Long-term study of high-comorbidity ESRD patients converted from conventional to short daily hemodialysis.
BACKGROUND
Conventional hemodialysis (CHD) is associated with suboptimal clinical outcomes and high mortality rates. Daily hemodialysis (DHD) has been reported to improve outcomes and quality of life (QOL), predominantly in self-care or home dialysis populations. The effect of short DHD (sDHD) on patients with end-stage renal disease (ESRD) with high comorbidities has not been established.


METHODS
This prospective study compared clinical outcomes and QOL in high-comorbidity patients with ESRD converted from CHD to sDHD while maintaining the same total weekly dialysis time. Study patients had 4.0 +/- 1.7 major comorbid conditions in addition to ESRD. Standard dialysis parameters, antihypertensive and erythropoietin (EPO) requirements, Kidney Disease Quality of Life (KDQOL) measurements, vascular access problems, and hospitalization rates were compared while on sDHD therapy versus the previous 12 months on CHD therapy.


RESULTS
Forty-two patients were studied on sDHD therapy for 793 patient-months during a 72-month period. During sDHD, standard Kt/V increased 31%, hospitalization days decreased significantly by 34%, and vascular access problems did not increase. Cumulative survival was 33% at 6 years. In the 20 patients who remained on sDHD therapy for 12 months, after 1 year, we found significant improvements in KDQOL scores, a 69% reduction in antihypertensive medications with stable blood pressure, and a 45% reduction in EPO requirements with stable hematocrits. We hypothesize that these improvements are the result of the less extreme solute and fluid fluctuations and greater dialysis dose provided by sDHD, even when weekly dialysis time is unchanged.


CONCLUSIONS
High-comorbidity patients with ESRD converted to sDHD therapy had significantly improved clinical outcomes and QOL and decreased hospitalizations, with no increase in vascular access problems.
El Camino Dialysis Services, Mountain View, CA, USA. ecrmg@pacbell.net
George O
GO
Ting
Carl
C
Kjellstrand
Terri
T
Freitas
Brian J
BJ
Carrie
Shahrzad
S
Zarghamee
D000368:Aged; D000740:Anemia / Q000188:drug therapy; D001794:Blood Pressure; D002408:Catheters, Indwelling; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009747:Nutritional Physiological Phenomena; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis / Q000379:methods* / Q000401:mortality; D013223:Statistics as Topic; D013997:Time Factors; D016896:Treatment Outcome