Let us give twice-weekly hemodialysis a chance: Revisiting the taboo

摘要

The thrice-weekly hemodialysis (HD) regimen is considered the 'standard of care' for both imitation and maintenance of this therapy. Historically, however, HD started with two treatment sessions per week in the 1960s and 70s, but by the early 1980s the HD frequency had increased to thrice-weekly [1]. This development was partly enhanced by the 7-day nature of a week providing two alternating every-other-day shifts of Monday-Wednesday-Friday versus Tuesday-Thursday-Saturday, leaving Sunday as the universal off-day for both patients and dialysis staff to recuperate. Thrice-weekly HD has established itself as the default format with out any randomized controlled trial to examine whether less frequent HD treatments including twice-weekly HD would be inadequate or harmful [2]. Clinical practice guidelines generally advise against a less than thrice-weekly HD schedule, which is considered as inferior. These guidelines do not recommend incremental transition from less to more frequent HD over time, while ironically according to most peritoneal dialysis (PD) guidelines PD dose is to be adjusted upwards parallel to decline in residual kidney function, the preservation of which is a high priority target in PD [2, 3].