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.
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
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.
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.
Study co-authors include Brett Larive, Susan Sherer, Paul
Eggers, PhD, Jennifer Gassman PhD, Sam James, Robert Lindsay, MD, Robert
Lockridge, MD, Daniel Ornt, MD, Michael Rocco, MD, George Ting, MD, Ala
Kliger, MD, and the Frequent Hemodialysis Network Trial Group.