New Options to Improve Hemodialysis Patient Outcomes

Abstract

Nearly three decades after the National Cooperative Dialysis Study showed that survival was related to time on dialysis and urea removal (1), little progress has been made to improve outcomes. The Hemodialysis Study (HEMO), a prospective randomized, controlled trial (RCT) comparing high- versus low-dosage and high- versus low-flux thrice-weekly dialysis failed to show improvement in survival for patients receiving the higher dosage dialysis (2). A move away from conventional thrice-weekly hemodialysis (HD) to more intensive treatments seems more promising. Enhanced solute removal is possible with hemodiafiltration (HDF), whereby diffusion and convection are combined across a highly permeable membrane. Several HDF techniques that may reduce morbidity and dialysis adverse effects have been developed (3). Although a meta-analysis of mortality showed no advantage of HDF (4), a more recent analysis of 2165 patients reported lower mortality for patients treated with HDF when compared with those receiving HD (5). Two intensive dialysis techniques are addressed in this issue of CJASN . Bujega et al. (6) describe their experience with in-center nocturnal HD (INHD). Thirty-nine patients who might benefit from more intensive HD were converted from standard HD to thrice-weekly overnight treatments lasting 7 to 8 h, with reduced blood pump speeds targeted at 300 ml/min. After conversion to INHD, serum phosphorus and calcium-phosphorus product improved, antihypertensive medication needed to control BP …