Intensive Hemodialysis and Treatment Complications and Tolerability

Jose Morfin, Richard J. Fluck, Eric D. Weinhandl, Sheru Kansal, Peter A. McCullough, Paul Komenda

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Hemodialysis (HD) treatment can be difficult to tolerate. Common complications are intradialytic hypotension (IDH) and long time to recovery after an HD session. IDH, as defined by nadir systolic blood pressure < 90 mm Hg and intradialytic decline > 30 mm Hg, occurs in almost 8% of HD sessions. IDH may be caused by aggressive ultrafiltration in response to interdialytic weight gain, can lead to myocardial stunning and cardiac arrhythmias, and is associated with increased risk for death. Long recovery time after a treatment session is also common. In DOPPS (Dialysis Outcomes and Practice Patterns Study), recovery time was 2 to 6 hours for 41% of HD patients and longer than 6 hours for 27%; recovery time was linearly associated with increased risks for death and hospitalization. Importantly, both decreases in blood pressure and feeling washed out or drained have been identified by patients as more important outcomes than death or hospitalization. Intensive HD likely reduces the likelihood of IDH. In the Frequent Hemodialysis Network trial, short daily and nocturnal schedules reduced the per-session probability of IDH by 20% and 68%, respectively, relative to 3 sessions per week. Due to lower ultrafiltration volume and/or rate, intensive HD may reduce intradialytic blood pressure variability. In a cross-sectional study, short daily and nocturnal schedules were associated with slower ultrafiltration and less dialysis-induced myocardial stunning than 3 sessions per week. In FREEDOM (Following Rehabilitation, Economics, and Everyday-Dialysis Outcome Measurements), a prospective cohort study of short daily HD, recovery time was reduced after 12 months from 8 hours to 1 hour, according to per-protocol analysis. Recovery time after nocturnal HD may be minutes. In conclusion, intensive HD can improve the tolerability of HD treatment by reducing the risk for IDH and decreasing recovery time after HD. These changes may improve the patient centeredness of end-stage renal disease care.

Original languageEnglish (US)
Pages (from-to)S43-S50
JournalAmerican Journal of Kidney Diseases
Volume68
Issue number5
DOIs
StatePublished - Nov 1 2016

Fingerprint

Renal Dialysis
Hypotension
Ultrafiltration
Therapeutics
Myocardial Stunning
Blood Pressure
Dialysis
Appointments and Schedules
Hospitalization
Chronic Kidney Failure
Weight Gain
Cardiac Arrhythmias
Emotions
Cohort Studies
Rehabilitation
Cross-Sectional Studies
Economics
Prospective Studies

Keywords

  • Chronic kidney disease
  • complications
  • daily dialysis
  • dialysis adequacy
  • end stage renal disease (ESRD)
  • fatigue
  • Frequent Hemodialysis Network
  • home dialysis
  • intensive hemodialysis
  • intradialytic hypotension
  • nocturnal hemodialysis
  • organ stunning
  • recovery time
  • review
  • short daily hemodialysis
  • treatment tolerability
  • ultrafiltration

ASJC Scopus subject areas

  • Nephrology

Cite this

Morfin, J., Fluck, R. J., Weinhandl, E. D., Kansal, S., McCullough, P. A., & Komenda, P. (2016). Intensive Hemodialysis and Treatment Complications and Tolerability. American Journal of Kidney Diseases, 68(5), S43-S50. https://doi.org/10.1053/j.ajkd.2016.05.021

Intensive Hemodialysis and Treatment Complications and Tolerability. / Morfin, Jose; Fluck, Richard J.; Weinhandl, Eric D.; Kansal, Sheru; McCullough, Peter A.; Komenda, Paul.

In: American Journal of Kidney Diseases, Vol. 68, No. 5, 01.11.2016, p. S43-S50.

Research output: Contribution to journalArticle

Morfin, J, Fluck, RJ, Weinhandl, ED, Kansal, S, McCullough, PA & Komenda, P 2016, 'Intensive Hemodialysis and Treatment Complications and Tolerability', American Journal of Kidney Diseases, vol. 68, no. 5, pp. S43-S50. https://doi.org/10.1053/j.ajkd.2016.05.021
Morfin, Jose ; Fluck, Richard J. ; Weinhandl, Eric D. ; Kansal, Sheru ; McCullough, Peter A. ; Komenda, Paul. / Intensive Hemodialysis and Treatment Complications and Tolerability. In: American Journal of Kidney Diseases. 2016 ; Vol. 68, No. 5. pp. S43-S50.
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