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Dialysis frequency versus dialysis time, that is the question
Raymond M Hakim1, Sharmeela Saha1
1Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Kidney International
|December 17, 2013
Summary
Intensive dialysis (daily or longer sessions) shows survival benefits in retrospective studies, but randomized trials show modest effects. Longer conventional dialysis sessions (three times weekly) are recommended over daily shorter sessions.
Area of Science:
- Nephrology
- Renal Replacement Therapy
Background:
- Dialysis prescription varies, with options including longer sessions or more frequent hemodialysis.
- Studies comparing intensive dialysis regimens have yielded conflicting results regarding survival benefits.
Purpose of the Study:
- To review and compare the efficacy of different dialysis prescriptions, focusing on survival outcomes.
- To reconcile discrepancies between retrospective and prospective studies on dialysis frequency and duration.
Main Methods:
- Review of prospective randomized controlled trials and retrospective cohort studies.
- Analysis of studies comparing conventional dialysis (≥3 times/week) with longer duration versus daily hemodialysis with shorter duration.
Main Results:
- Retrospective analyses suggest significant survival benefits with intensive dialysis.
- Prospective randomized trials show more modest benefits, potentially due to small sample sizes, recruitment challenges, and compliance issues.
- Discrepancies may stem from selection bias in retrospective studies.
Conclusions:
- Conventional dialysis frequency (at least three times per week) is favored, but with longer dialysis times than currently prescribed based solely on Kt/Vurea.
- The potential benefits of intensive dialysis must be weighed against patient lifestyle burden, access risks, and societal costs.
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