title: Should we extend the application of more frequent dialysis schedules? A 'yes' and a hopeful 'no'.
abstract: Observational studies associate long dialysis intervals with an excess risk for mortality and cardiovascular disease hospitalizations. The application alternate day dialysis is an appealing possibility to reduce the cardiovascular burden of long dialysis intervals and a small pilot study demonstrated that this regimen allows safe reduction of dry body weight, BP and left ventricular mass index. However, the actual impact of alternate day hemodialysis and of frequent hemodialysis in general on survival remains unknown. Frequent dialysis schedules may increase the risk of arteriovenous fistula problems and the burden of disease and eventually reduce treatment adherence. Furthermore we cannot safely exclude that more frequent dialysis regimens may be harmful. On the other hand increasing the duration of dialysis and/or frequency of hemodialysis in patients with refractory fluid overload, uncontrolled hypertension, hyperphosphatemia, malnutrition or cardiovascular disease is of unquestionable benefit in these problematic patients.Thus the moderators conclusion to the question being asked is a yes and a hopeful "no". Whenever and wherever possible we should pro-actively apply more frequent dialysis regimens, starting with the alternate day approach, in problematic patients. However, extensive application of frequent hemodialysis schedules is by now unjustified. Evidence that these regimens are beneficial mainly derives from observational studies and the possibility that frequent schedules are harmful cannot be excluded. A clinical trial is needed.
authors.affiliation: CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases, Ospedali Riuniti, 89124 Reggio Calabria, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
authors.affiliation: Department of Nephrology Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Dounousi
authors.affiliation: Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
authors.forename: Samar
authors.initials: S
authors.lastname: Abd ElHafeez
authors.affiliation: CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases, Ospedali Riuniti, 89124 Reggio Calabria, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tripepi
authors.affiliation: CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases, Ospedali Riuniti, 89124 Reggio Calabria, Italy Nephrology, Hypertension and Renal Transplantation Unit, Ospedali Riuniti, Reggio Calabria, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Mallamaci
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis / Q000706:statistics & numerical data*