Prospective Evaluation of an In-Center Daily Hemodialysis Program

Abstract

Short duration daily hemodialysis (DHD) emerges as a well-tolerated alternative to standard hemodialysis (SHD). In this prospective study 5 patients in SHD were recruited to participate in an in-center DHD program. The SHD consisted of 3 sessions of 4 h each per week. Nonproportional mixture machines without an ultrafiltration control device and low flow dialyzers were used. For DHD, dialysis equipment and procedures were kept the same. Dialysis sessions, however, began at 6 p.m. (from Monday to Saturday) and lasted 2 h. Data from the last 6 months on SHD of the same patients were compared with the ones from each semester on DHD. Bone biopsy was performed at start and at the end of the 2-year study period. Hypotensive episodes, hypertensive crisis, cramps and headaches became 7–10 times less frequent in daily dialysis. A significant fractional increase (∼12%) was seen in mean values for hematocrit. Predialysis urea levels as well as predialysis creatinine levels declined significantly. Also lower during the daily dialysis period were the mean values for both phosphorus and Ca×P product. Significant increases were found in serum bicarbonate, albumin and in dry weight. The frequency of mean blood pressure ≧110 mm Hg on arrival for dialysis was significantly lower in every semester on daily hemodialysis. A significant twofold improvement in quality of life scoring was observed. Finally, daily hemodialysis also seemed to be beneficial to low turnover bone disease and bone aluminum deposition. These beneficial effects occurred despite of an increase in the frequency of missing days. Results from the present study which prospectively addressed the role of in-center short daily hemodialysis in the management of ESRD are encouraging.

Survival in Daily Home Hemodialysis and Matched Thrice-Weekly In-Center Hemodialysis Patients

“…This pattern may reflect growing fatigue with the daily dialysis regimen, as reported in a prospective study of five daily in-center hemodialysis patients. 32 However, estimates of relative survival in later intervals mostly rely on follow-up data from patients who initiated DHHD in 2005 and 2006. We found that survival was better for patients who initiated DHHD in 2007 than for their predecessors, suggesting serial improvement in patient training and technique execution.…”

Daily Hemodialysis

“…Decreases in systolic or mean arterial BP were reported in 10 of 11 studies (10,14,16,17,(22)(23)(24)27,29,31), whereas six of eight studies found no statistically significant change in phosphate or phosphate binder dose with DHD at 3 to 24 mo of follow-up (12,14,16,24,26,27). Health-related quality of life improved in some studies but not in others.…”

“…Health-related quality of life improved in some studies but not in others. Improvements were seen in hematocrit, hemoglobin, or erythropoietin dose in 7 of 11 studies (14,16,17,22,24,29,31). Albumin increased in 5 of 10 studies (11,16,18,22,29).…”

Esquemas alternativos de hemodiálise

“…Such objectives are more easily achieved in longer and/or more frequent dialysis regimens. [6][7][8][9][10] There is evidence that the longer treatment, even in CHD, is associated with a smaller risk of death, regardless of the Kt/V achieved. Japan, where patients frequently undergo dialysis for four to five hours per session, has the lowest HD mortality rate in the world.…”

“…Patients on DHD show a significant improvement in several clinical, laboratory, and echocardiographic parameters. 9,10,20,22 Patients also improve their quality of life. 23 As previously mentioned, patients on CHD have only approximately 25% of remaining life expectancy when beginning dialysis as compared with the general population.…”