Clinical effectiveness and quality of life of conventional haemodialysis versus short daily haemodialysis: a systematic review.
BACKGROUND
End-stage renal disease is a troublesome health problem worldwide. The most usual renal replacement therapy is conventional haemodialysis (CHD), performed three times a week, 3.5-4 h per session. It has been proposed that this schedule is unphysiologic and that daily haemodialysis would be a more appropriate schedule. One of the variants of daily haemodialysis is the so-called short daily haemodialysis (SDHD), performed five to seven times per week, 1.5-3 h per session. The objective of this paper is to compare, through a systematic review, the clinical effectiveness and safety of SDHD versus CHD.


METHODS
The following databases were searched: MEDLINE, EMBASE, NHS Centre for Reviews and Dissemination (HTA, DARE and NHS EED), Cochrane, ISI Web of Knowledge, IME and IBECS. Two independent reviewers decided which papers were to be included after applying inclusion and exclusion criteria. Any discrepancy was resolved by consensus. The quality of the included papers was measured using a quality scale developed for the purpose of this report.


RESULTS
Seventeen original articles were included. There were no randomized controlled trials. SDHD seems to be more effective than conventional dialysis. Patients on daily haemodialysis seem to present less vascular access problems, better control of hypertension and in turn a reduction in the antihypertensive treatment, better quality of life, lower incidence of ventricular hypertrophy, lower consumption of rHuEPO due to the better control of anaemia and a reduction in the use of phosphate binders as a consequence of the better control of plasmatic phosphorous.


CONCLUSIONS
SDHD might result in a better clinical effectiveness, mainly through a better control of the arterial tension and, therefore, a lower consumption of antihypertensive drugs, and a better quality of life than CHD.
Puñal
Jeannete
J
Galician Department of Health, Galician Agency for Health Technology Assessment, Santiago de Compostela, Spain.
Lema
Leonor Varela
LV
Sanhez-Guisande
Domingo
D
Ruano-Ravina
Alberto
A
D000740:Anemia / Q000188:drug therapy; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002408:Catheters, Indwelling / Q000009:adverse effects; D004921:Erythropoietin / Q000008:administration & dosage; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000517:prevention & control; D017379:Hypertrophy, Left Ventricular / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy; D009752:Nutritional Status; D011788:Quality of Life; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D012449:Safety; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D011994:Recombinant Proteins; D004921:Erythropoietin