NDT Advance Access published online on April 3, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn010
Clinical effectiveness and quality of life of conventional haemodialysis versus short daily haemodialysis: a systematic review*
1 Galician Department of Health, Galician Agency for Health Technology Assessment, Santiago de Compostela 2 Nephrology Service, Clinic University Hospital of Santiago de Compostela 3 Department of Preventive Medicine and Public Health, University of Santiago de Compostela 4 CIBER de epidemiología y salud pública, CIBERESP, Spain
Correspondence and offprint requests to: Alberto Ruano Raviña, Galician Department of Health, Galician Agency for Health Technology Assessment, Edif Administrativo de San Lázaro, San Lázaro s/n, 15781 Santiago de Compostela, Spain. Tel: +34-981-541831; Fax: +34-981-542854; E-mail: alberto.ruano.ravina{at}sergas.es, mralbert{at}usc.es
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Abstract |
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Background. End-stage renal disease is a troublesome health problem worldwide. The most usual renal replacement therapy is conventional haemodialysis (CHD), performed three times a week, 3.5–4 h per session. It has been proposed that this schedule is unphysiologic and that daily haemodialysis would be a more appropriate schedule. One of the variants of daily haemodialysis is the so-called short daily haemodialysis (SDHD), performed five to seven times per week, 1.5–3 h per session. The objective of this paper is to compare, through a systematic review, the clinical effectiveness and safety of SDHD versus CHD.
Methods. The following databases were searched: MEDLINE, EMBASE, NHS Centre for Reviews and Dissemination (HTA, DARE and NHS EED), Cochrane, ISI Web of Knowledge, IME and IBECS. Two independent reviewers decided which papers were to be included after applying inclusion and exclusion criteria. Any discrepancy was resolved by consensus. The quality of the included papers was measured using a quality scale developed for the purpose of this report.
Results. Seventeen original articles were included. There were no randomized controlled trials. SDHD seems to be more effective than conventional dialysis. Patients on daily haemodialysis seem to present less vascular access problems, better control of hypertension and in turn a reduction in the antihypertensive treatment, better quality of life, lower incidence of ventricular hypertrophy, lower consumption of rHuEPO due to the better control of anaemia and a reduction in the use of phosphate binders as a consequence of the better control of plasmatic phosphorous.
Conclusions. SDHD might result in a better clinical effectiveness, mainly through a better control of the arterial tension and, therefore, a lower consumption of antihypertensive drugs, and a better quality of life than CHD.
Keywords: end-stage renal disease; daily haemodialysis; MeSH terms: renal replacement therapy; renal dialysis; systematic review
* The full systematic review (110 pages) can be downloaded in Spanish completely free through the webpage of the Galician Agency for Health Technology Assessment (http://avalia-t.sergas.es/).
Received for publication: 5. 9.07
Accepted in revised form: 7. 1.08