Daily home haemodialysis in the Netherlands; effects on metabolic control, heamodynamics, and quality of life

BACKGROUND: More frequent dialysis has been claimed to improve clinical outcome and quality of life. METHODS: Clinical status was optimized in 13 haemodialysis patients during a run-in period of 2 months with three dialysis sessions a week. Thereafter, daily home haemodialysis (DHHD, 6 sessions per week) was initiated. The total weekly dialysis dose (Kt/V) was kept constant. RESULTS: Weekly Kt/V was 3.2+/-0.13 (M+/-SEM) before, and 3.2+/-0.15 after 6 months of DHHD (NS), time-averaged concentration of urea (TACu) was 21.2+/-1.6 mmol/l and 20.1+/-0.9 mmol/l (NS). Urea reduction was 0.56+/-0.05 before DHHD, and 0.41+/-0.06 during DHHD (P<0.0001). Serum K remained unchanged, but significantly less exchange resins were used (P<0.02). Also, the dose of phosphate-binding agents could be decreased. Values for Na, K, Cl, bicarbonate, Ca, PTH, albumin, and Hb remained unchanged. Iron deficiency developed in some patients. Twenty-four-hour blood pressure monitoring showed a decrease of systolic blood pressure (141.1+/-17.2 mmHg before, and 130.9+/-19.2 mmHg during DHHD, P<0.001). Diastolic blood pressure remained constant (82.8+/-7.2 and 76.9+/-10.1 mmHg, NS). Mean arterial pressure decreased from 102.2+/-9.5 to 94.9+/-1.4 mmHg (P<0.02). Blood pressure decreased mainly in previously hypertensive patients. Mean target weight increased 0.8 kg. The amount of antihypertensive drugs used decreased from 1.88+/-0.35 to 0.75+/-0.17 (P<0.005, n=7). Dialysis sessions were much more stable, also in patients with cardiac insufficiency. Quality of life questionnaires (Rand 36, Nottingham Health Profile, Uraemic Symptoms Profile) showed a significant improvement of physical condition and fewer uraemic symptoms. CONCLUSION: DHHD compared to conventional thrice-weekly haemodialysis with similar weekly Kt/V results in an improved haemodynamic control and quality of life, but has lesser impact on metabolic regulation.