Intensive Hemodialysis and Potential Risks With Increasing Treatment

Michael Kraus, Sheru Kansal, Michael Copland, Paul Komenda, Eric D. Weinhandl, George L. Bakris, Christopher T. Chan, Richard J. Fluck, John M. Burkart

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Although intensive hemodialysis (HD) can address important clinical problems, increasing treatment also introduces risks. In this review, we assess risks pertaining to 6 domains: vascular access complications, infection, mortality, loss of residual kidney function, solute balance, and patient and care partner burden. In the Frequent Hemodialysis Network (FHN) trials, short daily and nocturnal schedules increased the incidence of access complications, although the incidence of access loss was not statistically higher. Observational studies indicate that infection-related hospitalization is an ongoing challenge with short daily HD. Excess risk may be catalyzed by poor infection control practices in the home setting in which intensive HD is typically delivered, but with fixed probability of bacterial contamination per cannulation, greater treatment frequency necessarily increases the risk for infectious complications. Buttonhole cannulation may increase the risk for metastatic infections. However, intensive HD in the home setting is associated with lower risk for infection than peritoneal dialysis. Data regarding mortality are equivocal. With extended follow-up of individuals in the FHN trials, short daily HD was associated with lower risk relative to the usual schedule, whereas nocturnal HD was associated with higher risk. In many, but not all, observational studies, short daily HD has been associated with lower risk than both in-center HD and peritoneal dialysis; however, observational studies are subject to unmeasured confounding. Intensive HD can accelerate the loss of residual kidney function in new dialysis patients with substantial urine output and can deplete solutes (eg, phosphorus) to the extent that supplementation is necessary. Finally, intensive HD may increase burden on patients and caregivers, possibly leading to technique failure. Some of these problems might be addressed with careful monitoring, so that relevant interventions (eg, antibiotics, retraining, and respite care) can be delivered. Ultimately, intensive HD is not a panacea for end-stage renal disease. Potential benefits and risks of treatment should be jointly considered.

Original languageEnglish (US)
Pages (from-to)S51-S58
JournalAmerican Journal of Kidney Diseases
Volume68
Issue number5
DOIs
StatePublished - Nov 1 2016

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Renal Dialysis
Observational Studies
Peritoneal Dialysis
Infection
Catheterization
Appointments and Schedules
Respite Care
Home Hemodialysis
Kidney
Mortality
Incidence
Infection Control
Phosphorus
Caregivers
Chronic Kidney Failure
Blood Vessels
Dialysis
Patient Care
Hospitalization
Therapeutics

Keywords

  • Buttonhole cannulation
  • caregiver
  • chronic kidney disease
  • daily dialysis
  • end stage renal disease (ESRD)
  • Frequent Hemodialysis Network
  • home dialysis
  • infection
  • intensive hemodialysis
  • mortality
  • nocturnal hemodialysis
  • residual renal function
  • review
  • short daily hemodialysis
  • survival
  • technique failure
  • vascular access

ASJC Scopus subject areas

  • Nephrology

Cite this

Kraus, M., Kansal, S., Copland, M., Komenda, P., Weinhandl, E. D., Bakris, G. L., ... Burkart, J. M. (2016). Intensive Hemodialysis and Potential Risks With Increasing Treatment. American Journal of Kidney Diseases, 68(5), S51-S58. https://doi.org/10.1053/j.ajkd.2016.05.020

Intensive Hemodialysis and Potential Risks With Increasing Treatment. / Kraus, Michael; Kansal, Sheru; Copland, Michael; Komenda, Paul; Weinhandl, Eric D.; Bakris, George L.; Chan, Christopher T.; Fluck, Richard J.; Burkart, John M.

In: American Journal of Kidney Diseases, Vol. 68, No. 5, 01.11.2016, p. S51-S58.

Research output: Contribution to journalArticle

Kraus, M, Kansal, S, Copland, M, Komenda, P, Weinhandl, ED, Bakris, GL, Chan, CT, Fluck, RJ & Burkart, JM 2016, 'Intensive Hemodialysis and Potential Risks With Increasing Treatment', American Journal of Kidney Diseases, vol. 68, no. 5, pp. S51-S58. https://doi.org/10.1053/j.ajkd.2016.05.020
Kraus M, Kansal S, Copland M, Komenda P, Weinhandl ED, Bakris GL et al. Intensive Hemodialysis and Potential Risks With Increasing Treatment. American Journal of Kidney Diseases. 2016 Nov 1;68(5):S51-S58. https://doi.org/10.1053/j.ajkd.2016.05.020
Kraus, Michael ; Kansal, Sheru ; Copland, Michael ; Komenda, Paul ; Weinhandl, Eric D. ; Bakris, George L. ; Chan, Christopher T. ; Fluck, Richard J. ; Burkart, John M. / Intensive Hemodialysis and Potential Risks With Increasing Treatment. In: American Journal of Kidney Diseases. 2016 ; Vol. 68, No. 5. pp. S51-S58.
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