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Daily Haemodialysis

Please note, this page is a summary of the full conference speech (click here for the full transcript).

Professor Terry Feest
Director of the Richard Bright Renal Unit in Bristol, Chairman of the UK Renal Registry, Member of the External Reference Group for the renal National Service Framework, Member of the Appraisals Board of NICE, Clinical advisor to the NKF.

More frequent dialysis meant that you still did 12 hours a week dialysis, but instead of doing three four-hour sessions you did six two-hour sessions.

There were good theoretical reasons why this should be better, said Professor Feest. Dialysis only cleaned the blood, not the whole body. Outside the blood vessels there were lots of space and cells with fluid inside them.

"Now as waste products and poisons build up in the body, they build up in these spaces and these cells," he said.

"So in the first hour or so of dialysis you get this very rapid cleaning of the blood, and for the rest of the time the removal of waste products and anything else is going to be limited by how fast they can get into the blood," he said.

"What we really need is the first hour of dialysis more often. And that's the principle of daily or more frequent dialysis."

But did it work in practice? The published information was only on a few hundred patients, from all around the world - in California, the East Coast of America, France and Holland - and only for short studies.

"Some of us have believed in it for 30 years, but we have not been able to put it into practice, particularly in the UK," said Professor Feest.

In a group of 12 patients, appetite and nutrition improved, and people put on weight - not fluid weight but proper weight. The anaemia also improved with a reduction of 30 to 40 per cent in the use of EPOs.

"This might be important when you start negotiating to get a treatment like this, because it will be said to cost money, but here is a cost saving that you can argue with your health authority," said Professor Feest.

Studies have not been long enough to establish whether people were likely to live longer on daily haemodialysis, but the big risk factors of anaemia, high blood pressure and high phosphate were all lowered and improved.

The first problem that people think about daily haemodialysis was the access, the fistula. Survival of fistulae was no worse than in normal patients, but daily haemodialysis had only been done on patients who had good fistulae in the first place.

The problem of hospital transport made it in many ways an ideal treatment for the home, but unit-based daily dialysis, while difficult, was not impossible, but it would need some fairly radical rethinking of how things were organised.

Probably at home daily dialysis might cost only £2,500 to £3,000 more and there were savings, particularly the drop of 30 percent in EPO and blood pressure drugs, and a 30 per cent reduction in admissions.

"So if you look at your top six symptoms, the cramps are better, the tiredness is better, the anaemia is better, the itching is certainly better, the headaches are better. What it doesn't address is joint pains - it doesn't make them worse but as far as we know it may not make them better. But that's not a bad list of your top six symptoms," said Professor Feest.

It was slowly being introduced in the UK for suitable patients. At the moment it was limited to home patients with good access.

"So I hope that some of you may get daily dialysis offered to you soon," said Professor Feest.

 

Please note, this page is a summary of the full conference speech (click here for the full transcript).