OPINION

Protecting Kidney Patients' Hearts: Has the Time Come to Rethink Dialysis Treatment Cadence?

FIGURE 1  |  In-center hemodialysis treatment schedule and mortality risk

 In-center hemodialysis treatment schedule and mortality risk chart.

These findings highlight the serious risks associated with the LIDI. Complications associated with the LIDI also include exacerbation of volume accumulation and cardiac re-modeling.4 In addition, the first hemodialysis treatment following the LIDI is more likely to require a higher ultrafiltration rate. Higher ultrafiltration rates during hemodialysis have received significant attention as the understanding of the deleterious consequences, including myocardial stunning, have advanced.

As kidney care evolves to become more personalized and precise for every person, cardiovascular health and prevention of chronic volume overload and the associated long-term complications must be addressed. The field must advance to provide a treatment frequency that aligns with physiologic needs. Instead of focusing on treatment of cardiac complications, it is necessary to proactively prevent or slow the progression of cardiac disease and focus on cardiovascular health. It must be considered whether both active monitoring for rhythm disturbances and understanding the nervous system’s input into arrythmias need consideration.

Examining how best to personalize the hemodialysis treatment frequency for each person’s physiologic needs—with the prescription informed by residual kidney function, blood pressure control, and cardiovascular treatment goals—is critical. Such an endeavor will require the collaboration of stakeholders across the entire healthcare delivery system, from patients to providers to payors and policy makers, and has the potential to make a lasting impact on advanced kidney disease care worldwide. 

Meet The Experts

 

FRANKLIN W. MADDUX, MD, FACP
Global Chief Medical Officer, Member of the Management Board 

References

  1. Roy-Chaudhury P, Tumlin JA, Koplan BA, et al. Primary outcomes of the Monitoring in Dialysis Study indicate that clinically significant arrhythmias are common in hemodialysis patients and related to dialytic cycle. Kidney Int 2018 Apr;93(4):941-51. doi: 10.1016/j.kint.2017.11.019.
  2. Foley RN, Gilbertson DT, Murray T, Collins AJ. Long interdialytic interval and mortality among patients receiving hemodialysis. N Engl J Med 2011 Sep 22;365(12):1099-1107. doi:10.1056/NEJMoa1103313.
  3. Zhang H, Schaubel DE, Kalbfleisch JD, et al. Dialysis outcomes and analysis of practice patterns suggests the dialysis schedule affects day-of-week mortality. Kidney Int 2012 Jun;81(11):1108-15. doi:10.1038/ki.2011.481.
  4. Rhee CM. Serum potassium and the long interdialytic interval: minding the gap. Am J Kidney Dis 2017 Jul;70(1):4-7. doi: 10.1053/j.ajkd.2017.04.007. PMID: 28646982.