More Kidney Dialysis Is Better, Research Finds02/23/12
THURSDAY, Feb. 23 (HealthDay News) -- If you're receiving kidney
dialysis, four new studies suggest that you could benefit from
longer or more frequent dialysis sessions.
The treatments can be done at home or at a dialysis center, but
it appears that more time spent doing dialysis can reduce mortality
rates and improve quality of life, according to the research
published online and in the March issue of the
Journal of the American Society of Nephrology.
"What all of these studies show is that the more time your kidneys are getting cleaned, the better off you are," said Dr. Robert Provenzano, chairman of the department of nephrology at St. John Providence Health System in Detroit. Provenzano was not involved in the research.
When someone's kidneys fail, the only options are dialysis or a
kidney transplant. Because there aren't enough donor kidneys to
give transplants to everyone who needs one, many people must turn
to dialysis. In dialysis, a machine takes over many of the jobs of
the kidneys, such as filtering excess fluid and waste. In the
United States, almost 400,000 people undergo dialysis every year,
according to the U.S. National Institute of Diabetes and Digestive
and Kidney Diseases (NIDDK). In 2008, fewer than 18,000 people
received a kidney transplant, according to NIDDK.
But, dialysis isn't perfect. It may not remove enough fluid, and
levels of important nutrients can get out of balance for people on
dialysis, according to background information in one of the
studies. In addition, people on dialysis have to eat a limited
Provenzano said improving dialysis is a big issue, and one of
the biggest questions has been whether more dialysis is better.
And, he said, "If it's true that more is better, is it longer
individual sessions or more frequent dialysis that's most
Previous research has suggested that longer dialysis sessions
seem to provide a benefit without increasing the risks of
complications. One past study found that more frequent dialysis
could increase the risk of problems with the dialysis access
Here's what the current studies found:
- One study included 1,873 daily home dialysis patients and 9,365
people undergoing in-center hemodialysis three times a week. "In
general, we saw a 13 percent reduction in mortality in the home
hemodialysis patients," said study author Eric Weinhandl, an
epidemiologist at the Chronic Disease Research Group at the
Minneapolis Medical Research Foundation. The survival benefit of
daily home dialysis was seen across different groups of people --
different sexes, races, weights and more. One area that wasn't
improved with more frequent dialysis was the number of people who
died from infections. That rate was slightly higher for the more
frequent dialysis group, though Weinhandl said it wasn't clear why
that was the case.
- The second study compared standard hemodialysis, which is
usually three sessions a week for between 2.5 and 5.5 hours a
session, to intensive home hemodialysis for almost five sessions a
week for more than seven hours each session. Almost 340 people
received home treatment compared to about 1,400 people receiving
standard care. People who received intensive dialysis at home were
45 percent less likely to die than patients receiving conventional
dialysis over the nearly two-year study period.
- In the third study, researchers compared the health of 746
patients who received hemodialysis treatments at a clinic three
nights per week for about eight hours each night to 2,062 similar
patients who received conventional dialysis care. As with the other
studies, the researchers saw a significant benefit from the longer
dialysis sessions. During a two-year follow-up period, those on
night-time dialysis had a 25 percent reduced risk of dying. The
night-time group also had benefits such as lower weight, blood
pressure and blood phosphorous levels. (Dialysis patients have
difficulty maintaining proper phosphorous levels, putting them at
risk of serious complications such as heart disease. Diet and
medications help to control these levels.)
- The last study reexamined the results of two previous studies.
They looked at frequent (six times per week) treatments vs.
conventional dialysis. The researchers concluded that more frequent
dialysis treatments helped lower patients' blood phosphorus levels
over 12 months. And, more frequent dialysis reduced their need for
phosphorus-lowering medications, and might also allow people on
dialysis to ease some of their dietary restrictions.
The bottom line, Provenzano said, is to "dialyze the maximum
amount of time you possibly can, based on your lifestyle. Get your
family actively involved in your care and, if you can, keep
working. Quality of life is significantly improved if you keep
working. Dialysis is not a reason to stop working or doing
activities. Stay active. You'll feel better."
Learn more about hemodialysis from the
U.S. National Institute of Diabetes and Digestive ...
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