More frequent hemodialysis: what do we know? Where do we stand?

The high mortality of hemodialysis patients has served as a strong incentive to increasing knowledge of the possible approaches to optimizing treatment strategies in this patient population. The majority of patients worldwide usually receive hemodialysis thrice-weekly, according to calculations of dialysis adequacy. An abundance of literature and studies, starting as early as the late 1960s, has shown that an increase in dialysis frequency has beneficial impacts on outcomes such as left ventricular hypertrophy, anemia, calcium and phosphorus metabolism, and health- related quality of life. Reductions in left ventricular mass and improvements in quality of life (as measured by RAND-36) by frequent hemodialysis were recently confirmed by a large-scale randomized trial. This is the first trial on this topic which was sufficiently powered and compared the findings in patients receiving frequent hemodialysis to an adequate control group. The significant findings of this trial thus confirmed the evidence in the literature which had been accumulating over decades. This manuscript reviews previous studies on more frequent hemodialysis, including published results of the Frequent Hemodialysis Network Daily Trial.