For Dialysis, Options Await
Treatment can be done at a health center or at home, daytime or overnight

(HealthDay News) -- When the kidneys don't do what they're supposed to -- which is cleanse the blood -- dialysis becomes necessary to remove minerals, wastes and excess fluid that would otherwise cause a lethal build-up in the body.

But what kind of dialysis is best?

People today have an array of treatment options, each with its own benefits and drawbacks. But evidence is growing that more frequent or longer dialysis might save more lives than conventional four-hour treatments three times a week.

"What we do know for a fact is that more dialysis is better," Dr. Robert Provenzano, vice chairman of nephrology at St. John Hospital and Medical Center in Detroit, told HealthDay.

Nearly a half-million Americans are living with kidney failure, requiring dialysis or a kidney transplant to survive, says the American Kidney Fund. Meantime, the number at risk for kidney failure continues to rise because of risk factors such as diabetes, high blood pressure and obesity.

There are two main types of dialysis: hemodialysis and peritoneal dialysis.

Hemodialysis uses an artificial kidney, called a hemodialyzer, to cleanse the blood before returning it to the person's body. Before this type of treatment is performed, people must have minor surgery to allow the machine to tap into the blood in their vessels, according to the National Kidney Foundation.

This is the most common treatment method and is typically performed at a dialysis center. Treatments usually run three to four hours, three times weekly, says the National Kidney and Urologic Diseases Information Clearinghouse.

At a growing number of clinics, however, dialysis nurses are teaching people to perform home hemodialysis. And those treatments can be performed day or night, as long as the person sticks to a regular schedule.

With peritoneal dialysis, the person's own abdomen is used as a filtering device. A soft tube, or catheter, is surgically implanted in the person's belly, explains the American Association of Kidney Patients. Cleansing fluid, called dialysate, flows into the abdomen and is later drained along with blood impurities sucked from the body. This process is usually repeated four times a day.

So which is best? In making that choice, researchers suggest, a person should consider such factors as age, general health and long-term need.

In a review of more than 25,000 people who had been on dialysis for at least 90 days, Australian researchers found that those undergoing peritoneal dialysis at day 90 had lower death rates during the 90- to 365-day period of the study than did hemodialysis patients. But only people younger than 60 and with no other medical conditions enjoyed that survival advantage.

What's more, after 12 months, the death rate increased for those on peritoneal dialysis at day 90.

"Our data suggest caution in the use of peritoneal dialysis in many patients, particularly when this therapy is continued beyond one to two years," the study's authors wrote.

Undergoing dialysis at night might also result in better outcomes.

In findings presented to the American Society of Nephrology, Turkish researchers reported on a study for which they followed 224 dialysis patients who switched from conventional hemodialysis to thrice weekly, eight-hour overnight sessions at a dialysis center.

Compared with people on a typical hemodialysis regimen, the nighttime treatment group had significantly better outcomes, including a 78 percent reduced rate of mortality. However, Provenzano noted, it was not a randomized, controlled study. "So what we need now is more randomized research," he said.

On the Web

To learn more about dialysis options, visit the U.S. National Kidney and Urologic Diseases Information Clearinghouse.

SOURCES: HealthDay News ; Robert Provenzano, M.D., vice-chairman, Department of Nephrology, St. John Hospital and Medical Center, Detroit; American Society of Nephrology, news releases, Oct. 30, 2008, and Dec. 17, 2008; Nov. 7, 2008, presentation, American Society of Nephrology annual meeting, Philadelphia; American Kidney Fund, Rockville, Md.; American Association of Kidney Patients, Tampa, Fla.; National Kidney and Urologic Diseases Information Clearinghouse (www.kidney.niddk.nih.gov)
Author: Karen Pallarito
Publication Date: Nov. 30, 2009
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