Raymond Hakim
Last active: 6/9/2014

Dialysis frequency versus dialysis time, that is the question.

Hakim RM, Saha S
Kidney Int. 2014 85 (5): 1024-9

PMID: 24336033 · DOI:10.1038/ki.2013.474

We reviewed a number of prospective randomized and multiple retrospective cohort studies of different dialysis prescriptions: longer dialysis time, at a frequency of at least three times a week, or a frequency of daily hemodialysis with a shorter dialysis time. Interestingly, the retrospective analyses have generally found significant survival benefits in the intensive dialysis groups, whereas more modest effects were observed in the prospective randomized controlled trials. The reason for this discrepancy may be related to the retrospective nature of the studies and possible selection bias; for example, the patients who were prescribed more frequent dialysis may have had more difficulties with volume control or high blood pressure. In contrast, the randomized controlled trials of increased dialysis frequency, which have shown indirect and modest benefits in complex coprimary end points, have small sample sizes and are plagued with difficulties in recruitment and compliance with the randomly allocated more frequent dialysis. This review, which attempts to balance the potential benefits of more frequent dialysis with the burden on the patient's lifestyle, an increased risk of access malfunction, as well as societal costs of such intensive dialysis prescriptions, concludes in favor of the conventional three times per week dialysis (at a minimum) but at longer dialysis times than is currently prescribed based on the Kt/Vurea metric alone.

MeSH Terms (11)

Humans Kidney Diseases Patient Selection Prospective Studies Randomized Controlled Trials as Topic Renal Dialysis Retrospective Studies Risk Assessment Risk Factors Time Factors Treatment Outcome

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