Daily Hemodialysis Short Term Clinical Evaluation

Background: The clinical outcome of hemodialysis can be improved when frequency increases. Daily hemodialysis, with short dialytic session and reduction of interdialytic interval, may increase the depurative efficiency and optimize the physiology of dialytic treatment.
Objectives: Our aim was to evaluate the feasibility of daily hemodialysis in routine clinical practice & its effect on some aspect of uremic pathology.
Methods: We studied, prospectively, 10 patients (6 M, 4 F), aged 37.4 ± 9.57years, treated for at least 3 months with daily hemodialysis. A standard cumulative weekly time (12-15 hrs) with session length (120-150 min) for 6 sessions a week and a delivered calculated Kt/V ranging 3.24-3.93 per week was achieved. Patients were allowed free diet and selection of their preferable time for the session. All patients were switched from standard HD (4 hrs 3 times weekly) for a period of 35 ± 15.2 months, due to patients preference (3 patients) or because they could not be managed satisfactorily on standard schedule (4 patients due to fluid overload &/or severe hypertension, 3 patients due to extreme cardiovascular instability). Diabetics were excluded, as well as, patients having problems with their vascular access or with poor clinical metabolic conditions.
Results: There was a significant increase in the mean (SD) dry body weight (Kg) from 65.2 ± 13.01 to 66.07 ± 13.56 (p ˂ 0.01) & a decline in mean arterial BP (mmHg) from a mean (SD) of 101.0 ± 7.81 to 96.53 ± 3.4 at the beginning & end of the study respectively. A significant rise in Hb (gm/dl) from 7.52 ± 1.7 to 8.37 ± 1.84 & Htc % from 24.05 ± 5.67 to 27.33 ± 6.30. The serum PO4 (mg/dl) declined from 5.37 ± 0.6 to 4.7 ± 0.35 with elevation of HCO3 (mEq/L) from 20.04 ± 0.74 to 23.02 ± 0.48 at the beginning & the end of the study respectively. The mean (SD) of the serum albumin, cholesterol & triglyceride in mg/dl at the entry & end were respectively, 4.09 ± 0.23 & 4.23 ± 0.24, 171.5 ± 12.24 & 195.5 ± 8.93, 151 ± 11.3 & 154.3 ± 10.52. Echocardiographic assessment at the entry & end of the study revealed a significant decrease in LVTDD (56.53 ± 3.90 to 52.31 ± 3.90), IVS (13.16 ± 1.57 to 11.97 ± 1.43), LVPW (11.36 ± 1.76 to 10.51 ± 1.53) (p ˂ 0.01) in min.
Conclusions: We conclude from our study that the protocol of daily hemodialysis is feasible in routine clinical practice, is well tolerated by patients and has a low incidence of complications. The clinical results are better than those obtained with standard dialysis, leading to a better correction of some uremia-induced pathology (anemia, malnutrition, acid-base balance, hemodynamic instabilities, and cardiac hypertrophy).