Review: Differences in prescription between conventional and alternative haemodialysis

Abstract

SUMMARY AT A GLANCELonger hours dialysis has several challenges -one of these -modifying the dialysate composition is addressed in this article. ABSTRACT:There is growing interest worldwide in the beneficial effects of increasing the frequency and/or time of haemodialysis (HD) sessions. Alternative HD regimens to incorporate these changes, also called 'quotidian' HD schedules, likely offer advantages over conventional thrice-weekly HD. Alternative regimens include short-daily HD (typically performed 1.5-3 h, 5-7 days per week) and nocturnal HD (typically 6-8 h, 3-7 nights per week). Both regimens can be performed at home or in the hospital setting, although in Australia and New Zealand the predominant alternative regimen is nocturnal HD at home. Dialysis prescriptions for alternative schedules vary in many aspects when compared with conventional HD and this review describes differences in dialysate concentrations, blood and dialysate flow rates, ultrafiltration rates, vascular access issues and adequacy of HD between the different HD modalities. An international quotidian dialysis registry has also recently been created to capture observational data on patients receiving alternative HD regimens and provides further information on dialysis prescriptions for these therapies.

French patients on daily hemodialysis: clinical characteristics and treatment trajectories

“…Moreover, 20 % of all our patients had albumin levels <30 g/dl and 31 % hemoglobin levels <10 g/dl, suggesting that our population is predisposed to malnutrition [ 21 , 23 ] and anemia [ 5 , 21 , 24 ]. The finding that 48 and 33.5 % of patients in the dDHD group had low hemoglobin and albumin levels, respectively, indicates, as reported in previous studies [ 9 , 18 , 21 , 24 , 36 ], that patients started DHD as an emergency because of their poor medical status which did not allow proposing thrice-weekly HD with long sessions. Our results showed that patients who started directly with DHD presented a higher risk of mortality (HR = 2.44; 95 % CI: 1.91–3.11), but paradoxically they had a better access to renal transplantation (HR = 2.03; 95 % CI: 1.38–3.0).…”

“…Additionally, the REIN registry includes also data on the treatment modalities as well as on the pre- and post-DHD treatment switches. Therefore, and differently from previous studies that only described the first RRT modality and/or the length of the pre-DHD period [ 16 , 18 , 22 , 28 , 33 ], we could analyze and describe all the RRT modality changes before switching to DHD.…”

“…Some studies have shown that increasing the weekly frequency of dialysis sessions is the best approach to reproduce the kidney physiological functional role, compared to three times/week HD [ 5 , 15 , 18 , 23 ]. For instance, Daily HemoDialysis (DHD) consists of more sessions per week (≥5), delivered either as shorter daily sessions (1.5–3 h) [ 4 , 8 , 14 , 15 , 24 ] or as longer nocturnal sessions (≥5 h) [ 4 , 8 , 14 , 15 , 23 , 24 ].…”

Association between daily haemodialysis, access to renal transplantation and patients' survival in France

“…New dialysis regimens have been developed and tested with the aim of improving the patients' quality of life and blood purification . For instance, some authors have shown that increasing the weekly frequency of dialysis sessions is the best regimen to mimic the kidney functional role, compared with haemodialysis (HD) three times/week . Several studies on daily haemodialysis (DHD) reported the positive effects of increasing the number of HD sessions per week on the control of blood pressure, uraemia and ventricular hypertrophy in patients with end stage renal disease (ESRD).…”

“…3,4 For instance, some authors have shown that increasing the weekly frequency of dialysis sessions is the best regimen to mimic the kidney functional role, compared with haemodialysis (HD) three times/week. 3,[5][6][7] Several studies on daily haemodialysis (DHD) reported the positive effects of increasing the number of HD sessions per week on the control of blood pressure, 4,[8][9][10][11] uraemia 3,4 and ventricular hypertrophy [9][10][11] in patients with end stage renal disease (ESRD). On the other hand, DHD effects on mortality are less clear-cut.…”