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Should a more frequent dialysis schedule be applied?

In general, patients with are dialyzed 3 times per week for about four hours each time. [1] have associated long dialysis intervals with an and cardiovascular disease hospitalizations, and on the other hand a rather new study[2] has suggested that daily dialysis might improve left-ventricular mass and health-related quality of life. Therefore the idea to implement a more schedule seems appealing.

However is a more really efficient, e.g. beneficial and economically justifiable? Prof. , NDT Editor-in-Chief took the task to analyze the pros and cons on this matter and to draw a conclusion. His review[3] can be read in the January edition of NDT.

As Zoccali points out, there might be a benefit on mortality but, on the other hand, a more frequent (e.g. alternate) hemodialysis might increase the risk of arteriovenous fistula problems and, thus, increase the disease burden. The impact on the outcome has not yet been proven, emphasized Zoccali: “Evidence that these regimes are beneficial mainly derives from observational studies and the possibility that the same regimes are harmful cannot be excluded”. As long as new data is missing, there is no need to change dialysis schedules. “Only in problematic patients we should think about pro-actively applying more frequent HD regimes”.

Source

[1] Foley RN et al. N Engl J Med. 2011; 365(12): 1099-107; Chertow GM et al. N Engl J Med. 2010; 363(24): 2287-300

[2] Suri RS et al. Kidney Int. 2013; 83(2): 300-7

[3] Should we extend the application of more frequent dialysis schedules? A ‘yes’ and a hopeful ‘no’, Carmine Zoccali, Evangelia Dounousi, Samar Abd ElHafeez, Giovanni Tripepi and Francesca Mallamaci, Nephrol. Dial. Transplant. doi: 10.1093/ndt/gfu373, published online 23 December 2014.

Source: ERA-EDTA (European Renal Association – European Dialysis and Transplant Association)