Blog entry by Arif Khwaja
The ‘long and slow’ approach to haemodialysis as advocated by the group from Tassin, France has yielded impressive results in terms of blood pressure control and patient survival. This has lead to increasing interest in daily haemodialysis as more effective alternative to the standard thrice weekly prescription.
Chertow, Levin and other members of the Frequent Hemodialysis Network (FHN) report the early (12 months ) results of their study involving 245 patients comparing in center haemodialysis (HD) six times per week compared to three times per week. They conclude that frequent HD, as compared to conventional HD, was associated with a favourable outcome. Emphasis was on progression of left ventricular mass, death and quality of life based on a physical-health composite score. Whilst promising, this study is limited by the very short follow-up period that precludes any conclusion on long term outcomes in HD patients dialysed more frequently. Outcomes are also difficult to evaluate as left ventricular mass index may reflect a better fluid balance and reduced blood volume in those dialysed more frequently. Quality of life and evaluation of physical health through health surveys and questionnaires can be biased by the non-blinded nature of the study -patients dialysed six times weekly may be subject to the placebo effect of frequent medical attention.
Interestingly, the daily HD group were much more likely to experience vascular access problems. Furthermore the study was underpowered and the sample size too small to show differences in survival over such a short period of time in such patients population.
Reference: In-Center Hemodialysis Six Times per Week versus Three Times per Week. The FHN Trial Group. N Engl J Med 2010; 363:2287-2300