BACKGROUND: Conventional hemodialysis (CHD) is associated with suboptimal clinical outcomes and high mortality rates. Daily hemodialysis (DHD) has been reported to improve outcomes and quality of life (QOL), predominantly in self-care or home dialysis populations. The effect of short DHD (sDHD) on patients with end-stage renal disease (ESRD) with high comorbidities has not been established. METHODS: This prospective study compared clinical outcomes and QOL in high-comorbidity patients with ESRD converted from CHD to sDHD while maintaining the same total weekly dialysis time. Study patients had 4.0 +/- 1.7 major comorbid conditions in addition to ESRD. Standard dialysis parameters, antihypertensive and erythropoietin (EPO) requirements, Kidney Disease Quality of Life (KDQOL) measurements, vascular access problems, and hospitalization rates were compared while on sDHD therapy versus the previous 12 months on CHD therapy. RESULTS: Forty-two patients were studied on sDHD therapy for 793 patient-months during a 72-month period. During sDHD, standard Kt/V increased 31%, hospitalization days decreased significantly by 34%, and vascular access problems did not increase. Cumulative survival was 33% at 6 years. In the 20 patients who remained on sDHD therapy for 12 months, after 1 year, we found significant improvements in KDQOL scores, a 69% reduction in antihypertensive medications with stable blood pressure, and a 45% reduction in EPO requirements with stable hematocrits. We hypothesize that these improvements are the result of the less extreme solute and fluid fluctuations and greater dialysis dose provided by sDHD, even when weekly dialysis time is unchanged. CONCLUSION: High-comorbidity patients with ESRD converted to sDHD therapy had significantly improved clinical outcomes and QOL and decreased hospitalizations, with no increase in vascular access problems.
BACKGROUND: Conventional hemodialysis (CHD) is associated with suboptimal clinical outcomes and high mortality rates. Daily hemodialysis (DHD) has been reported to improve outcomes and quality of life (QOL), predominantly in self-care or home dialysis populations. The effect of short DHD (sDHD) on patients with end-stage renal disease (ESRD) with high comorbidities has not been established. METHODS: This prospective study compared clinical outcomes and QOL in high-comorbidity patients with ESRD converted from CHD to sDHD while maintaining the same total weekly dialysis time. Study patients had 4.0 +/- 1.7 major comorbid conditions in addition to ESRD. Standard dialysis parameters, antihypertensive and erythropoietin (EPO) requirements, Kidney Disease Quality of Life (KDQOL) measurements, vascular access problems, and hospitalization rates were compared while on sDHD therapy versus the previous 12 months on CHD therapy. RESULTS: Forty-two patients were studied on sDHD therapy for 793 patient-months during a 72-month period. During sDHD, standard Kt/V increased 31%, hospitalization days decreased significantly by 34%, and vascular access problems did not increase. Cumulative survival was 33% at 6 years. In the 20 patients who remained on sDHD therapy for 12 months, after 1 year, we found significant improvements in KDQOL scores, a 69% reduction in antihypertensive medications with stable blood pressure, and a 45% reduction in EPO requirements with stable hematocrits. We hypothesize that these improvements are the result of the less extreme solute and fluid fluctuations and greater dialysis dose provided by sDHD, even when weekly dialysis time is unchanged. CONCLUSION: High-comorbidity patients with ESRD converted to sDHD therapy had significantly improved clinical outcomes and QOL and decreased hospitalizations, with no increase in vascular access problems.
Authors: D M Connaughton; A Jamal; J McWilliams; P O'Kelly; J Ormond; A Butler; N McEntee; E Tierney; G Lambe; M Denton; C Magee; P J Conlon Journal: Ir J Med Sci Date: 2012-06-03 Impact factor: 1.568
Authors: Glenn M Chertow; Nathan W Levin; Gerald J Beck; John T Daugirdas; Paul W Eggers; Alan S Kliger; Brett Larive; Michael V Rocco; Tom Greene Journal: J Am Soc Nephrol Date: 2015-10-14 Impact factor: 10.121
Authors: Glenn M Chertow; Nathan W Levin; Gerald J Beck; Thomas A Depner; Paul W Eggers; Jennifer J Gassman; Irina Gorodetskaya; Tom Greene; Sam James; Brett Larive; Robert M Lindsay; Ravindra L Mehta; Brent Miller; Daniel B Ornt; Sanjay Rajagopalan; Anjay Rastogi; Michael V Rocco; Brigitte Schiller; Olga Sergeyeva; Gerald Schulman; George O Ting; Mark L Unruh; Robert A Star; Alan S Kliger Journal: N Engl J Med Date: 2010-11-20 Impact factor: 91.245
Authors: Joshua Zaritsky; Brian Young; Barbara Gales; He-Jing Wang; Anjay Rastogi; Mark Westerman; Elizabeta Nemeth; Tomas Ganz; Isidro B Salusky Journal: Clin J Am Soc Nephrol Date: 2010-03-18 Impact factor: 8.237
Authors: Peter Kotanko; Amit X Garg; Tom Depner; Andreas Pierratos; Christopher T Chan; Nathan W Levin; Tom Greene; Brett Larive; Gerald J Beck; Jennifer Gassman; Alan S Kliger; John B Stokes Journal: Hemodial Int Date: 2015-01-05 Impact factor: 1.812
Authors: Yoshio N Hall; Brett Larive; Patricia Painter; George A Kaysen; Robert M Lindsay; Allen R Nissenson; Mark L Unruh; Michael V Rocco; Glenn M Chertow Journal: Clin J Am Soc Nephrol Date: 2012-03-15 Impact factor: 8.237
Authors: Stuart L Goldstein; Douglas M Silverstein; Jocelyn C Leung; Daniel I Feig; Beth Soletsky; Cathy Knight; Bradley A Warady Journal: Pediatr Nephrol Date: 2007-11-08 Impact factor: 3.714