Chronic Hemodialysis Therapy in the West

Background: Chronic hemodialysis (HD) in the 1960s encompassed a wide variety of prescriptions from twice weekly to five times per week HD. Over time, HD prescriptions in the West became standardized at three times per week, 2.5–4 h per session, with occasional additional treatments for volume overload. Summary: When clinical trials of dialysis dose failed to show significant benefit of extending time compared with the traditional dialysis prescription, interest in more frequent HD was renewed. Consequently, there has been growth in home HD therapies as well as alternative dialysis prescriptions. Data from recent randomized clinical trials have demonstrated the benefits and risks of these more frequent therapies, with surprising differences in outcomes between short daily HD and long nocturnal HD. More frequent therapies improve control of both hypertension and hyperphosphatemia, but at the expense of increased vascular access complications and, at least for nocturnal HD, a faster loss of residual renal function. Key Messages: In the West, the standard HD prescription is three treatments per week with a minimal time of 3.0 h and dialysis is performed in an outpatient dialysis center. A minority of patients will have a fourth treatment per week for volume issues. Alternative HD prescriptions, although rare, are more available compared to the recent past. Facts from East and West: (1) While develReceived: September 28, 2015 Accepted after revision: October 18, 2015 Published online: November 18, 2015 Michael V. Rocco, MD, MSCE Section on Nephrology, Wake Forest School of Medicine Medical Center Boulevard Winston-Salem, NC 27157-1053 (USA) E-Mail mrocco @ wakehealth.edu © 2015 S. Karger AG, Basel 2296–9381/15/0013–0178$39.50/0 www.karger.com/kdd For hemodialysis therapy in Asia, see Prasad and Jha, Kidney Dis