Hemeral (daily) hemodialysis

Hemodialysis is generally performed 3 times per week, a treatment prescript ion not based on optimizing the physiology of the normal kidney that mainta ins body homeostasis by removing water and waste products continuously and efficiently. Peritoneal dialysis might be continuous but it is not efficien t. Daily hemodialysis is both frequent and efficient and theoretically shou ld be superior to other forms of dialysis for renal replacement therapy. Th ere is again a growing interest in daily hemodialysis (it was originally de scribed in 1969), and a number of investigators in North America and Europe are using it. As yet, there have been no randomized prospective studies co mparing hard outcomes in patients dialyzed by conventional 3-times-per-week hemodialysis with those treated with daily hemodialysis (either short high -efficiency or long, slow nocturnal). The London, Ontario, study is the fir st attempt to obtain comparative data. It is a 3-year study to compare dail y dialysis patients with cohort controls. To date, the study shows that sho rt daily dialysis does provide more dialysis based on Kt/V than standard th erapy. However, predialysis blood urea values are not different because of improved nutrition (increased normalized protein from nitrogen appearance ( nPNA) and serum albumin levels). Anemia is improved with less erythropoeiti n usage in the study group. Phosphate control is good, but no better than b y conventional dialysis and phosphate binders are still required unlike pat ients receiving nocturnal dialysis. Blood pressure and volume management is better with daily dialysis. So far, the study patients show a trend to les s morbidity than their controls, but differences are not (as yet) statistic ally different. Blood access in daily dialysis dose not cause problems. Qua lity of life is significantly increased in a number of areas with daily dia lysis. The economic impact of daily dialysis is not yet known; the general premise is that the higher dialysis costs attributable to an increment in t reatments will be offset by increased wellness and less morbidity with the subsequent beneficial impact on drugs, hospitalizations, and so on. The pro vision of daily dialysis in the home has attractive economic implications. A considerable growth for this superior form of therapy is expected. (C) 20 01 by the National Kidney Foundation, Inc.