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Long-term study of high-comorbidity ESRD patients converted from conventional to short daily hemodialysis

Am J Kidney Dis. 2003 Nov;42(5):1020-35
Long-term study of high-comorbidity ESRD patients converted from conventional to short daily hemodialysis.
Ting GO, Kjellstrand C, Freitas T, Carrie BJ, Zarghamee S.
El Camino Dialysis Services, Mountain View, CA, USA

Background

Conventional hemodialysis (CHD) is associated with suboptimal clinical outcomes and high mortality rates. Daily hemodialysis (DHD) has been reported to improve outcomes and quality of life (QOL), predominantly in self-care or home dialysis populations. The effect of short DHD (sDHD) on patients with end-stage renal disease (ESRD) with high comorbidities has not been established.

Methods

Prospective study compared clinical outcomes and QOL in high-comorbidity patients with ESRD converted from CHD to sDHD while maintaining the same total weekly dialysis time. Study patients had 4.0 +/- 1.7 major comorbid conditions in addition to ESRD. Standard dialysis parameters, antihypertensive and erythropoietin (EPO) requirements, Kidney Disease Quality of Life (KDQOL) measurements, vascular access problems, and hospitalization rates were compared while on sDHD therapy versus the previous 12 months on CHD therapy.

Results

• Forty-two patients were studied on sDHD therapy for 793 patient-months during a 72-month period. During sDHD, standard Kt/V increased 31%, hospitalization days decreased significantly by 34%, and vascular access problems did not increase. Cumulative survival was 33% at 6 years.
• In 20 patients who remained on sDHD therapy for 12 months, after 1 year, the significant improvements in KDQOL scores, a 69% reduction in antihypertensive medications with stable blood pressures, 45% reduction in EPO requirements with stable hematocrits were observed.
• The authors hypothesize that these improvements are the result of the less extreme solute and fluid fluctuations and greater dialysis dose provided by sDHD, even when weekly dialysis time is unchanged.

Conclusion

High-comorbidity patients with ESRD converted to sDHD therapy had significantly improved clinical outcomes and QOL and decreased hospitalizations, with no increase in vascular access problems.