Reduced Requirement for Erythropoietin with Quotidian Hemodialysis Therapy

Quotidian (daily) hemodialysis has many potential advantages over conventional three times weekly hemodialysis, including improved control of anemia. However, previous reports do not consistently describe beneficial effects regarding anemia and erythropoietin requirements. We sought to determine whether erythropoietin dose is altered in this form of therapy, and elucidate the potential contributing factors. An analysis of an ongoing, nonrandomized, prospective trial of daily nocturnal, daily short, and their cohort of conventional hemodialysis controls was performed. Those patients who had completed 15 months of the trial were analyzed, which include nine patients in the quotidian dialysis group and nine cohort controls receiving conventional three times weekly dialysis. At 15 months, the weekly Kt/V in the quotidian group was 6.8 (+/-0.6) and 4.5 (+/-0.4) in the conventional group (p = 0.001). Mean erythropoietin dose fell in the quotidian group from 87 (+/-66) to 53 (+/-50) U/week per kg (p = 0.020). The mean hemoglobin rose from 115 (+/- 18) to 129 (+/- 14) g/L (p = 0.008). There was no significant change in erythropoietin dose or hemoglobin in the conventional hemodialysis group. Serum ferritin and the transferrin-saturation did not change significantly and remained above 100 microg/L and 20%, respectively, throughout. Serum albumin and C-reactive protein were similar between the quotidian and conventional dialysis groups and did not change over time. In patients who were receiving conventional thrice weekly hemodialysis, initiation of quotidian hemodialysis led to a 39% reduction in erythropoietin dose at 15 months, most likely due to the increased dose of delivered dialysis.