Effect of frequent hemodialysis on residual kidney function

Abstract

Frequent hemodialysis can alter volume status, blood pressure and the concentration of osmotically active solutes, each of which might affect residual kidney function (RKF). In the Frequent Hemodialysis Network Daily and Nocturnal Trials, we examined the effects of assignment to 6 compared to 3 times per week hemodialysis on follow up RKF. In both trials, baseline RKF was inversely correlated with number of years since onset of ESRD. In the Nocturnal Trial, 63 participants had non-zero RKF at baseline (mean urine volume 0.76 l/d, urea clearance 2.3 ml/min, and creatinine clearance 4.7 ml/min). In those assigned to frequent nocturnal dialysis, these indices were all significantly lower at month 4 and were mostly so at month 12 compared to controls. In the frequent dialysis group, urine volume had declined to zero in 52% and 67% of patients at months 4 and 12, respectively, compared to 18% and 36% in controls. In the Daily Trial, 83 patients had non-zero RKF at baseline (mean urine volume 0.43 l/d, urea clearance 1.2 ml/min, and creatinine clearance 2.7 ml/min). Here, treatment assignment did not significantly influence follow-up levels of the measured indices, although the range in baseline RKF was narrower, potentially limiting power to detect differences. Thus, frequent nocturnal hemodialysis appears to promote a more rapid loss of RKF, the mechanism of which remains to be determined. Whether RKF also declines with frequent daily treatment could not be determined.

Comparison of Urine Output among Patients Treated with More Intensive Versus Less Intensive RRT: Results from the Acute Renal Failure Trial Network Study

“…In our exploratory analyses, we noted that adjustment for time-updated measurements of BUN resulted in attenuation of the effect estimate for the difference in daily rate of change in urine output, supporting the notion that adjustment for BUN as a marker of solute load resulted in a smaller difference in changes in urine output between the less intensive and more intensive arms. Again, analogous evidence exists in patients on chronic HD, in whom more frequent HD (resulting in lower timeaveraged urea concentrations) has been reported to be associated with a more rapid decline in urine output (33,34).…”

Caregiver Burden and Hemodialysis

“…Self-reported physical health and functioning were improved but had no significant effect on objective physical performance (8). The FHN Group also reported on cardiac function (9,10), anemia (11), residual kidney function (12), and nutrition (13).…”

Treatment frequency and mortality among incident hemodialysis patients in the United States comparing incremental with standard and more frequent dialysis

“…Randomized, controlled trials of a higher dialysis dose or frequency have shown inconsistent results [7][8][9][10][11][12] and may accelerate residual kidney function (RKF) decline. 13 An incremental approach to HD initiation may offer many potential benefits to patients, including better preservation of an arteriovenous fistula, reduced cost, and preservation of RKF. Less frequent (i.e., twice weekly) HD has been associated with greater preservation of RKF after initiation of HD, [14][15][16] and higher RKF is associated with better patient survival in both PD and HD patients.…”