Frequent dialysis poses risks for kidney disease patients

Frequent hemodialysis requires accessing the blood more often than conventional hemodialysis. This is usually done via a long-lasting site through which blood can be removed and returned. While daily or nightly dialysis seems to improve patients' health and quality of life, it's not known whether it increases their risk of experiencing complications. For example, more frequent access use could theoretically cause increased trauma, more inflammation, and greater exposure to bacteria.

To investigate, Rita Suri, MD (Western University and Lawson Health Research Institute, in London, Canada) and her colleagues conducted two separate 12-month clinical trials in which they randomly assigned 245 patients to receive either in-center daily hemodialysis (6 days/week) or conventional hemodialysis (3 days/week) and 87 patients to receive either home nocturnal hemodialysis (6 nights/week) or conventional hemodialysis. Three access events were recorded: repair, loss, and access-related hospitalizations.

Among the major findings:

• In the Daily Trial, 77 (31%) of 245 patients experienced one of these events, with the daily group having 33 repairs and 15 losses and the conventional group having 17 repairs, 11 losses, and 1 hospitalization.
• Overall, the risk for an access event was 76% higher with daily hemodialysis compared with conventional hemodialysis.
• Similar trends were seen in the Nocturnal Trial, although the results were not statistically significant.

"Our study is the first randomized trial to show that dialyzing more frequently may have potential harmful effects on the hemodialysis vascular access. This has important implications for patients and physicians considering or performing frequent hemodialysis," said Dr. Suri.

More information: The article, entitled "Increased Risk of Vascular Access Complications with Frequent Hemodialysis," will appear online on February 7, 2013, doi: 10.1681/ASN.2012060595

Journal reference: Journal of the American Society of Nephrology

Provided by American Society of Nephrology