Study calls dialysis treatment into question

For patients needing dialysis treatment, less isn’t always more.

With roughly two million people around the world receiving the treatment – meant to counter kidney failure by artificially filtering blood – more frequent treatment can improve quality of life. While studies support this claim, a new study from the Lawson Health Research Institute shows more frequent treatment, while beneficial, isn’t without risk.

A recent study led by Schulich School of Medicine & Dentistry professor Dr. Rita Suri shows for patients who undergo the rising trend of receiving dialysis six times a week – twice the usual regime – the risk of complications associated with the treatment’s intravenous access point is significantly greater.

It is the first randomized study showing more frequent dialysis could have potentially harmful effects.

“Every medical treatment has associated benefits and risks,” Suri said. She explained her research team expected to see more problems in patients receiving more frequent dialysis, more “wear and tear” at the “vascular access” – an intravenous catheter or surgically created vein site where blood leaves and re-enters the body.

She noted complications could range from damage to the vein used as an access site, clots, needed access site repairs arising from frequent use, or total loss of the access site.

Over the course of a year and two clinical trials, Suri and her research team found the risk of an access site-related complication in patients receiving more frequent dialysis increased by 76 per cent.

Nearly one third of patients in the first trial experienced a problem with the dialysis access site. Of 245 patients, those who received more frequent treatment needed 33 repairs and experienced 15 losses, while those who received conventional treatment needed 17 repairs and had 11 losses. The second trial showed a similar distribution.

“We must monitor patients carefully to ensure if the access is not working properly, that we treat it properly,” Suri said. “If there is a blockage in the access, then there are procedures to dilate the blockage – the blockage can lead to a clot in the access. We saw more procedures to get rid of blockages, but (patients) didn’t actually lose the access as frequently.”

Suri is careful to note just because the risks of complications is higher for patients receiving more frequent dialysis, it doesn’t mean more frequent treatment should be discounted as a good option for some patients.

Treatment should be patient-oriented and take into account the individual’s lifestyle and preferences, she said.

“We don’t know what types of patients derive the best benefits (from more frequent treatment) but their quality of life is about three points higher on the scale – significantly better. Coming in (for treatment) six times a week is time-consuming and not for everyone. It’s patient choice and with patients who are coming to the dialysis unit twice as often, you’d think that would decrease their quality of life – but they felt quality of life was better.”

This study won’t affect dialysis treatment or the recommendations doctors make, Suri continued, noting the only thing that could change is the way patients are monitored. She hopes further studies will come out of this one, looking to better serve patients’ needs and administer quality care.

The study can be found online in the Journal of the American Society of Nephrology.