High-efficiency short daily haemodialysis--morbidity and mortality rate in a long-term study.
BACKGROUND
In conventional haemodialysis (CHD), the morbidity and mortality rate is unacceptably high; consequently, variations in the length and frequency of the haemodialysis sessions have been studied to reduce the complications of dialysis treatment. In this sense, high-efficiency short daily haemodialysis (SDHD) has been proposed as an alternative for patients on renal replacement therapy. In this study, we have related our experience with this dialysis modality.


METHODS
Twenty-six patients (16 males, mean age 35.6 +/- 14.7 years) were treated by SDHD for 33.6 +/- 18.5 months (range 6-57 months). The mean time on CHD before the switch to SDHD was 25.5 +/- 31.9 months (range 1-159 months). In 23 (88.5%) patients, native arteriovenous fistulae were used for vascular access. SDHD was performed six times a week, 1.5-2 h per session, and high flux polysulfone dialysers (surface area: 1.8 m(2)) were employed. The blood flow and dialysate flow rate were 350 and 800 ml/min, respectively.


RESULTS
In this trial, the patient survival was 100%. The vascular access survival after 12, 24, 36 and 48 months on SDHD was 100, 89, 89 and 80%, respectively. There were three failures of vascular access in 72.7 patient-years (0.04 failures/patient-year). In 15 patients on SDHD during 36 consecutive months, the vascular access survival after 12, 24, 36 and 48 months was 100, 93, 93 and 84%, respectively. Also, in this group of patients, there were 0.27 hospitalizations/patient-year and 1.24 days of hospitalizations/patient-year.


CONCLUSIONS
We concluded that in a long-time study of patients on SDHD the morbidity and mortality rate is very low. Furthermore, we observed that failures of vascular access are not a significant problem. Consequently, we believe that SDHD is a powerful renal replacement therapy for treatment of patients on maintenance haemodialysis.
Martins Castro
Manuel Carlos
MC
Hospital das Clínicas da Faculdade de Medicina da USP, Divisão de Nefrologia, Av Dr Enéas Carvalho de Aguiar, 2557 andar ICHC, sala 7080, CEP 05403-000, São Paulo, Brazil. crica.dialise@hcnet.usp.br
Luders
Cláudio
C
Elias
Rosilene Motta
RM
Abensur
Hugo
H
Romão Junior
João Egidio
JE
D000293:Adolescent; D000328:Adult; D002408:Catheters, Indwelling; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000150:complications / Q000453:epidemiology; D006331:Heart Diseases / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis / Q000191:economics / Q000379:methods* / Q000523:psychology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome