Quality of life and daily hemodialysis.

Preliminary findings indicate that daily hemodialysis positively impacts patients' energy/fatigue and other uremic and intradialytic symptoms. In addition to improvements in perceived symptoms, improvements in patients' perceived physical and psychosocial functioning have been reported. These findings have come from small series of patients, however, and may reflect an increased attention effect. Confirmation of preliminary findings and identification of changes in other quality of life outcomes await an adequately powered randomized clinical trial. Sleep quality, sexual functioning, and cognitive functioning are quality of life dimensions that may be impacted by daily hemodialysis but about which there is limited information in the preliminary data that exist. Understanding relationships among different levels of quality of life outcomes associated with daily hemodialysis requires consideration of emotional and psychological variables such as burden, depression, and satisfaction with care that may intervene between treatment and the quality of life outcomes that patients report. Deriving health utilities relevant to patient experience on different daily hemodialysis therapies, analyzing longitudinal quality of life outcomes reported by patients on daily hemodialysis, and investigating the effectiveness of daily hemodialysis for specific patient subgroups are research agendas that can provide information needed to facilitate treatment decision making in which quality of life has an important role.