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Review
. 2022 Mar 25;11(2):39-57.
doi: 10.5527/wjn.v11.i2.39.

Hidden risks associated with conventional short intermittent hemodialysis: A call for action to mitigate cardiovascular risk and morbidity

Bernard Canaud  1 , Jeroen P Kooman  2 , Nicholas M Selby  3 , Maarten Taal  3 , Andreas Maierhofer  4 , Pascal Kopperschmidt  4 , Susan Francis  5 , Allan Collins  1 , Peter Kotanko  6
Affiliations
Review

Hidden risks associated with conventional short intermittent hemodialysis: A call for action to mitigate cardiovascular risk and morbidity

Bernard Canaud et al. World J Nephrol. .

Abstract

The development of maintenance hemodialysis (HD) for end stage kidney disease patients is a success story that continues to save many lives. Nevertheless, intermittent renal replacement therapy is also a source of recurrent stress for patients. Conventional thrice weekly short HD is an imperfect treatment that only partially corrects uremic abnormalities, increases cardiovascular risk, and exacerbates disease burden. Altering cycles of fluid loading associated with cardiac stretching (interdialytic phase) and then fluid unloading (intradialytic phase) likely contribute to cardiac and vascular damage. This unphysiologic treatment profile combined with cyclic disturbances including osmotic and electrolytic shifts may contribute to morbidity in dialysis patients and augment the health burden of treatment. As such, HD patients are exposed to multiple stressors including cardiocirculatory, inflammatory, biologic, hypoxemic, and nutritional. This cascade of events can be termed the dialysis stress storm and sickness syndrome. Mitigating cardiovascular risk and morbidity associated with conventional intermittent HD appears to be a priority for improving patient experience and reducing disease burden. In this in-depth review, we summarize the hidden effects of intermittent HD therapy, and call for action to improve delivered HD and develop treatment schedules that are better tolerated and associated with fewer adverse effects.

Keywords: Biologic storm; Cardiovascular mortality; Circulatory stress; Dialysis sickness; Dialytic morbidity; End stage kidney disease; Personalized medicine.

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Conflict of interest statement

Conflict-of-interest statement: Canaud B is acting as scientist consultant for FMC. No conflict of interest exists for other authors.

Figures

Figure 1
Figure 1
Intermittent extracorporeal renal replacement therapy is the source of permanent stress in hemodialysis patients. HD: Hemodialysis; CVC: Central venous catheter.
Figure 2
Figure 2
Dialysis Related Pathology linked to patient outcomes. GI: Glycaemic index; PROM: Patient reported outcomes measures; PREM: Patient reported experience measures; HRQOL: Health-related quality of life.
Figure 3
Figure 3
Action plan to design and implement a more cardioprotective renal replacement treatment in order to improve patient outcomes. HD: Hemodialysis; PBUT: Protein bound uremic toxins; LMW: Low-molecular-weight; HMW: High-molecular-weight; HDF: On-line hemodiafiltration.
See this image and copyright information in PMC

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