Clinical and biochemical correlates of starting "daily" hemodialysis

Daily hemodialysis has been proposed to improve outcomes for patients with end-stage renal disease. There has been increasing evidence that daily hemodialysis might have potential advantages over intermittent dialysis. However, despite these potential advantages, daily hemodialysis is infrequently used in the United States, and published accounts on the technique are few.

We describe patient outcomes after increasing their hemodialysis frequency from three to six times per week in a cohort of 72 patients treated at nine centers during 1972 to 1996. Analyses of predialysis blood pressure and laboratory parameters from 6 months before until 12 months after starting frequent hemodialysis used a repeated-measures statistical technique.

Predialysis systolic and diastolic blood pressures fell by 7 and 4 mm Hg, respectively, after starting frequent hemodialysis (P = 0.02). Reductions were greatest among patients being treated with antihypertensive medications, despite a reduction in their dosage of medications. Postdialysis weight fell by 1.0% within one month of starting frequent hemodialysis and improved control of hypertension. After the initial drop, postdialysis weight increased at a rate of 0.85 kg per six months. Serum albumin rose by 0.29 g/dl (P < 0.001) between months 1 to 12 of treatment with daily hemodialysis. Hematocrit rose by 3.0 percentage points (P = 0.02) among patients (N = 56) not treated with erythropoietin during this period. Two years after the start of daily hemodialysis, Kaplan-Meier analyses showed a patient survival of 93%, a technique survival of 77%, and an arteriovenous fistula patency of 92%. Vascular access patency was excellent despite more frequent use of the access.

These results suggest that in certain patients, daily hemodialysis might have advantages over three times per week hemodialysis.