 The recommendation of a minimum of thrice-weekly dialysis was recently supported by Hakim and Saha 98 in their review of the effects of dialysis frequency versus dialysis time. The authors also suggest a minimum initial dialysis duration of 4 hours per session, which later could be increased to 6 hours or even 8 hours if clinical and/or subclinical parameters dictate.…”

Nocturnal intermittent hemodialysis

“…NIHD is probably the best compromise between sufficient-but not too much-dialysis [35,36]. There is also the advantage of sparing the blood access from frequent cannulation, as well as limiting frequent dialysis sessions.…”

Home Hemodialysis Dose: Balancing Patient Needs and Preferences

“…However, these treatment regimens also have the potential to increase costs and can be perceived by patients to be less convenient and tolerable than CHD. Increasing the duration of HD sessions can improve clearance of middle molecules and larger solutes, and use lower ultrafiltration rates; but this approach can also lead to hypophosphatemia and more rapid loss of residual renal function [5]. Increasing frequency of HD can improve left ventricular hypertrophy; but can lead to vascular access complications.…”