Abstract
Cardiovascular complications are the most prominent causes of morbidity and mortality among chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients undergoing standard hemodialysis (HD) therapy. Cardiovascular disease risk is increased significantly through persistent hypertension and blood pressure (BP) fluctuation, which are the most common complications of CKD. It was hypothesized that an extended approach with lengthier and more frequent dialysis sessions, referred to in this paper as “extended hemodialysis” (EHD), can potentially lower and stabilize blood pressure, and consequently reduce the rate of morbidity and mortality. A greater reduction of volume (salt and water) with higher frequency can improve patient quality of life (QOL). Eleven papers, including clinical trials and systematic reviews were chosen and analyzed. The extracted data was used to evaluate the change in blood pressure levels between standard HD and EHD. Overall, the studies showed that EHD resulted in improved blood pressure management; therefore, we concluded that there will be a decrease in cardiovascular disease risk, stroke, and morbidity and mortality rate. There will be also an improvement in patient QOL due to beneficial effects of the EHD.
Highlights
Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are two main global health concerns with prevalence as high as 11–13% and 0.1% in the general population, respectively [1].The costs of treatment procedures are extremely high, annually amounting up to $42 billion dollars for hemodialysis (HD) in the United States alone, which accounts up to 9% of all Medicare payments [2,3].According to the 2015 US Renal Data System Annual Data Report, in 2014, 87.9% of all incident cases began renal replacement therapy with hemodialysis, 9.3% started with peritoneal dialysis, and 2.6%received a pre-emptive kidney transplant [4]
In order to illustrate the importance of a normotensive blood pressure (BP), it is important to outline the basic physiology of BP control and how it is affected by standard HD and extended hemodialysis” (EHD)
EHD results in a decrease in inter-dialytic period, lower intradialytic BP fluctuations, and increased duration of volume removal per session, all leading to a variety of benefits
Summary
Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are two main global health concerns with prevalence as high as 11–13% and 0.1% in the general population, respectively [1].The costs of treatment procedures are extremely high, annually amounting up to $42 billion dollars for hemodialysis (HD) in the United States alone, which accounts up to 9% of all Medicare payments [2,3].According to the 2015 US Renal Data System Annual Data Report, in 2014, 87.9% of all incident cases began renal replacement therapy with hemodialysis, 9.3% started with peritoneal dialysis, and 2.6%received a pre-emptive kidney transplant [4]. The costs of treatment procedures are extremely high, annually amounting up to $42 billion dollars for hemodialysis (HD) in the United States alone, which accounts up to 9% of all Medicare payments [2,3]. This paper will only focus on HD, due to the high prevalence of this treatment. Standard HD consists of three sessions a week with a duration of about four hours per session [5]. Patients receiving this form of treatment have high hospitalization rates with a long duration of stay. With such high costs, patients should be receiving a higher quality of HD
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