Clinical effectiveness and quality of life of conventional haemodialysis versus short daily haemodialysis: a systematic review

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2008-08, Vol.23 (8), p.2634-2646
• Main Authors: Puñal, Jeannete, Lema, Leonor Varela, Sanhez-Guisande, Domingo, Ruano-Ravina, Alberto
• Format: Article
• Language: English
• Subjects: Anemia - drug therapy; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antihypertensive Agents - therapeutic use; Biological and medical sciences; Catheters, Indwelling - adverse effects; daily haemodialysis; Emergency and intensive care: renal failure. Dialysis management; end-stage renal disease; Erythropoietin - administration & dosage; Humans; Hypertension - drug therapy; Hypertension - prevention & control; Hypertrophy, Left Ventricular - prevention & control; Intensive care medicine; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - therapy; Medical sciences; MeSH terms: renal replacement therapy; Nutritional Status; Quality of Life; Recombinant Proteins; renal dialysis; Renal Dialysis - adverse effects; Renal Dialysis - methods; Safety; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; systematic review; Treatment Outcome
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfn010

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.