NDT Advance Access originally published online on April 21, 2006
Nephrology Dialysis Transplantation 2006 21(8):2232-2238; doi:10.1093/ndt/gfl171
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Dialysis and Transplantation
High-efficiency short daily haemodialysis—morbidity and mortality rate in a long-term study
Department of Internal Medicine, Division of Nephrology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
Correspondence and offprint requests to: Manuel Carlos Martins Castro, MD, Hospital das Clínicas da Faculdade de Medicina da USP, Divisão de Nefrologia, Av Dr Enéas Carvalho de Aguiar, 255 7° andar ICHC, sala 7080, CEP 05403-000, São Paulo, Brazil. Email: crica.dialise{at}hcnet.usp.br
Background. In conventional haemodialysis (CHD), the morbidity and mortality rate is unacceptably high; consequently, variations in the length and frequency of the haemodialysis sessions have been studied to reduce the complications of dialysis treatment. In this sense, high-efficiency short daily haemodialysis (SDHD) has been proposed as an alternative for patients on renal replacement therapy. In this study, we have related our experience with this dialysis modality.
Methods. Twenty-six patients (16 males, mean age 35.6 ± 14.7 years) were treated by SDHD for 33.6 ± 18.5 months (range 6–57 months). The mean time on CHD before the switch to SDHD was 25.5 ± 31.9 months (range 1–159 months). In 23 (88.5%) patients, native arteriovenous fistulae were used for vascular access. SDHD was performed six times a week, 1.5–2 h per session, and high flux polysulfone dialysers (surface area: 1.8 m2) were employed. The blood flow and dialysate flow rate were 350 and 800 ml/min, respectively.
Results. In this trial, the patient survival was 100%. The vascular access survival after 12, 24, 36 and 48 months on SDHD was 100, 89, 89 and 80%, respectively. There were three failures of vascular access in 72.7 patient-years (0.04 failures/patient-year). In 15 patients on SDHD during 36 consecutive months, the vascular access survival after 12, 24, 36 and 48 months was 100, 93, 93 and 84%, respectively. Also, in this group of patients, there were 0.27 hospitalizations/patient-year and 1.24 days of hospitalizations/patient-year.
Conclusions. We concluded that in a long-time study of patients on SDHD the morbidity and mortality rate is very low. Furthermore, we observed that failures of vascular access are not a significant problem. Consequently, we believe that SDHD is a powerful renal replacement therapy for treatment of patients on maintenance haemodialysis.
Keywords: daily haemodialysis; morbidity; mortality; vascular access
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