Frequent hemodialysis: a critical review

Area of Science:

• Nephrology
• Internal Medicine

Background:

• Conventional thrice-weekly hemodialysis (CHD) is standard but associated with increased mortality risk during the extended interdialytic interval.
• Registry data indicate high mortality rates during the 2-day gap in CHD, suggesting a need for alternative strategies.

Purpose of the Study:

• To review and compare the effects of frequent hemodialysis (HD) regimens versus CHD on patient outcomes.
• To evaluate survival, hospitalizations, complications, quality of life, and other key parameters across different HD modalities.

Main Methods:

• Systematic review of current data comparing frequent HD (short daily, nocturnal, alternate-day) with CHD.
• Analysis of outcomes including mortality, hospitalizations, vascular access, quality of life, renal function, cardiovascular health, bone metabolism, and anemia.

Main Results:

• Frequent HD may mitigate risks associated with the long interdialytic period of CHD.
• Data comparison across modalities addresses survival, complications, and patient-reported outcomes.
• Limitations in current data and the practical role of frequent dialysis are discussed.

Conclusions:

• Frequent hemodialysis offers potential benefits over CHD, particularly in improving survival and reducing interdialytic risks.
• Further research and clinical data are needed to fully establish the role and optimal implementation of frequent HD regimens.
• The review highlights the trade-offs between treatment frequency, patient outcomes, and the overall burden of therapy.