Hemeral (daily) hemodialysis

Abstract

Hemodialysis is generally performed 3 times per week, a treatment prescription not based on optimizing the physiology of the normal kidney that maintains body homeostasis by removing water and waste products continuously and efficiently. Peritoneal dialysis might be continuous but it is not efficient. Daily hemodialysis is both frequent and efficient and theoretically should be superior to other forms of dialysis for renal replacement therapy. There is again a growing interest in daily hemodialysis (it was originally described in 1969), and a number of investigators in North America and Europe are using it. As yet, there have been no randomized prospective studies comparing hard outcomes in patients dialyzed by conventional 3-times-per-week hemodialysis with those treated with daily hemodialysis (either short high-efficiency or long, slow nocturnal). The London, Ontario, study is the first attempt to obtain comparative data. It is a 3-year study to compare daily dialysis patients with cohort controls. To date, the study shows that short daily dialysis does provide more dialysis based on Kt/V than standard therapy. However, predialysis blood urea values are not different because of improved nutrition (increased normalized protein from nitrogen appearance (nPNA) and serum albumin levels). Anemia is improved with less erythropoeitin usage in the study group. Phosphate control is good, but no better than by conventional dialysis and phosphate binders are still required unlike patients receiving nocturnal dialysis. Blood pressure and volume management is better with daily dialysis. So far, the study patients show a trend to less morbidity than their controls, but differences are not (as yet) statistically different. Blood access in daily dialysis dose not cause problems. Quality of life is significantly increased in a number of areas with daily dialysis. The economic impact of daily dialysis is not yet known; the general premise is that the higher dialysis costs attributable to an increment in treatments will be offset by increased wellness and less morbidity with the subsequent beneficial impact on drugs, hospitalizations, and so on. The provision of daily dialysis in the home has attractive economic implications. A considerable growth for this superior form of therapy is expected.