title: Flexibility as an implementation strategy for a daily dialysis program.
abstract: BACKGROUND
  Daily hemodialysis (DHD) is an interesting dialysis option, experienced worldwide by only a few hundred patients, because of clinical and logistic limitations. This study describes the main clinical and implementation results of a flexible policy applied in starting a DHD program.
  
  
  METHODS
  The setting is the University Nephrology Center of Turin, Italy (approximately 150 hemodialysis and 50 peritoneal dialysis (PD) patients) where in November 1998 a short daily DHD program was started. Outcome measures were logistical (enrollment rate, indications and drop-outs) and clinical (dialysis efficiency, metabolic control, hypertension and anemia control).
  
  
  RESULTS
  25 patients experienced DHD, 16 (11% of the hemodialysis pool) were on DHD in November 2001; overall the DHD follow-up was 409.1 months (median 18, range 0.7-36 months). Flexibility was applied to schedules (patients modulated dialysis time and could switch to 3-4 sessions/wk); treatment setting (home: 11 patients, limited care center: 13; alternate settings: one); clinical selection (23/25 patients with comorbidity). Main reasons for choice were poor tolerance of previous schedule and the search for "best" treatment. Five patients dropped out (work reasons), one died on DHD and three were grafted. As compared to baseline, dialysis efficiency increased (EKRc pre-DHD 14.5 +/- 2.1 mL/min; 17.4 +/- 2.8 mL/min and 17.7 +/- 3.5 mL/min at 1-6 months; p<0.000). Despite the potentially confusing effect of comorbidity, the main clinical data improved.
  
  
  CONCLUSIONS
  A flexible approach allowed development of DHD in approximately 11% of hemodialysis patients, with promising clinical results, despite frequent comorbidity.
authors.affiliation: Chair of Nephrology, Department of Internal Medicine, University of Turin, Turin, Italy. gbpiccoli@hotmail.com
authors.forename: Giorgina Barbara
authors.initials: GB
authors.lastname: Piccoli
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Mezza
authors.forename: Marco
authors.initials: M
authors.lastname: Quaglia
authors.forename: Francesca
authors.initials: F
authors.lastname: Bermond
authors.forename: Francesca
authors.initials: F
authors.lastname: Bechis
authors.forename: Manuel
authors.initials: M
authors.lastname: Burdese
authors.forename: Massimo
authors.initials: M
authors.lastname: Gai
authors.forename: Alfonso
authors.initials: A
authors.lastname: Pacitti
authors.forename: Alberto
authors.initials: A
authors.lastname: Jeantet
authors.forename: Giuseppe Paolo
authors.initials: GP
authors.lastname: Segoloni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Piccoli
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001071:Appointments and Schedules; D001794:Blood Pressure; D015897:Comorbidity; D004921:Erythropoietin / Q000097:blood; D005260:Female; D006436:Hemodialysis Units, Hospital; D006437:Hemodialysis, Home; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D010530:Peritoneal Dialysis; D010710:Phosphates / Q000097:blood; D018583:Pliability; D006435:Renal Dialysis; D012709:Serum Albumin / Q000032:analysis
chemical_list: D000959:Antihypertensive Agents; D006454:Hemoglobins; D010710:Phosphates; D012709:Serum Albumin; D004921:Erythropoietin