Treatment time

The session duration for hemodialysis (HD) patients has become an old-fashioned issue since the blooming debate on dialysis frequency. However, all over the dialysis community, the most frequent scheme of HD treatment remains three-weekly sessions. Pursuing long dialysis strategy 3 times/week for ESRD patients in Tassin after the retirement of the historical leaders relies on the wisdom pillars of dialysis clinical adequacy that are survival, session tolerance, blood pressure control, nutrition and phosphate control. Recent data, including those of the large-scale DOPPS, clearly indicate that survival is associated with the length of the HD session and the ultrafiltration (UF) rate. The UF rate is the key factor for session tolerance and long dialysis reduces dramatically the incidence of significant intradialytic hypotension episodes. The corollary result is the easier and efficient control of extracellular volume overload and its complications, hypertension, left ventricular hypertrophy and acute pulmonary edema. Whereas conventional HD patients present with progressive nutritional impairment, like in the HEMO study, stability of nutritional markers is obtained with long dialysis. It also allows a significant reduction of hyperphosphatemia and phosphate-binder prescriptions when compared to DOPPS data. All these clinical markers that represent the essence of dialysis adequacy, favor strongly the strategy of a sequential long-hour dialysis program that may clinically and economically challenge with daily programs.