A crossover study of short daily haemodialysis

• Published in: Nephrology, dialysis, transplantation Vol. 21; no. 1; pp. 166 - 175
• Main Authors: Goldfarb-Rumyantzev, Alexander S., Leypoldt, John K., Nelson, Natalia, Kutner, Nancy G., Cheung, Alfred K.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.01.2006; Oxford Publishing Limited (England)
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; blood pressure; Blood Pressure Determination; Cross-Over Studies; daily haemodialysis; Emergency and intensive care: renal failure. Dialysis management; Female; Humans; Intensive care medicine; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - therapy; Kidney Function Tests; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; outcome; Patient Compliance; Probability; Prognosis; Quality of Life; quotidian haemodialysis; Renal Dialysis - methods; Renal failure; Risk Assessment; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Time Factors; Treatment Outcome; Urea - blood; urea kinetics; Kidney disease; urea kinetics; Urinary system disease; Prognosis; Hemodialysis; Quality of life; Extrarenal dialysis; Urea; quotidian haemodialysis; Renal failure; daily haemodialysis; Arterial pressure; Blood pressure; outcome
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfi116

Background. The benefits of daily haemodialysis (DHD) compared to conventional three times per week haemodialysis (CHD) have been described in a number of observational studies. Most of these previous studies however have not been performed with rigorous controls. Methods. We performed a crossover study following an A-B-A design: phase A was 4 weeks of thrice weekly dialysis, 3–4 h per treatment (CHD); phase B was 8 weeks of six times/week dialysis, each session being one-half of the usual time (DHD) and phase A with 4 weeks of thrice weekly dialysis (CHD) was repeated. Patients characteristics: n = 12, six males; age 52±18 years, six diabetics. Results. Weekly single-pool Kt/V, equilibrated Kt/V and standard Kt/V of urea, and β-2-microglobulin clearance values were greater during DHD. Eight of 12 patients who completed the study reported symptomatic benefits from DHD that partially or completely disappeared during the second period of CHD. Quality of life of patients improved during DHD. Three patients had problems with arteriovenous access during DHD. Average blood pressure was lower during DHD (systolic 139.5±22.7 mmHg) compared to the initial (147.7±21.4 mmHg, P<0.001) and last (146.4±20.0 mmHg, P<0.005) CHD periods. No significant changes in predialysis haemoglobin and the serum concentration of albumin, phosphate, β-2-microglobulin or B-type natriuretic peptides (BNP) were observed, although BNP trended downward during DHD and returned to baseline level during the second period of CHD. The dose of erythropoietin did not change significantly. Patient compliance with the dialysis schedule was lower during DHD. Dialysis staff perceived an increased workload but felt that the patients benefited medically from DHD. Conclusions. The results of this cross-over study suggest symptomatic benefits and decrease in blood pressure, but there are potential problems with compliance and vascular access during DHD.