Short daily hemodialysis: A four-year experience

From thr beginning of 1997, 15 patients were converted from standard hemodi alysis (SHD) to short daily haemodialysis (S-DHD). The same dialysis config uration (i.e., machine, dialyzer, blood and dialysate flows, etc.) and tota l weekly time were maintained for at least 1 year. Along with frequency, th e weekly Kt/V was increased by about 10%. Clinical and biological improveme nts were observed: excellent dialysis tolerance of the ultra-short session, disappearance of post-dialysis fatigue, optimal blood pressure control, re gression of left ventricualar hypertrophy, better nutritional status with a n increase in dry body weight, general well-being, and better quality of li fe. In order to differentiate the effects of increased dialysis dose or inc reased frequency, we reduced the weekly Kt/V in 5 patients so that they had the same Kt/V as when they were on SHD. Since the clinical improvements we re maintained, it appears that frequency is the main factor of amelioration . The optimum Kt/V during S-DHD remains to be precisely fixed. These excell ent clinical results have allowed us to look for a new definition of dialys is adequacy, taking into account three markers-time-averaged concentration (TAC), time-averaged deviation (TAD), and interdialytic hydrosodic inflatio n. Although S-DHD can be used as a temporary rescue therapy, it usually sho uld be considered to be a long-term therapy in cases of failure of peritone al dialysis or intractable SHD complications (cardiovascular, nutritional, etc.). Everyday sessions are certainly the most physiological way for treat ing chronic renal failure.