• Duration and frequency of haemodialysis therapy. Nephrology 2005 Oct;10(S4):S71-4.



• Duration and frequency of haemodialysis therapy. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2004 Dec. 9 p. [19 references]

This is the current release of the guideline.

End-stage kidney disease (ESKD)

Assessment of Therapeutic Effectiveness
Management
Treatment

Family Practice
Internal Medicine
Nephrology
Nursing

Allied Health Personnel
Nurses
Physicians

To review the available evidence for the benefit of prolonged duration and more frequent hemodialysis

Patients with end-stage kidney disease (ESKD) who are approaching hemodialysis

Evaluation

Patient education

• Advantages of prolonged and more frequent dialysis
• Advantages of home (including nocturnal) dialysis
• Short daily dialysis

Management/Treatment

1. Home hemodialysis
   • Prolonged (6-8 hours) hemodialysis
   • More frequent dialysis than thrice weekly
2. In-center hemodialysis

• Dialysis adequacy
  • Urea reduction ratio
• Hospitalization at 1 year
• Patient acceptance rate
• Quality of life
• Mortality

Searches of Electronic Databases

Databases searched: Medical Subject Headings (MeSH) terms and text words for dialysis were combined with MeSH terms and text words for short daily, nocturnal, frequency and duration, and then combined with the Cochrane highly sensitive search strategy for randomized controlled trials. The search was carried out in Medline (1966 – February Week 1 2004). The Cochrane Renal Group Trials Register was also searched for trials not indexed in Medline.

Date of searches: 18 February 2004.

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Levels of Evidence

Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)

Level II: Evidence obtained from at least one properly designed RCT

Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group

Level IV: Evidence obtained from case series, either post-test or pretest/post-test

Review of Published Meta-Analyses
Systematic Review with Evidence Tables

Not stated

Expert Consensus

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Comparison with Guidelines from Other Groups
Peer Review

Recommendations of Others. Recommendations regarding duration and frequency of hemodialysis therapy from the following groups were discussed: Kidney Disease Outcomes Quality Initiative, British Renal Association, Canadian Society of Nephrology, European Best Practice Guidelines, and International Guidelines.

Definitions for the levels of evidence (I–IV) can be found at the end of the "Major Recommendations" field.

Guidelines

No recommendations possible based on Level I or II evidence

Suggestions for Clinical Care

(Suggestions are based on Level III and IV sources)

• The advantages of prolonged and more frequent dialysis should be discussed in depth with patients approaching dialysis, and the advantages of home haemodialysis should be presented in detail. While 6–8 hours each night, five or six nights weekly, might be optimal therapy, it may be difficult to persuade patients to accept more than (for example) 7 hours each night on alternate nights. Even this would be an improvement on current regimens.
• Short daily dialysis is also an option.
• While extending hours and increasing dialysis frequency would be difficult in dialysis centres, it could perhaps be tried in selected patients.

Definitions:

Levels of Evidence

Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)

Level II: Evidence obtained from at least one properly designed RCT

Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group

Level IV: Evidence obtained from case series, either post-test or pretest/post-test

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

• Appropriate education will be given to patients with end-stage kidney disease who are approaching hemodialysis.
• Dialysis patients fare better when the duration and/or the frequency of dialysis is extended beyond the conventional regimen of around 4 hours, three times each week.
• Compared with short thrice-weekly dialysis, nocturnal dialysis is associated with improved salt and water control, increased solute removal, improved calcium and phosphate control, and a marked improvement in quality of life.

Not stated

An implementation strategy was not provided.

Living with Illness

Effectiveness

• Duration and frequency of haemodialysis therapy. Nephrology 2005 Oct;10(S4):S71-4.



• Duration and frequency of haemodialysis therapy. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2004 Dec. 9 p. [19 references]

Not applicable: The guideline was not adapted from another source.

2005 Oct

Caring for Australasians with Renal Impairment - Disease Specific Society

Industry-sponsored funding administered through Kidney Health Australia

Not stated

David Harris, Convenor (Westmead, New South Wales); Merlin Thomas (Prahran, Victoria); David Johnson (Woolloongabba, Queensland); Kathy Nicholls (Parkville, Victoria); Adrian Gillin (Camperdown, New South Wales)

All guideline writers are required to fill out a declaration of conflict of interest.

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI Institute on April 22, 2008.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.