Daily haemodialysis, an underused technique despite its haemodynamic benefits
DOI:
https://doi.org/10.25796/bdd.v8i3.87086Keywords:
home hemodialysis, daily hemodialysisAbstract
Conventional three-times-weekly haemodialysis causes alternating phases of acute haemodynamic stress during the session (with a risk of hypotension and ischaemia) and chronic overload between sessions (promoting hypertension, pulmonary oedema and left ventricular hypertrophy). The risk is particularly high after the long interdialytic interval. Studies show a correlation between high ultrafiltration rates and excess mortality, suggesting that longer or more frequent dialysis — known as ‘intensive’ dialysis — could better protect the hearts and blood vessels of these patients.
We report our opinion, based on a recent analysis of the literature, regarding the benefits of daily haemodialysis.
Intensive (daily or prolonged) HD improves several parameters:
- High blood pressure: meta-analyses and the FHN trial show a significant decrease in blood pressure and left ventricular hypertrophy, with a reduction in the use of antihypertensive drugs.
- Per-dialytic hypotension: studies (FHN, RECAP, Murashima) show a decrease in the frequency of hypotensive episodes and improved haemodynamic stability due to lower volume variations.
- Myocardium: Conventional HD is particularly associated with myocardial stunning, a factor in ventricular dysfunction and mortality. Daily HD significantly reduces these contractile abnormalities.
- Post-dialysis recovery: post-session fatigue, which is common and associated with excess mortality, is greatly reduced by daily HD (LONDON and FREEDOM studies), improving quality of life and psychological well-being.
Despite these benefits, evidence remains limited due to the lack of randomised controlled trials on hard endpoints such as mortality.
Daily home HD appears to be a promising option, facilitated by new devices, although it is currently hampered by the lack of home visits by nurses to puncture the arteriovenous fistula. Nevertheless, it should be offered more widely, particularly to frail patients with refractory hypertension or those who do not tolerate conventional dialysis well.
References
1. Agence de la biomédecine. Rapport REIN 2023 : Registre français des traitements de suppléance de l’insuffisance rénale chronique [Internet]. Saint-Denis la Plaine (France) : Agence de la biomédecine ; 2025 [cité le 8 sept. 2025]. available at: https://back.agence-biomedecine.fr/uploads/RAPPORT_REIN_2023_v2_62f524710c.pdf
2. Allison, S. Dialysis is associated with cardiovascular and noncardiovascular mortality. Nat Rev Nephrol 6, 66 (2010). https://doi.org/10.1038/nrneph.2009.217
3. Johnson DW & al. Modification of cardiovascular risk in hemodialysis patients: an evidence-based review. Hemodial Int. 2007 Jan;11(1):1-14. doi: 10.1111/j.1542-4758.2007.00146.x. PMID: 17257349.
4. Canaud B, Chazot C, Koomans J, Collins A. Fluid and hemodynamic management in hemodialysis patients: challenges and opportunities. J Bras Nefrol. 2019 Oct-Dec;41(4):550-559. doi: 10.1590/2175-8239-JBN-2019-0135. PMID: 31661543; PMCID: PMC6979572.
5. Foley RN, Gilbertson DT, Murray T, Collins AJ. Long interdialytic interval and mortality among patients receiving hemodialysis. N Engl J Med. 2011 Sep 22;365(12):1099-107. doi: 10.1056/NEJMoa1103313. PMID: 21992122.
6. Flythe JE, Kimmel SE, Brunelli SM. Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality. Kidney Int. 2011 Jan;79(2):250-7. doi: 10.1038/ki.2010.383. Epub 2010 Oct 6. PMID: 20927040; PMCID: PMC3091945.
7. Raimann JG, Wang Y, Mermelstein A, Kotanko P, Daugirdas JT. Ultrafiltration Rate Thresholds Associated With Increased Mortality Risk in Hemodialysis, Unscaled or Scaled to Body Size. Kidney Int Rep. 2022 Apr 22;7(7):1585-1593. doi: 10.1016/j.ekir.2022.04.079. PMID: 35812299; PMCID: PMC9263411.
8. Bucharles SGE, Wallbach KKS, Moraes TP, Pecoits-Filho R. Hypertension in patients on dialysis: diagnosis, mechanisms, and management. J Bras Nefrol. 2019 Jul-Sep;41(3):400-411. doi: 10.1590/2175-8239-jbn-2018-0155. Epub 2018 Nov 8. PMID: 30421784; PMCID: PMC6788847.
9. Liu F, Sun Y, Xu T, Sun L, Liu L, Sun W, Feng X, Ma J, Wang L, Yao L. Effect of Nocturnal Hemodialysis versus Conventional Hemodialysis on End-Stage Renal Disease: A Meta-Analysis and Systematic Review. PLoS One. 2017 Jan 20;12(1):e0169203. doi: 10.1371/journal.pone.0169203. PMID: 28107451; PMCID: PMC5249197.
10. Susantitaphong P, Koulouridis I, Balk EM, Madias NE, Jaber BL. Effect of frequent or extended hemodialysis on cardiovascular parameters: a meta-analysis. Am J Kidney Dis. 2012 May;59(5):689-99. doi: 10.1053/j.ajkd.2011.12.020. Epub 2012 Feb 25. PMID: 22370022; PMCID: PMC3395217.
11. Kotanko P, Garg AX, Depner T, Pierratos A, Chan CT, Levin NW, Greene T, Larive B, Beck GJ, Gassman J, Kliger AS, Stokes JB; FHN Trial Group. Effects of frequent hemodialysis on blood pressure: Results from the randomized frequent hemodialysis network trials. Hemodial Int. 2015 Jul;19(3):386-401. doi: 10.1111/hdi.12255. Epub 2015 Jan 5. PMID: 25560227; PMCID: PMC4490029.
12. Assimon MM, Flythe JE. Intradialytic Blood Pressure Abnormalities: The Highs, The Lows and All That Lies Between. Am J Nephrol. 2015;42(5):337-50. doi: 10.1159/000441982. Epub 2015 Nov 20. PMID: 26584275; PMCID: PMC4761237.
13. NKF KDOQI GUIDELINES.KDOQI Clinical Practice Guidelines for Cardiovascular Disease in Dialysis Patients. [Internet]. 2025 Sept 8 [cited 2025 Sep. 8]; Available from:https://kidneyfoundation.cachefly.net/professionals/KDOQI/guidelines_cvd/intradialytic.htm
14. Kanbay M, Ertuglu LA, Afsar B, Ozdogan E, Siriopol D, Covic A, Basile C, Ortiz A. An update review of intradialytic hypotension: concept, risk factors, clinical implications and management. Clin Kidney J. 2020 Jul 8;13(6):981-993. doi: 10.1093/ckj/sfaa078. PMID: 33391741; PMCID: PMC7769545.
15. Flythe JE, Chang TI, Gallagher MP, et al. Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2020;97(5):861-876. doi:10.1016/j.kint.2020.01.046
16. Flythe JE, Xue H, Lynch KE, Curhan GC, Brunelli SM. Association of mortality risk with various definitions of intradialytic hypotension. J Am Soc Nephrol. 2015 Mar;26(3):724-34. doi: 10.1681/ASN.2014020222. Epub 2014 Sep 30. PMID: 25270068; PMCID: PMC4341481.
17. Hamrahian SM, Vilayet S, Herberth J, Fülöp T. Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects. Int J Nephrol Renovasc Dis. 2023 Aug 1;16:173-181. doi: 10.2147/IJNRD.S245621. PMID: 37547077; PMCID: PMC10404053.
18. Wang J, Yao J, Zhu X, Wang T, Lu J, Wei Q, Xue J, Wu Y, You L. Impact of frequent intradialytic hypotension on quality of life in patients undergoing hemodialysis. BMC Nephrol. 2023 Jul 14;24(1):209. doi: 10.1186/s12882-023-03263-6. PMID: 37452301; PMCID: PMC10347841.
19. Murashima M, Kumar D, Doyle AM, Glickman JD. Comparison of intradialytic blood pressure variability between conventional thrice-weekly hemodialysis and short daily hemodialysis. Hemodial Int. 2010 Jul;14(3):270-7. doi: 10.1111/j.1542-4758.2010.00438.x. PMID: 20337744.
20. Fessi H, Nicoud P, Serrato T, Gilbert O, Courivaud C, Daoud S, Morena M, Thomas M, Canaud B, Cristol JP. Two Years’ Experience of Intensive Home Hemodialysis with the Physidia S3 System: Results from the RECAP Study. J Clin Med. 2023 Feb 8;12(4):1357. doi: 10.3390/jcm12041357. PMID: 36835894; PMCID: PMC9958970.
21. Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clin J Am Soc Nephrol. 2009 May;4(5):914-20. doi: 10.2215/CJN.03900808. Epub 2009 Apr 8. PMID: 19357245; PMCID: PMC2676185.
22. McIntyre CW, Burton JO, Selby NM, Leccisotti L, Korsheed S, Baker CS, Camici PG. Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow. Clin J Am Soc Nephrol. 2008 Jan;3(1):19-26. doi: 10.2215/CJN.03170707. Epub 2007 Nov 14. PMID: 18003765; PMCID: PMC2390980.
23. Dasselaar JJ, Slart RH, Knip M, Pruim J, Tio RA, McIntyre CW, de Jong PE, Franssen CF. Haemodialysis is associated with a pronounced fall in myocardial perfusion. Nephrol Dial Transplant. 2009 Feb;24(2):604-10. doi: 10.1093/ndt/gfn501. Epub 2008 Sep 4. PMID: 18775808.
24. Jefferies HJ, Virk B, Schiller B, Moran J, McIntyre CW. Frequent hemodialysis schedules are associated with reduced levels of dialysis-induced cardiac injury (myocardial stunning). Clin J Am Soc Nephrol. 2011 Jun;6(6):1326-32. doi: 10.2215/CJN.05200610. Epub 2011 May 19. PMID: 21597028; PMCID: PMC3109928.
25. Caplin B, Kumar S, Davenport A. Patients’ perspective of haemodialysis-associated symptoms. Nephrol Dial Transplant. 2011 Aug;26(8):2656-63. doi: 10.1093/ndt/gfq763. Epub 2011 Jan 6. PMID: 21212166.
26. Urquhart-Secord R, Craig JC, Hemmelgarn B, Tam-Tham H, Manns B, Howell M, Polkinghorne KR, Kerr PG, Harris DC, Thompson S, Schick-Makaroff K, Wheeler DC, van Biesen W, Winkelmayer WC, Johnson DW, Howard K, Evangelidis N, Tong A. Patient and Caregiver Priorities for Outcomes in Hemodialysis: An International Nominal Group Technique Study. Am J Kidney Dis. 2016 Sep;68(3):444-54. doi: 10.1053/j.ajkd.2016.02.037. Epub 2016 Mar 8. PMID: 26968042.
27. Rayner HC, Zepel L, Fuller DS, Morgenstern H, Karaboyas A, Culleton BF, Mapes DL, Lopes AA, Gillespie BW, Hasegawa T, Saran R, Tentori F, Hecking M, Pisoni RL, Robinson BM. Recovery time, quality of life, and mortality in hemodialysis patients: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2014 Jul;64(1):86-94. doi: 10.1053/j.ajkd.2014.01.014. Epub 2014 Feb 14. PMID: 24529994; PMCID: PMC4069238.
28. Lindsay RM, Heidenheim PA, Nesrallah G, Garg AX, Suri R; Daily Hemodialysis Study Group London Health Sciences Centre. Minutes to recovery after a hemodialysis session: a simple health-related quality of life question that is reliable, valid, and sensitive to change. Clin J Am Soc Nephrol. 2006 Sep;1(5):952-9. doi: 10.2215/CJN.00040106. Epub 2006 Jul 6. PMID: 17699312.
29. Jaber BL, Lee Y, Collins AJ, Hull AR, Kraus MA, McCarthy J, Miller BW, Spry L, Finkelstein FO; FREEDOM Study Group. Effect of daily hemodialysis on depressive symptoms and postdialysis recovery time: interim report from the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study. Am J Kidney Dis. 2010 Sep;56(3):531-9. doi: 10.1053/j.ajkd.2010.04.019. Epub 2010 Jul 29. PMID: 20673601.
30. Weinhandl ED, Liu J, Gilbertson DT, Arneson TJ, Collins AJ. Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. J Am Soc Nephrol. 2012 May;23(5):895-904. doi: 10.1681/ASN.2011080761. Epub 2012 Feb 23. PMID: 22362906; PMCID: PMC3338294.
31. Ayus JC, Achinger SG, Mizani MR, Chertow GM, Furmaga W, Lee S, Rodriguez F. Phosphorus balance and mineral metabolism with 3 h daily hemodialysis. Kidney Int. 2007 Feb;71(4):336-42. doi: 10.1038/sj.ki.5002044. Epub 2006 Dec 27. PMID: 17191084.
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