Caccetta F, Caroppo M, Greco AD, Musio F, Cossa C, Ramundo S,
Nuzzo V, Mastrangelo F
Effects of different dialysis schedules on anemia and
hypertension
17th Annual CAPD Conference
Perit Dial Int Suppl 1
(Feb) 17:S79 1997
The 3x/week dialysis schedule is unphysiologic in that it allows a 2-day
interdialytic interval over the weekend, with a relatively large amount of
accumulation of both fluid and waste products. Ifudu et al from Eli
Friedman's group last year published an article suggesting that increasing
Kt/V improved anemia therapy. At last year's Seattle PD meetings, Buoncristiani and
colleagues presented data that anemia was improved with daily HD.
Also, there is data from the Tassin group that long dialysis improves
control of hypertension.
In this paper a less radical approach,
giving dialysis every other day, is evaluated. 70 patients were divided
into two groups: 3x/week dialysis, 4 hrs each session, and dialysis every
other day, 3.5 hours per session. Control of anemia and hypertension were
compared. Outcomes were number of patients requiring EPO or
antihypertensive drugs to achieve a goal Hgb of > 9 g/dl and a goal MAP
of < 107 mm Hg.
With regard to EPO, only 25% of patients
undergoing qod dialysis required it vs. 50% of patients in standard 3x/wk
therapy. Similar results were found with requirements for
antihypertensives (12% vs. about 56%). The conclusion is, that simply
switching to an alternate-day dialysis schedule will substantially improve
anemia and hypertension. Few specifics are given in the abstract, and
criteria for group assignment as well as baseline parameters are not
given. However the number of patients in each group is impressive, and the
results re anemia are in accord with the findings mentioned above.
(John T. Daugirdas, M.D., University of Illinois at Chicago)
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17th Annual CAPD Conference
Basic hemodialysis :
Adequacy, prescription, urea kinetics
CRF by problem area :
Anemia/Erythropoietin/Iron