Conventional haemodialysis (CHD) consists of three four-hour sessions a week, but a more regular daily haemodialysis (DHD) regimen of six three-hour sessions a week can improve cardiovascular health in chronic kidney disease (CKD) patients. This is according to recent research by Steven G Achinger (University of South Florida, Tampa, USA) and Juan Carlos Ayus (University of California Irvine, Irvine, USA).
The work was published in Hemodialysis International, and its text sketches out a previous gap in the literature—that though DHD “leads to improvements in left ventricular hypertrophy and mineral metabolism at one-year follow-up”, there is “no information from prospective studies” on the cardiovascular effects in the longer term. A 2013 meta-analysis by Paweena Susantitaphong (St Elizabeth’s Medical Center, Boston, USA) and colleagues in the American Journal of Kidney Diseases highlights a “paucity of randomised controlled trials” in the area.
Looking to help fill that gap, Achinger and Ayus carried out a four-year prospective cohort study comparing the cardiovascular outcomes of 26 patients receiving DHD and 51 receiving CHD. At four years, 15 DHD and 26 CHD patients completed follow-up, and the authors took measurements of left ventricular mass index (LVMI), blood pressure, haemoglobin and mineral metabolism markers.
There was found to be a “significantly lower” rate of systolic and diastolic blood pressures in the DHD group (128 mmHg, 95% confidence interval [CI], 111–143) compared to the CHD group (148 mmHg, 95% CI, 137–158; p<0.05). There was also an association between DHD and lower rates of patients taking any anti-hypertensive drug, with 50% of DHD patients taking one vs. 80% with CHD (p<0.05). DHD also demonstrated “improved attainment of mineral metabolism goals for phosphorus” (adjusted hazard ratio [aHR] 3.6, p=0.002) and calcium × phosphorus product (aHR 3.66, p=0.001) at four-year follow-up in comparison to CHD, while there was a “nonsignificant trend toward lower LVMI in the DHD group”. Haemoglobin improvements, meanwhile, were shown to persist at four-year follow-up.
In their conclusion, the authors state that “DHD is associated with long-term improvements in key cardiovascular risk factors”, noting the differences between the two groups in blood pressure, mineral metabolism and anaemia while also highlighting the “trends toward improved LVMI” that they uncovered.
