Authors' objectives:

Assess the most adequate hemodialysis frequency in relation to the clinical benefits for the patients in terms of morbidity, mortality, acceptability of this regimen of dialysis and quality of life. This report also aims to compare the cost of daily hemodialysis in relation to conventional hemodialysis techniques.

Authors' results and conclusions: After applying the inclusion/exclusion criteria 17 original articles were selected: 13 investigations presented a pre-post design, 6 were non randomized clinical trials and 2 cross over studies (A-B-A). There were no randomized controlled trials found. The results displayed in the articles included in our systematic review show that daily hemodialysis seems to be more efficient than conventional dialysis. Patients on daily hemodialysis seems to present less vascular access problems, higher access survival, better control of hypertension and in turn a reduction in the antihypertensive treatment, better quality of life, lower incidence of ventricular hypertrophy, higher clearance of plasmatic substances (urea, phosphorous and β2-microglobuline), lower consumption of rHuEPO due to the better control of anaemia and a reduction in the use of phosphate binders as a consequence of the better control of plasmatic phosphorous. The results of our own assessment show that the patients have a better quality of life when they are in daily hemodialysis and that there are no important differences in relation to the costs.

Authors' recommendations: Taking into account the methodological deficiencies of the studies it can not be definitively concluded that daily hemodialysis is better than conventional hemodialysis. Our recommendation would be to continue with the actual indications, which are to treat with daily hemodialysis (generally at home) only in certain previously selected patients. Higher quality studies are needed to conclude that daily hemodialysis is a better option for the general population on renal replacement therapy. To take this decision it is very important to have available the results of the randomized controlled trials actually underway in USA, comparing both dialysis modalities.

Authors' methods: Systematic Review

Project Status: Completed

URL for project: http://avalia-t.sergas.es/

Year Published: 2007

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Scientific Advice Unit, avalia-t; The Galician Health Knowledge Agency (ACIS)

Contact Address: Conselleria de Sanidade, Xunta de Galicia, San Lazaro s/n 15781 Santiago de Compostela, Spain. Tel: 34 981 541831; Fax: 34 981 542854;

Contact Name: avalia-t@sergas.es

Contact Email: avalia-t@sergas.es

Copyright: Galician Agency for Health Technology Assessment (AVALIA-T)