Prolonged Protective Effect of Short Daily Hemodialysis against Dialysis-Induced Hypotension

Abstract

Background/Aims: Short daily hemodialysis (HD) has a protective effect against dialysis-induced hypotension (DIH). We examined whether this effect extends beyond the treatment period. Methods: We analyzed clinical variables in 6 patients (5 with diabetes mellitus) who underwent conventional hemodialysis (CHD) for 4 h three times weekly for 12 weeks; then short daily HD for 2 h six times weekly for 12 weeks, and then 12 more weeks of CHD. All patients had been given vasopressors for severe DIH. Results: The severe DIH disappeared during the short daily HD. There were significant decreases in body weight (BW), cardiothoracic ratio (CTR), blood pressure (BP), normal saline solution (NSS) amount (62.8 ± 26.4 vs. 9.8 ± 7.4 ml/session, p < 0.05), frequency (0.60 ± 0.26 vs. 0.10 ± 0.07 infusions/session, p < 0.05) and postdialysis atrial natriuretic peptide (ANP) (176.8 ± 56.4 vs. 104.8 ± 42.3 pg/ml, p < 0.05). Weekly ultrafiltration volume (6.3 ± 0.9 vs. 7.9 ± 0.7 l, p < 0.05) was significantly higher during the short daily HD period than during the first CHD period. The vasopressor treatment was therefore stopped or reduced in all patients during the short daily HD period. Because DIH recurred in the second CHD period despite a significant increase in BP, the vasopressor treatment was resumed in 5 patients. BW, CTR, NSS infusion amount and frequency, or postdialysis ANP did not differ significantly between the short daily HD and second CHD periods. Conclusions: The protective effect of short daily HD against DIH lasted more than 12 weeks after the treatment ended. We therefore conclude that temporary short daily HD is useful for preventing DIH.

Hemodialysis-Induced Cardiac Injury

“…More frequent daily or nocturnal HD therapies can improve cardiovascular outcome measures and quality of life (26,27). Such treatments have been shown to improve both intradialytic hemodynamics (by reducing IDH) (28) and plasma concentrations of biochemical markers of myocardial injury (29). We have already demonstrated that dialysisbased strategies such as cooled dialysate can improve intradialytic hemodynamics and reduce myocardial stunning (5).…”

Circulating Endotoxaemia and Frequent Haemodialysis Schedules

“…Quotidian dialysis therapies are characterised by reduced ultrafiltration (UF) requirements within each dialysis session, with improved intradialytic haemodynamics [4], advantageous effects on cardiovascular structure and function [5,6], and superior survival [7]. Current data suggest NHD is associated with maximal benefit, with lower levels of systemic inflammation, a trend towards lower EPO requirements and improved cardiac function [5,8].…”

Blood Pressure and Hemodialysis

“…The 2007 European Best Practice Guidelines recommend that the treatment time and/or frequency of dialysis should be increased in patients with hypertension despite optimal volume removal (Tattersall et al, 2007). The prescription of longer and/or more frequent hemodialysis sessions allows the decrease in ultrafiltration rate and reduces the risk of intradialytic complications (Brunet et al, 1996, Laurent & Charra, 1998, Okada et al, 2005.…”