Extended daily dialysis in acute renal failure: a new therapeutic approach

Although intermittent hemodialysis (IHD) is the standard therapy in patients with acute renal failure, it is associated with several drawbacks. Extended daily dialysis (EDD) has been described as a compromise between IHD and continuous therapies and could potentially overcome problems associated with IHD.

We compared EDD with IHD each administered in 15 patients with acute renal failure. The IHD was administered 4 hours per session thrice weekly, while EDD was given for 8 hours per session daily with the same machines at similar blood and dialysate flow rates. Treatment outcome, metabolic control, and hemodynamic stability were assessed in the patients of each group.

A total of 140 EDD treatment sessions and 82 IHD sessions were administered. Patients in the EDD and the IHD groups received a mean of 74.67 +/- 29.70 hours and 21.73 +/- 5.99 hours of dialysis, respectively (P < .001). The median urea reduction ratio in the EDD group was significantly higher (83.82% versus 64.66%, P < .001). Patients on EDD showed faster normalization of deranged metabolic parameters. Hemodynamically, EDD was better tolerated compared to IHD. The median predialysis mean arterial pressure in the EDD and IHD patients were 103.3 mm Hg and 100 mm Hg, respectively, while the postdialysis values were 78.6 mm Hg and 73 mm Hg, respectively.

Extended daily dialysis appears to be a promising technique for dialysis in moderately ill patients having up to 2 organ failures.