More Frequent, Intense Dialysis Beneficial to Patients

Christopher Chan, MD

Will increasing the recommended weekly dialysis sessions from 3 to 6 have a beneficial impact on the outcome of cardiovascular patients?

During the Heart Failure Society of America (HFSA) 2019 Scientific Sessions in Philadelphia, PA, Christopher Chan, MD, of the University of Toronto, presented data that shows that more intense dialysis sessions 6 times a week can have a significant impact on patient outcomes.

“More frequency dialysis as described by 6 times a week, both long and short, reduces blood pressure and also the regressive left ventricular hypertrophy,” Chan said. “I just want to draw your attention that for those studies out the rejection fraction has also improved.”

Chan said 1 of the limitations currently preventing a better understanding of how frequent dialysis impacts cardiovascular outcomes, as well as sleep apnea and quality of life is that there is very little randomized data.

He explained that common practice is for dialysis patients to undergo the procedure 3 times a week, which he said was suboptimal. However, internationally there has been a “renaissance” in efforts to improve dialysis.

“Because of that there has been a plethora of initiative to try to optimize the dialysis by doing it either more frequently during the week and/or actually doing it longer,” he said. “The magnitude of treatments effect on blood pressure, which is significant.”

Chan said by performing dialysis 6 times a week, they have been able to show a meaningful reduction in both the volume and the mass of the left ventricle.

Another mark where more frequent dialysis is beneficial is with an improvement in cardiovascular vibration.

"It is interesting to note that we thought it was more frequently that there has been also association with in cardiovascular vibrations," he said

One of the initiatives to show how more frequent dialysis is beneficial a change of the entire dialysis schedule, where they diagnose patients using dialysis 3 times a week and then ramp up the frequency in a shorter period of time.

“The heart is actually working much more efficient,” Chan said. “So, it's not just actually how much dialysis we do is also others dialysis is due at the right time. So that we're actually able to remove the fluid at the right time at the right place."

Another study Chan mentioned involves 14 sleep apnea patients in Toronto undergoing dialysis simultaneously to a sleep study.

“You'll see that the apnea index actually decreased significantly from 46 episodes per hour to 9 episodes per hour,” he said.

According to Chan, another improved feature of more frequent dialysis is an improvement in heart rate variability (HRV).

“We ensure that by doing more dialysis, we and other research shows that heart variability also actually has been changed both maternal HRV as well with 24 hour HRV,” Chan said.

Moving forward, Chan said more research is needed in term of dialysis clearance and dose.