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Nephrology Dialysis Transplantation, Vol 13, Issue 11 2853-2860, Copyright © 1998 by Oxford University Press
M Kooistra, J Vos, H Koomans and P Vos
Background: More frequent dialysis has been claimed to
improve clinical outcome and quality of life. Methods:
Clinical status was optimized in 13 haemodialysis patients during a run-in
period of 2 months with three dialysis sessions a week. Thereafter, daily
home haemodialysis (DHHD, 6 sessions per week) was initiated. The total
weekly dialysis dose (Kt/V) was kept constant.
Results: Weekly Kt/V was 3.2±0.13
(M±SEM) before, and 3.2±0.15 after 6 months of DHHD
(NS), time averaged concentration of urea (TACu) was 21.2±1.6
mmol/l and 20.1±0.9 mmol/l (NS). Urea reduction was
0.56±0.05 before DHHD, and 0.41±0.06 during DHHD
(P<0.0001). Serum K remained unchanged, but significantly less
exchange resins were used (P<0.02). Also, the dose of
phosphate-binding agents could be decreased. Values for Na, K, Cl,
bicarbonate, Ca, PTH, albumin, and Hb remained unchanged. Iron deficiency
developed in some patients. Twenty-four-hour blood pressure monitoring
showed a decrease of systolic blood pressure (141.1±17.2 mmHg
before, and 130.9±19.2 mmHg during DHHD, P<0.001).
Diastolic blood pressure remained constant (82.8±7.2 and
76.9±10.1 mmHg, NS). Mean arterial pressure decreased from
102.2±9.5 to 94.9±1.4 mmHg (P<0.02). Blood
pressure decreased mainly in previously hypertensive patients. Mean target
weight increased 0.8 kg. The amount of antihypertensive drugs used
decreased from 1.88±0.35 to 0.75±0.17
(P<0.005, n=7). Dialysis sessions were much more stable, also in
patients with cardiac insufficiency. Quality of life questionnaires (Rand
36, Nottingham Health Profile, Uraemic Symptoms Profile) showed a
significant improvement of physical condition and fewer uraemic symptoms.
Conclusion: DHHD compared to conventional
thrice-weekly haemodialysis with similar weekly Kt/V results in an improved
haemodynamic control and quality of life, but has lesser impact on
metabolic regulation. Key words: daily home
haemodialysis; hypertension; quality of life
ORIGINAL ARTICLES
Daily home haemodialysis in the Netherlands; effects on metabolic control, heamodynamics, and quality of life
Stichting Thuisdialyse Midden-West Nederland (Foundation of Home Dialysis Mid-West Netherlands) and Department of Nephrology, University Hospital Utrecht, Utrecht, The Netherlands; Corresponding author at: Stichting Thuisdialyse Midden-West Nederland, Brennerbann 130, 3524 BN Utrecht, Nederland
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