What is important in dialysis? The frequency of treatment sessions.
Outcomes from conventional thrice-weekly hemodialysis (CHD) are disappointing for a lifesaving therapy. The results of the HEMO Study show that the recommended minimum dose (Kt/V) for adequacy is also the optimum attainable with CHD. Interest is therefore turning to alternative therapies exploring the effects of increased frequency and time of hemodialysis treatment. This paper is mainly concerned with frequency. The rationale for daily hemodialysis is discussed and a short history of its use given. The results of studies of more frequent hemodialysis indicate the potential for health and quality of life improvement in a number of areas. Blood pressure control is improved and this appears to be associated with improvement in left ventricular geometry and mass. At face value the studies suggest that increased frequency (and/or time) improve intermediate outcomes that may be associated with survival. The need for well-designed, randomized prospective trials is indicated and these are underway. An international registry has also been established. Results from these initiatives will tell whether the improvement potential is realized.
Lindsay
Robert M
RM
The University of Western Ontario and London Health Sciences Centre, London, Ont., Canada.
D006801:Humans; D006435:Renal Dialysis; D013997:Time Factors