The results of transfer to four times a week hemodialysis mode

Introduction: many dialysis/CKD complications remain unsolved despite standard regimen intensifying. The most of studies of frequent dialysis evaluate the six times a week regimen. Aim: to evaluate the efficacy and safety of the four times a week dialysis regime. Method: transfer of a dialysis unit to the seven days per week schedule opens the possibility to increase the dialysis frequency up to four times a week for 15% of patients. The indications for transfer were: uncontrolled hypertension (HT) and hyperphosphatemia (HP), hemodynamic instability (HI). Results: eighteen patients have been treating four times per week during >6 months due to HT (6 cases), HP (7), HI (3), or its combination (4). The baseline HD/HDF duration was 52 (19÷81) month, age was 54±11 years; spKt/V was 1.49±0.24; 82% of patients had Hb >10 g/dl - similar to that in other patients in the center. In three months, blood pressure normalized in 12/12 (100%) of patients with baseline blood pressure >140/90 mmHg; hyperphosphatemia >1.78 (2.15±0.54) resolved in 11/12 (92%); hypotension - in 8/11 patients. The interdialytic weight gain decreased in 15/16 (94%) patients. No vascular access deterioration occurred despite 33% increase of fistula puncture frequency. No hypokalemia episode was registered (dialysate K+ was 2 mEq/l). No one refused more frequent mode. The Hb, ferritin and albumin levels were stable. In some patients with substantial phosphate decrease, the total calcium level increased (remained in target range). Thus, there were no adverse effects of more frequent dialysis during 6-12 months of follow-up. The increased dialysis frequency does not contradict to the current National Clinical Guidelines on (dialysis regimen no less than three times per week). Conclusion: four times a week regime is efficient and safe modality for patients with resistant hypertension, hyperphosphatemia, hemodynamic instability.

частота гемодиализа, артериальная гипертензия, гиперфосфатемия, гемодинамическая нестабильность, hemodialysis frequency, hypertension, hyperphosphatemia, hemodynamic instability

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