How Do We Improve the Quality of Life of Haemodialysis Patients? Now That's a Good Question

this issue of the AJN, Hussein et al. [2] found that 20% of patients took more than 12 h to recover. Our understanding of the pathophysiology of recovery after dialysis is poor. Patients describe feeling fatigued and tired rather than dizzy or faint and wish to rest or sleep, suggesting that the symptoms originate predominantly in the brain. The dialysis disequilibrium syndrome, with seizures and coma, is now rare but was a serious problem when treatment times were reduced from 8 h to 4 h or less in the 1970s. To counteract this syndrome, dialysate sodium concentration was increased [3] . The finding in the DOPPS that a dialysate sodium concentration of 140 mEq/L is associated with shorter recovery times suggests that cerebral disequilibrium plays a role. Some patients exhibit a measurable decline in cognitive function during an HD session, which takes time to recover [4] . This effect is only weakly associated with treatment-related factors [5] . It would be interesting to study whether change in cognitive function is correlated with recovery time, as this would further validate its use as an outcome measure in future investigations. In their study, Hussein et al. [2] showed an association between a fast ultrafiltration (UF) rate and longer recovery time. This finding is consistent with symptoms becoming worse after HD treatments that cause more severe Wise clinicians know the value of asking the right questions. A good one to ask haemodialysis (HD) patients is: “how long does it take for you to recover from a dialysis session?” Dr. Robert Lindsay and others demonstrated the remarkable power of this question in a study of 45 Canadian patients taking part in a frequent HD trial [1] . Subsequent data from the much larger DOPPS confirmed their finding that patient-reported recovery time correlates strongly with quality of life (QOL) scores from validated questionnaires. The DOPPS went on to show that it is also predictive of mortality, patients reporting a recovery time greater than 12 h having a 22% higher rate of hospitalization and a 47% higher mortality rate than patients needing between 2 and 6 h to recover. The recovery time question is valuable because of its simplicity. In a routine consultation, patients can much more easily report their symptoms after dialysis than complete a QOL questionnaire. It is also highly relevant to patients’ lives and may trigger a more detailed conversation about the impact that HD has on patients and their families. Prolonged recovery time is common; 27% of patients in the DOPPS reported taking more than 6 h to recover. Reporting their experience of recording recovery time in 2,689 patients from 46 dialysis facilities in 3 US states in Published online: May 30, 2017 Nephrology American Journal of