Daily Hemodialysis

Abstract

Several studies have reported improved outcomes with daily hemodialysis (DHD), but the strength of this evidence has not been evaluated. The published evidence on DHD was synthesized and its quality rated to inform need and sample size calculations for a randomized trial. Citations were identified in MEDLINE and EMBASE using validated search strategies. Dialysis journals that were not indexed and bibliographies of relevant articles were hand-searched. Two authors reviewed all citations. Articles that reported original data on five or more adults who were receiving DHD (1.5 to 3 h, 5 to 7 d/wk) for >3 mo were included. Twenty-five articles reporting 14 unique populations with 268 patients (five to 72 per study) met inclusion criteria. Of the 14 cohorts, 13 were studied with an observational design, 10 were studied prospectively, and four had parallel control groups. Mean age ranged form 41 to 64 yr, mean time on dialysis was 2 to 11 yr, 0 to 28% of patients had diabetes, >90% had arteriovenous fistulae, and >50% were dialyzed at home. Most data were described at <12 mo of follow-up. Outcomes included quality of life, cardiovascular disease, erythropoiesis, nutritional status, hospitalizations, and vascular access failures. Reporting was too heterogeneous to allow pooling of data. Ten of 11 studies suggested improvements in blood pressure; findings for other outcomes varied. Discontinuation of DHD occurred in 0 to 57% in-center and 0 to 15% home patients. Studies of DHD are limited by small sample size, nonideal control groups, selection and dropout biases, and paucity of data on potential risks. Randomized trials with adequate statistical power are required to establish the efficacy and the safety of DHD.

Clinical Effects of Personalized Dialysate Sodium in Conventional, Quotidian, and Nocturnal Home Hemodialysis Patients: A Randomized Crossover Trial

“…Consider the common clinical situation of a patient undergoing thrice weekly conventional haemodialysis with persistent volume overload and recurrent intradialytic hypotension. Increased dialysis frequency could improve fluid removal [15,43,44] and a slightly positive DPNa + gradient would protect from intradialytic hypotension [39,41,45]. Our data provides evidence to support increasing haemodialysis frequency to decrease IDWG in such patients.…”

Modalidades de hemodiálise ambulatorial: breve revisão

“…Durante três meses foram avaliadas ocorrências de sintomas relacionados à diálise; tiveram como resultado, que o maior benefício foi no campo psicológico, o controle da pressão arterial foi mais eficaz, e a adequação da diálise foi melhorada e cinco pacientes apresentaram grande dificuldade em manter o peso seco adequado quando retornaram para hemodiálise convencional. Suri et al (6) demonstraram que apesar de promissores esses esquemas alternativos são de difícil implementação em larga escala por razões que passam pela viabilidade econômica e a aceitação pelo paciente já que apresenta inconveniências por exigir, tempo disponível para se submeterem às sessões e para os centros de diálise, por não permitir o rodízio da clientela em dias alternados como ocorre na hemodiálise convencional.…”

High-Frequency Hemodialysis

“…The authors of recently published critical reviews of nocturnal and daily hemodialysis conclude that previous studies have been limited by inconsistent findings, small sample sizes, inadequate assessment of potential risks, and the biases that are inherent in observational studies. The current evidence does not support the widespread implementation of daily or nocturnal hemodialysis, also suggesting that an RCT is needed (16,17). In addition, there has been little information published on the feasibility, safety, and possible adverse effects of frequent hemodialysis.…”

“…They reported improved BP control, anemia, and health-related quality of life, with mixed results for changes in left ventricular hypertrophy and mineral metabolism. A systematic review of daily hemodialysis studies through May 2005 was published by Suri et al (17). Here again, differences in the duration of a single hemodialysis session make it difficult to draw definitive conclusions.…”