By Peter Laird, MD
In-center conventional dialysis as practiced in America results in an average survival of about 40% over a five year period of time depending on which survey is looked at. The results of our rapid ultrafiltration rates and short treatment times thrice weekly is only a shadow of the original treatments times of 8-9 hours thrice weekly developed by the pioneers of dialysis. The survival of common cancers and even HIV are actually better than the outcomes of American style, in-center dialysis care.
Nearly 50 years later, the wisdom of longer duration or more frequent dialysis prevails. Many entering into the world of dialysis are confronted with the knowledge of our dreadful survival statistics and look for alternative treatment options. One such option that many choose is short daily hemodialysis in the comfort of their own homes, dialysis 5-7 days a week for 2-3.5 hours at a time. The good news is that observational studies show excellent outcomes with this treatment option.
Short daily haemodialysis: survival in 415 pateints treated for 1006 patient-years
Results. Eighty-five patients (20%) died; 5-year cumulative survival was 68 ± 4.1% and 10-year survival was 42 ± 9%. Age, secondary renal failure and in-centre dialysis were associated with
mortality, while gender, frequency of dialysis (5, 6 or 7 per week), continent, country and blood access were not. Survival was compared with matched patients from the USRDS 2005 Data Report using the standardized mortality ratio and cumulative survival curves. Both comparisons showed that the survival of the daily haemodialysis patients was 2–3 times higher and the predicted 50% survival time 2.3–10.9 years longer than that of the matched US haemodialysis patients. Survival of patients dialyzing daily at home was similar to that of age-matched recipients of deceased donor renal transplants.
Conclusions. Survival of patients on short daily haemodialysis was 2–3 times better than that of matched three times weekly haemodialysis patients reported by the USRDS.
Returning to optimal dialysis strategies as first practiced in America supplying patients with more frequent and longer duration dialysis breaks the cycle of death and suffering that in-center dialysis patients encounter today. While we have no true cures for ESRD, there is excellent data to promote the use of short daily dialysis over the conventional treatments. The Frequent Hemodialysis Network Trial Group followed their cohort of patients for 12 months likewise showing a significant benefit, yet we continue to fail to provide only a fraction of American patients optimal dialysis today. After 50 years of consistent efficacy, alternative treatment options should become the standard treatment offered to all eligible patients.