DAILY HOME HEMODIALYSIS IN THE NETHERLANDS - EFFECTS ON METABOLIC CONTROL, HEMODYNAMICS, AND QUALITY-OF-LIFE

Background. More frequent dialysis has been claimed to improve clinica l outcome and quality of life. Methods. Clinical status was optimized in 13 haemodialysis patients during a run-in period of 2 months with t hree dialysis sessions a week. Thereafter, daily home haemodialysis (D HHD, 6 sessions per week) was initiated. The total weekly dialysis dos e (Kt/V) was kept constant. Results. Weekly Kt/V was 3.2 +/- 0.13 (M /- SEM) before, and 3.2 +/- 0.15 after 6 months of DHHD (NS), time-ave raged concentration of urea (TACu) was 21.2 +/- 1.6 mmol/l and 20.1 +/ - 0.9 mmol/l (NS). Urea reduction was 0.56 +/- 0.05 before DHHD, and 0 .41 +/- 0.06 during DHHD (P < 0.0001). Serum K remained unchanged, but significantly less exchange resins were used (P < 0.02). Also, the do se of phosphate-binding agents could be decreased. Values for Na, K, C l, bicarbonate, Ca, PTH, albumin, and Hb remained unchanged. Iron defi ciency developed in some patients. Twenty-four-hour blood pressure mon itoring showed a decrease of systolic blood pressure (141.1 +/- 17.2 m mHg before, and 130.9 +/- 19.2 mmHg during DHHD, P < 0.001). Diastolic blood pressure remained constant (82.8 +/- 7.2 and 76.9 +/- 10.1 mmHg , NS). Mean arterial pressure decreased from 102.2 +/- 9.5 to 94.9 +/- 1.4 mmHg (P < 0.02). Blood pressure decreased mainly in previously hy pertensive patients. Mean target weight increased 0.8 kg. The amount o f antihypertensive drugs used decreased from 1.88 +/- 0.35 to 0.75 +/- 0.17 (P < 0.005, n = 7). Dialysis sessions were much more stable, als o in patients with cardiac insufficiency. Quality of life questionnair es (Rand 36, Nottingham Health Profile, Uraemic Symptoms Profile) show ed a significant improvement of physical condition and fewer uraemic s ymptoms. Conclusion. DHHD compared to conventional thrice-weekly haemo dialysis with similar weekly Kt/V results in an improved haemodynamic control and quality of life, but has lesser impact on metabolic regula tion.