Conversion from conventional in-centre thrice-weekly haemodialysis to short daily home haemodialysis ameliorates uremia-associated clinical parameters

Abstract

Background: Under physiological conditions, kidneys work continuously, 168 h/week. In contrast, patients with end-stage renal disease are usually dialysed only 12 h/week. Even if considered adequate by current Kt/V-based dose estimates, this unphysiological dose is associated with an unacceptable annual mortality rate of 10-20%. Increasing dialysis dose might ameliorate this mortality rate.

Design: Eleven patients were switched from their conventional haemodialysis (cHD, 3 × 4 h/week) to an intensified short daily home haemodialysis regimen (sdhHD, 6 × 3 h/week) and followed up for 12 months. Different parameters were evaluated before treatment conversion and quarterly during follow-up [i.e. dialysis efficacy, mean arterial pressure (MAP), antihypertensive drug score, haemoglobin, transferrin saturation, ferritin, dose of erythropoiesis-stimulating agents (ESA), iron requirement, parameters of nutrition (body weight, albumin, protein), C-reactive protein, calcium-phosphate product, alkaline phosphatase (AP), intact parathyroid hormone (iPTH) and amount of phosphate-binding pharmacotherapy].

Results: HD efficacy as assessed by cumulative blood volume increased after dialysis intensification (P < 0.01). The pre- and post-dialytic MAP declined during the study period (P < 0.0001), while antihypertensive drugs could be reduced (P = 0.02). Haemoglobin levels improved (P < 0.0001). Additionally, the need for ESAs fell under intensified sdhHD (P = 0.008). Nutritional status improved [albumin, P = 0.03; total serum protein, P = 0.02; 'dry' body weight (BW) and body mass index (BMI) (both P < 0.001)]. The calcium-phosphate product declined (P < 0.01), without changes in the dose of phosphate binders.

Conclusion: Conversion from conventional in-centre to short daily home HD leads to an improvement in numerous dialysis-associated metabolic variables and thus represents an attractive treatment modality for selected patients.