Daily home haemodialysis in The Netherlands: effects on metabolic control, haemodynamics, and quality of life

Background. More frequent dialysis has been claimed to improve clinical outcome and quality of life. Methods. Clinical status was optimized in 13 haemodialysis patients during a run-in period of 2 months with three dialysis sessions a week. Thereafter, daily home haemodialysis (DHHD, 6 sessions per week) was initiated. The total weekly dialysis dose (Kt/V) was kept constant. Results. Weekly Kt/V was 3.2 +/- 0.13 (M +/- SEM) before, and 3.2 +/- 0.15 after 6 months of DHHD (NS), time-averaged concentration of urea (TACu) was 21.2 +/- 1.6 mmol/l and 20.1 +/- 0.9 mmol/l (NS). Urea reduction was 0.56 +/- 0.05 before DHHD, and 0.41 +/- 0.06 during DHHD (P < 0.0001). Serum K remained unchanged, but significantly less exchange resins were used (P < 0.02). Also, the dose of phosphate-binding agents could be decreased. Values for Na, K, Cl, bicarbonate, Ca, PTH, albumin, and Hb remained unchanged. Iron deficiency developed in some patients. Twenty-four-hour blood pressure monitoring showed a decrease of systolic blood pressure (141.1 +/- 17.2 mmHg before, and 130.9 +/- 19.2 mmHg during DHHD, P < 0.001). Diastolic blood pressure remained constant (82.8 +/- 7.2 and 76.9 +/- 10.1 mmHg, NS). Mean arterial pressure decreased from 102.2 +/- 9.5 to 94.9 +/- 1.4 mmHg (P < 0.02). Blood pressure decreased mainly in previously hypertensive patients. Mean target weight increased 0.8 kg. The amount of antihypertensive drugs used decreased from 1.88 +/- 0.35 to 0.75 +/- 0.17 (P < 0.005, n = 7). Dialysis sessions were much more stable, also in patients with cardiac insufficiency. Quality of life questionnaires (Rand 36, Nottingham Health Profile, Uraemic Symptoms Profile) showed a significant improvement of physical condition and fewer uraemic symptoms. Conclusion. DHHD compared to conventional thrice-weekly haemodialysis with similar weekly Kt/V results in an improved haemodynamic control and quality of life, but has lesser impact on metabolic regulation.