When is more frequent hemodialysis beneficial?

Abstract

The use of frequent hemodialysis (HD) is growing, with the hope of improving outcomes in end-stage renal disease. We narratively review the three randomized trials, 15 comparative cohort studies, and several case series of frequent HD that empirically demonstrate the potential efficacy and adverse effects of these regimens. Taken together, the randomized studies suggest frequent HD may result in left ventricular mass regression. This effect is most pronounced when left ventricular mass is abnormal, but attenuated by significant residual urine output. Both frequent short and long HD consistently improved blood pressure control and reduced antihypertensive use, despite greater weekly interdialytic weight gains. Serum phosphate was lowered. Frequent short daytime HD improved health-related quality of life, while frequent long overnight HD did not. Regarding adverse effects, frequent HD patients underwent significantly more procedures to salvage arteriovenous vascular accesses. An absolute increase in hypotensive episodes was observed with frequent short HD, while frequent long HD accelerated residual renal function loss and increased perceived caregiver burden. The effect of frequent HD on mortality is controversial, due to conflicting results and limitations of published studies. Finally, pregnancy outcomes may be substantially better with frequent long HD. On the basis of these data, we suggest frequent HD is most likely to benefit patients with left ventricular hypertrophy particularly if there is minimal urine output, those unable to attain dry weight on a thrice weekly schedule, and pregnant women. All patients receiving frequent HD should be advised of and monitored for potential risks.

The effect of cognitive–behavioral intervention on hope and death anxiety level in patients undergoing hemodialysis

“…HD treatment was found to lead patients to experience limitations and frustration frequently, because it imposes many restrictions such as changing one’s daily routine and body appearance, fluid control and modifications related to diet (Ottaviani et al , 2014). In addition, these patients mostly experience painful treatment for a long duration, have to intake medications and live daily with an incurable disease and its complications (Suri and Kliger, 2018). These problems may consequently affect the individuals’ level of hopefulness, so these patients experience death anxiety due to living under stressful conditions (Ottaviani et al , 2014), which may induce non-adherence to their medical guidelines and exacerbate their medical problems (Sohn et al , 2018).…”

The nitty-gritties of Kt/Vurea calculations in hemodialysis and peritoneal dialysis

“…[ 7 ] Though the studies have shown conflicting results regarding whether more frequent dialysis improves mortality, there are other benefits including regression of left ventricular mass (if it was abnormal earlier), improved blood pressure control, reduced use of antihypertensives, and better pregnancy outcomes. [ 8 ]…”

Introduction to unresolved issues in the care of dialysis patients

“…Recently, interest and subsequent research have grown on the topic of optimal hemodialysis frequency. Suri and Kliger consider when and in which patient frequent hemodialysis may be beneficial, while Mathew et al review the benefits and risks of a twice weekly or incremental approach to initiation of hemodialysis . While this Seminars in Dialysis issue focuses on the dialysis patient, it is recognized that renal transplantation provides better survival in most patient populations.…”