Chapter 21 Chronic dialysis

21.1 Chronic Haemodialysis

21.1.1 Modality

ESHOL (2013): - online-HDF vs. HD. Lower rates of all-cause, infective and CVS mortality in the HDF group. Lower rates of intra-dialytic hypotension in HDF group.

21.1.2 Dose

HEMO (2002): - 2x2 factorial low- vs. high-flux and standard dose (spKt/V ~1.3) vs. high-dose (spKt/V ~1.7). No difference in all-cause mortality in any group.

21.1.3 Initiation

IDEAL (2010): - early (eGFR 10–14) vs. late (eGFR 5–7) initiation of dialysis. No difference in all-cause mortality.

Kurella Tamura et al. (2009): - effect of dialysis initiation on functional status of nursing-home residents. Initiation of dialysis was associated with sustained decline in functional status.

21.2 Peritoneal Dialysis

CANUSA (1996): study of outcomes in PD. Higher (peritoneal and renal) clearance was associated with reduced risk of death.

ADEMEX (2002): - standard vs. intense (peritoneal CrCl >60L/week) PD. No effect on all-cause mortality.

IMPENDIA & EDEN (2013): - control vs. low-glucose dialysate in patients with diabetes on PD. Low-glucose group had improved HbA1C and lipid profiles but higher rates of death and adverse events associated with volume-expansion.

EAPOS (2003): - observational study of anuric patients on APD. Outcomes acceptable if UF > 750 ml/day (as was achieved in ~75%).

21.3 Conservative care

So far, no RCT has assessed benefits of conservative vs. dialysis treatment of ESKD.

Verberne et al. (2016): - single-centre observational study in the Netherlands. Conservative care associated with improved survival in patients aged <80; no difference if over 80. Any survival benefit was attenuated in the presence of severe co-morbidity.