Review: Differences in prescription between conventional and alternative haemodialysis

Abstract

There is growing interest worldwide in the beneficial effects of increasing the frequency and/or time of haemodialysis (HD) sessions. Alternative HD regimens to incorporate these changes, also called 'quotidian' HD schedules, likely offer advantages over conventional thrice-weekly HD. Alternative regimens include short-daily HD (typically performed 1.5-3 h, 5-7 days per week) and nocturnal HD (typically 6-8 h, 3-7 nights per week). Both regimens can be performed at home or in the hospital setting, although in Australia and New Zealand the predominant alternative regimen is nocturnal HD at home. Dialysis prescriptions for alternative schedules vary in many aspects when compared with conventional HD and this review describes differences in dialysate concentrations, blood and dialysate flow rates, ultrafiltration rates, vascular access issues and adequacy of HD between the different HD modalities. An international quotidian dialysis registry has also recently been created to capture observational data on patients receiving alternative HD regimens and provides further information on dialysis prescriptions for these therapies.