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Daily versus standard hemodialysis: one year experience
J Traeger1, R Sibai-Galland, E Delawari
1Association Utilisation Rein Artificiel Lyon, France.
Insights
Daily hemodialysis significantly improved blood pressure and cardiac health in uremic patients. This approach enhanced nutritional status and reduced the need for erythropoietin, suggesting it is a preferred treatment for managing hypertension and left ventricular hypertrophy.
Area of Science:
- Nephrology
- Cardiology
- Clinical Nutrition
Background:
- Hypertension and left ventricular hypertrophy are common complications in uremic patients undergoing hemodialysis.
- Standard hemodialysis regimens may not fully address these comorbidities.
- Optimizing dialysis frequency could offer clinical benefits.
Purpose of the Study:
- To compare clinical and biological outcomes in hemodialysis patients before and after conversion to daily hemodialysis.
- To evaluate the impact of increased dialysis frequency on cardiovascular parameters and nutritional status.
Main Methods:
- A cohort of 4 hemodialysis patients was switched from thrice-weekly sessions (4-5 hours each) to daily sessions (2-2.5 hours each).
- Total weekly dialysis time and modalities remained constant.
- Clinical and biochemical parameters, including blood pressure, left ventricular mass index, urea time averaged deviation (TAD), Kt/V, caloric intake, and normalized protein catabolic rate (nPCR), were monitored.
Main Results:
- Daily hemodialysis led to significant reductions in blood pressure (p < 0.01) and left ventricular mass index (p < 0.01).
- Improvements were observed in urea TAD (p < 0.005) and Kt/V (p < 0.05).
- Patients showed increased caloric intake (p < 0.05) and nPCR (p < 0.0038), with one patient discontinuing erythropoietin therapy.
Conclusions:
- Daily hemodialysis appears to be a superior treatment strategy for managing hypertension and left ventricular hypertrophy in uremic patients.
- The increased frequency of dialysis, leading to improved urea clearance, likely explains the observed clinical improvements.
- Daily hemodialysis positively impacts cardiovascular health and nutritional status in hemodialyzed individuals.
Abstract:
The aim of this study was to compare clinical and biological results in 4 standard hemodialyzed patients originally treated by three 4-5 h sessions per week and converted within one year to daily hemodialysis sessions of 2-2.5 h each 6 times per week. The modalities and the total weekly dialysis times remained the same. With daily hemodialysis, the blood pressure and left ventricular mass index decreased significantly (p < 0.01). A significant decrease in the urea time averaged deviation (TAD) (p < 0.005) and increase in the Kt/V index (p < 0.05) were observed. A gain in dry weight was shown with a rise in caloric intake from 33+/-3.21 to 40.8+/-6.35 kcal/kg/day (p < 0.05), and the normalized protein catabolic rate (nPCR) increased significantly (p < 0.0038). One patient who was receiving erythropoietin (EPO) for anemia could stop his treatment. No arteriovenous fistula complications were observed. Daily hemodialysis seems to be the method of choice to manage hypertension and left ventricular hypertrophy in uremic patients. The increase of the urea TAD to a value closer to that of the healthy kidney due to the increase of the frequency of dialysis is probably the main explanation for clinical improvement.