{"id":2778,"date":"2020-03-18T20:36:15","date_gmt":"2020-03-19T01:36:15","guid":{"rendered":"https:\/\/ami.advancedrenaleducation.com\/wparep\/?post_type=article&p=972"},"modified":"2025-09-02T11:20:23","modified_gmt":"2025-09-02T16:20:23","slug":"the-influence-of-dose-time-and-frequency","status":"publish","type":"article","link":"https:\/\/ami.advancedrenaleducation.com\/wparep\/asiapacific\/article\/the-influence-of-dose-time-and-frequency\/","title":{"rendered":"The Influence of Dose, Time, and Frequency"},"content":{"rendered":"

Over the past six decades, the frequency, session length, and dialysis dose of HD prescriptions have empirically evolved in search of the optimal therapeutic regimen.<\/p>\n

In the early days of HD, treatment was initially performed for 20 to 24 hours once every 5 to 7 days with notable improvement in uremic symptoms and quality of life in many patients1<\/sup>.\u00a0 However, uremic symptoms would reappear and become more severe 24-36 hours prior to the next dialysis session1<\/sup>.\u00a0 These interdialytic complications (symptoms of underdialysis), especially the accumulation of significant fluid overload and the emergence of peripheral neuropathy, prompted the initiation of a twice weekly HD regimen2\u20134<\/sup>. \u00a0A further increase to thrice weekly dialysis frequency occurred to reduce the progression of neuropathy and prevent the occurrence of a gout-like syndrome5<\/sup>. Thrice weekly ICHD with 4-hour long sessions was eventually accepted and has remained the dominant kidney replacement therapy globally for uremic patients since the mid-1960s5,6<\/sup>.<\/p>\n

A growing wealth of emerging studies, however, have challenged the traditional thrice-weekly HD dogma by showing improved outcomes with intensified treatment7\u20139<\/sup>. Alternative, personalized HD regimens \u2013 either through more frequent or longer-duration nocturnal treatment \u2013 may offer improved patient outcomes such as better volume and blood pressure control, reduced cardiovascular-related injury and hospitalizations, decreased medication dependency, and shorter post-dialysis recovery times 7\u20139<\/sup>. While the majority of HD treatments prescribed still follow the conventional<\/strong> HD<\/strong> schedule of 4-hour sessions three times weekly, frequent HD<\/strong> involves increasing treatment days beyond thrice weekly (4-7 days per week), extended-hours HD <\/strong>involves longer dialysis session duration, and intensive HD<\/strong> focuses on increasing cumulative weekly treatment time through a combination of increasing treatment days (frequency) and length of each dialysis session (duration)10<\/sup>. Dialysis treatment prescription variations can be applied in-center or at home, but the most convenient treatment location to flexibly modify treatment regimens is at home. In 2022, 86.3% of US home HD patients were prescribed 4 or more sessions per week (Figure 1), an increase from 73% in 201511<\/sup>.<\/p>\n

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Figure 1:<\/strong> Prescribed number of treatments per week in adult patients performing home HD in the US. In 2022, 12.7% patients were prescribed 3-3.9 sessions per week, 42.6% of patients were prescribed 4 to 4.9 sessions per week, and 41.2% of patients were prescribed 5-5.9 sessions per week (Adapted from USRDS 2024 ADR11 <\/sup>Chapter 2: Home Dialysis. Figure 2.11a).<\/h6>\n<\/div>\n<\/div>\n

 <\/p>\n

This overview explores the current state of research in various HD treatment schedules and the impact of dose, time, and frequency on clinical outcomes of HD.<\/p>\n

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References:<\/h4>\n
    \n
  1. SCRIBNER BH, BURI R, CANER JE, HEGSTROM R, BURNELL JM. The treatment of chronic uremia by means of intermittent hemodialysis: a preliminary report. Trans Am Soc Artif Intern Organs<\/em>. 1960;6:114-122. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/13749429.<\/li>\n
  2. Curtis FK, Cole JJ, Fellows BJ, Tyler LL, Scribner BH. Hemodialysis in the home. Trans Am Soc Artif Intern Organs<\/em>. 1965;11:7-10.<\/li>\n
  3. De Palma JR. Daily hemodialysis: A very old concept. Semin Dial<\/em>. 1999;12(6):406-409.<\/li>\n
  4. Hegstrom RM, Murray JS, Pendras JP, Burnell JM, Scribner BH. Two year\u2019s experience with periodic hemodialysis in the treatment of chronic uremia. Trans Am Soc Artif Intern Organs<\/em>. 1962;8:266-280.<\/li>\n
  5. Scribner BH, Cole JJ, Ahmad S, Blagg CR. Why thrice weekly dialysis? Hemodialysis International<\/em>. 2004;8(2):188-192.<\/li>\n
  6. Eschbach Jr J, Wilson Jr W, Peoples R, Wakefield A, Babb A, Scribner B. Unattended overnight home hemodialysis. Trans Am Soc Artif Intern Organs<\/em>. 1966;12:346-356.<\/li>\n
  7. Ok E, Demirci C, Asci G, et al. Patient Survival With Extended Home Hemodialysis Compared to In-Center Conventional Hemodialysis. Kidney Int Rep<\/em>. 2023;8(12):2603-2615. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/38106580\/.<\/li>\n
  8. Chertow GMG, Levin NNW, Beck GGJ, et al. In-center hemodialysis six times per week versus three times per week. N Engl J Med<\/em>. 2010;363(24):2287-2300. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21091062.<\/li>\n
  9. Jaber BL, Lee Y, Collins AJ, et al. Effect of daily hemodialysis on depressive symptoms and postdialysis recovery time: interim report from the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study. Am J Kidney Dis<\/em>. 2010;56(3):531-539. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20673601.<\/li>\n
  10. Perl J, Chan CT. Home hemodialysis, daily hemodialysis, and nocturnal hemodialysis: Core Curriculum 2009. American journal of kidney diseases<\/em>. 2009;54(6):1171-1184. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19748715.<\/li>\n
  11. United States Renal Data System. 2024 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2024.<\/em><\/li>\n<\/ol>\n

    GMO-001410\u00a0 Rev B\u00a0 11\/2024<\/span><\/p>\n

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