Daily haemodialysis: dialysis for the 21st century

Most patients with end stage renal disease (ESRD) currently undergo haemodialysis three times a week. In an effort to improve morbidity, mortality and quality of life in such patients, several small clinical studies have been conducted to evaluate the benefit of short daily haemodialysis (over 90-120 min) and nocturnal slow haemodialysis (overnight for 8-10 h). Although limited by study design and small patient numbers, the results of these studies offer promise that patients who undergo daily haemodialysis benefit from improved long-term outcomes. The most striking benefits of daily haemodialysis are improved quality of life and better blood pressure control with fewer or no antihypertensive medications. Other advantages of daily haemodialysis include higher haemoglobin levels with lower erythropoietin dosages, better nutrition and improved energy as a result of more physiological and efficient dialysis. Nocturnal haemodialysis has also been reported to improve sleep apnoea and control plasma phosphate concentration. Economic advantages of daily haemodialysis arise as the result of lower medication costs and less expensive at-home care. Early data suggest that there may be improvements in survival and reduced hospitalization in patients who receive daily versus conventional haemodialysis.