Intensive Hemodialysis in the Clinic and At Home

Part of the Studies in Computational Intelligence book series (SCI, volume 404)


Conventional hemodialysis delivered so that urea clearance is adequate may still leave patients with uremic symptoms and unsatisfactory outcomes. This has led to an interest in more intensive hemodialysis prescriptions, where dialysis is delivered with increased frequency, duration or both. Intensive hemodialysis can improve the clearance of small solutes such as urea, but can have an even larger effect on the clearance of larger solutes that tend to maintain a large gradient between blood and dialysate through the course of a dialysis treatment. This is particularly true of intensive hemodialysis prescriptions that increase the total weekly hours of dialysis. Studies have suggested a number of potential benefits for intensive hemodialysis, including improved nutritional markers, easier control of anemia, lower hospitalization rates, improvements in sleep apnea and restoration of fertility. The most convincing studies suggest that intensive hemodialysis can improve blood pressure control, reduce left ventricular mass, improve health related quality of life and improve mineral metabolism parameters. Intensive hemodialysis techniques appear to be associated with an increase in access related difficulties. These techniques also appear to be cost-effective, especially when delivered in the home. The evidence of benefit of intensive hemodialysis generated in these studies has generated increasing interest in these modalities, and their prevalence has been increasing. However, it remains unclear whether intensive hemodialysis should be offered to a wide range of patients with end-stage renal disease, or instead targeted to patients whose clinical status is poor on conventional hemodialysis.


Conventional hemodialysis Hemodialysis adequacy Home hemodialysis Intensive hemodialysis Kt/V Nocturnal hemodialysis Short daily hemodialysis Urea kinetics Ultrafiltration Urea clearance Urea rebound 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.St. Michael’s HopsitalUniversity of TorontoTorontoCanada

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