It is likely that daily HD may prove unacceptable to some patients due to its impact on their life styles. HD3.5 could significantly benefit the patient’s life style. Patients should dialyze to live rather than live to dialyze. The reality is that “quotidian” dialysis is seldom performed. In fact, it is usually prescribed six days per week and performed less often than that.
Patients also value flexibility of schedule and prescription. Experience with long nightly and short daily home HD has shown that some patients like to mix both prescriptions in order to accommodate their life styles. The danger associated with this practice is the lack of control over delivered dialysis and the possibility of insufficient dose caused by short sessions (< 3.5 hr). Online clearance (OLC) can be used to monitor and calculate the cumulative weekly clearance and guide the user in prescription modification. The program should be based on a weekly stdKt/V > 2.2.
Modern monitoring technology such as iCare™ have the dual advantage of adding safety and confidence1,2. The knowledge that dialytic events are being monitored and that advice is readily available is comforting to the patient and their partners. The records generated by the system can also be utilized to monitor the adequacy of therapy and initiate appropriate and timely interventions.
Shaldon, a pioneer and strong proponent of home HD, pointedly stated “Unless the increase in frequency of home nocturnal hemodialysis to 5 to 7 times per week can really be shown to be applicable on a large scale in less than highly motivated patients and staff, I doubt that the aspirations and claims (of the proponents of daily HD) will stand the test of time more than our hopes and aspirations of 40 years ago”3. In view of the excellent survival rates reported for HD3.54, the lower cost of supplies and minimal increase in the number of weekly sessions, is it reasonable to embrace quotidian dialysis without a rigorous study? The use of every other day or four times per week HD is already a reality in several programs, whether in-center or at home. Until future controlled studies allow us to determine the precise contribution of quotidian HD, it seems logical to offer HD3.5 to as many patients as possible.
References:
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Diaz-Buxo JA, Schlaeper C, Vanvalkenburgh D. Evolution of home hemodialysis monitoring systems. Hemodial Int 7:353-355, 2003
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Schlaeper C, Diaz-Buxo JA. Home hemodialysis and remote monitoring: current technology, requirements and capabilities. Blood Purif 23:18-22, 2005
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Shaldon S. Letter to the editor: Home nocturnal hemodialysis. Kidney Int 65:1115, 2004
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Mastrangelo F, Alfonso L, Napoli M, DeBlasi V, Russo F, Patruno P. Dialysis with increased frequency of sessions (Lecce dialysis). Nephrol Dial Transplant 13 (Suppl 6):139-147, 1998