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Daily Dialysis: Toward a New Standard in Well‐Being
Author(s) -
Piccoli Giorgina B.,
Bechis Francesca,
Pozzato Marco,
Ettari Giorgio,
Alloatti Sandro,
Vischi Margherita,
Mezza Elisabetta,
Iacuzzo Candida,
Quaglia Marco,
Burdese Manuel,
Anania Patrizia,
Gai Massimo,
Quarello Francesco,
Jeantet Alberto,
Segoloni Giuseppe Paolo
Publication year - 2001
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.2001.5.1.19
Subject(s) - medicine , hemodialysis , dialysis , comorbidity , drop out , clinical trial , logistic regression , disease , intensive care medicine , emergency medicine , demographic economics , economics
Daily hemodialysis (DHD) is a promising option; however, logistic obstacles and clinical perplexities limit its dissemination. Understanding the mechanisms of, and the time until, the onset of improved well‐being may help to quantify clinical advantages and to define the minimum length of a “trial” of daily dialysis. By following 30 patients treated in 4 centers, this study aimed to determine how long a period of time is needed until a patient experiences subjective improvement. From November 1998 to November 2000, 30 patients tried at least 2 weeks of short daily dialysis in four Northern Italian centers of Piemonte and Valle d'Aosta. The DHD (2 – 3 hours; blood flow 270 – 350 mL/min; individual HCO 3 , Na, K) was performed at home or in a center. Motivations to try DHD, fears and concerns regarding DHD, and changes in perceived well‐being were assessed by semi‐structured interview. The main clinical indications for a trial of DHD were poor tolerance of conventional treatment, cardiovascular disease, and hypertension or hypotension; only 6 patients had no comorbidity at start. The patients' main reasons for choosing DHD were related to job problems and the search for a better treatment. Most of the patients continued DHD because of improved well‐being; logistic reasons accounted for the drop‐outs (5 patients). The main fears were related to logistic aspects, vascular access problems, and excessive involvement of the partner on home dialysis. Improved well‐being was reported by 28 of 30 patients; 2 patients reported no difference. Subjective improvement was perceived within 2 weeks in 22 of 30 patients, and within 1 month in 28 of 30 patients. An offer of a 2 – 4 week trial of DHD may help patients and caregivers to determine whether subjective and objective benefits outweigh logistic problems and whether a permanent transfer to DHD is worthwhile.