News and Traditional Indications from Short Daily Dialysis: Different Schemes to Optimized ESF Response

Abstract

Interest in quotidian (daily) hemodialysis (DHD) seems to be growing. DHD improves quality of life, blood pressure control, and nutrition, and decreases the need of medications, including erythropoiesis stimulating factors (ESF). We evaluate the short daily dialysis (SDHD) efficacy in 14 patients in conventional hemodialysis (HD) (3 weekly sessions/4 h), mean age 52.1 years, range 25–75, 10 males and 4 females, and found that they needed to increase dialysis efficiency by different medical indications: in 11 cases traditional indications – 5 cases with hypertensive myocardiopathy and severe LVH (2 of them with low left ventricle ejection fraction), 2 cases with symptomatic, ischemic cardiopathy 2 patient with big body‐surface area and elevated phosphorus levels, and 2 patients by inadequate dialysis (infradialysis conditioning malnutrition status) secondary to HD with permanent catheter. In one female (25 yr old), SDHD was prescribed to improve cardiac toxicity secondary to chemotherapy for acute promyelocytic leukemia. The index resistance of ESF decreased since the first month, and the Aranesp doses decreased by more than 40%. 1 male (49 years) with nephrogenic fibrosing dermopathy showed skin lesions with osteoblastic transformation. The skin lesions were improving since the first week, obtaining a decrease of the index resistance ESF higher than 60% in the first month. 1 male with symptomatic obstructive hypertrophic myocardiopathy showed improvement of symptoms and quality of life since the first weeks, as well as echocardiograpic signs and improvement in Hb levels and decreasing dose of ESF. The schedule in all of them was 5–6 days/week sessions between 2.15 h and 3 h, depending on body‐surface area. To obtain a weekly Kt/V nearest to 4, HD sessions were realized in the hospital (7 pts) or in satellite unit (7 pts). The time remaining in this schedule was between 1 and 42 months. All the patients showed clinical improvement, subjective and objective, since the first week of start of SDHD. 3 patients could be included in Tx waiting list again. Anemia improved, decreasing index resistance of ESF. In relation with this, the time necessary to improve the response to ESF was different, showing a decrease in the first month higher than 40% in two cases dialyzing with a membrane high‐flux with pore size 100 A, appearing high Hb levels also in a polycystic patient always without ESF. We observed by analyzing the results in 12 stable patients; the patients with high‐flux dialyzers showed better response to ESF. Perhaps it could offer a better clearance of large molecules (inhibitor erythropoiesis factor and high molecular weight toxins) that participate to respond to ESF.Conclusion: Our experience shows new indications for SDHD with very good results. Anemia was improved in relation with SDHD, when synthetic high‐flux membranes and high pore size were used.