How More Frequent Dialysis Facilitates Patient Recovery

04/29/2023 | Alice Hellebrand, DNP, RN, CNN, Chief Nursing Officer & Senior Vice President

Overview

Conventional hemodialysis (HD) is known to cause prolonged, debilitating post-dialysis symptoms. HD’s long recovery time seriously impacts the health and quality of life of end-stage kidney disease (ESKD) patients who reside in skilled nursing facilities (SNFs). Dialyze Direct hypothesized that more frequent dialysis (MFD) results in shorter recovery times for HD patients and better patient outcomes and sought to illustrate this with a study.

The challenge

Patients age 65 or older with ESKD who receive dialysis total 52% of dialysis patients in the U.S. each year.¹ Many of these patients reside in SNFs for a period of their treatment. Conventional dialysis involves transportation from the SNF to a dialysis center for treatment, three days per week. 

Following these dialysis treatments, which occupy most of the day with transportation included, patients experience a long post-dialysis recovery time. Multiple studies have noted this can exceed four hours.²,³ In one study, 10% of patients reported even greater than twelve hours’ recovery time.⁴

Common dialysis symptoms include fatigue or feeling “washed out,” cramping, headaches, nausea, and low blood pressure.⁵ These adverse effects can cause patients to skip treatment or shorten sessions.⁶

Longer recovery times are associated with poorer quality of life and increased hospitalization and mortality risk.⁷ For patients who receive rehabilitation services at the SNF, this time away for dialysis and recovery may also interrupt their rehabilitation.

The solution

MFD is becoming more common in skilled nursing facilities (SNFs), provided that the patient exhibits co-morbidities that are medically reasonable and necessary to receive MFD. Dialyze Direct provides these services onsite in dedicated dialysis dens, staffed by specially trained nurses. 

Patients receiving MFD in these dialysis dens can expect treatments five days per week, for less than three hours total duration, and do not require costly transportation to offsite dialysis centers.

Various studies have shown benefits to MFD in clinic settings. ⁸,⁹ Recovery time in SNF dialysis patients had previously not been studied. Of note, the majority of in-SNF patients treated with MFD by Dialyze Direct are elderly, frail patients with multiple comorbidities. 

To answer the question of whether MFD improves post-dialysis recovery times in the SNF population, Dialyze Direct initiated a study of end-stage renal dialysis (ESRD) patients residing in 154 SNFs across twelve states. The total number of patients included in the study criteria was 2,309 patients receiving 108,876 dialysis treatments. 

Clinical research findings

SNF dialysis patients receiving MFD were questioned about recovery to baseline functioning. Results indicated the following: ¹⁰

• Dialysis recovery time (DRT) of less than two hours was reported in 92% of patients
• 80% reported DRT within one hour
• From the first dialysis through day 90, cumulative mortality or hospitalization was significantly lower for patients with a recovery time of less than two hours

Again, this was despite advanced age, frailty, and multiple complex health conditions. By comparison, DRT within two hours has been reported in only 21-62% of patients receiving conventional dialysis treatment. ¹¹

Conclusion

More frequent dialysis (MFD) offers the possibility of significant ESKD patient quality-of-life enhancements due to improved rehabilitation and long-term (even post-SNF) outcomes. 

These important findings are a gateway for further investigation to provide clinical evidence on the benefits of SNF onsite MFD to patient health outcomes and value-based care initiatives.   

References

¹ Hellebrand AM, Bellin EY, Kaplan SM. Epidemiology of nursing home dialysis patients- A hidden population. Wiley Online Library. https://onlinelibrary.wiley.com/doi/10.1111/hdi.12943. Published June 16, 2021. Accessed February 21, 2023.

² Alvarez L, Hu D, Brown D. Intradialytic Symptoms and Recovery Time in Patients on Thrice-Weekly In-Center Hemodialysis: A Cross-sectional Online Survey. Kidney Medicine Journal. https://doi.org/10.1016/j.xkme.2019.10.010. Published December 19, 2019. Accessed February 21, 2023. 

³ Bossola M;Di Stasio E;Antocicco M;Silvestri P;Tazza L; Variables associated with time of recovery after hemodialysis. Journal of nephrology. https://pubmed.ncbi.nlm.nih.gov/22941875/. Accessed February 21, 2023. 

⁴ Rayner HC, Zepel L, Fuller DS, et al. Recovery time, quality of life, and mortality in hemodialysis patients: The Dialysis Outcomes and Practice Patterns Study (dopps). American journal of kidney diseases : the official journal of the National Kidney Foundation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4069238/. Published February 14, 2014. Accessed February 21, 2023. 

⁵ Alvarez L, Hu D, Brown D. Intradialytic Symptoms and Recovery Time in Patients on Thrice-Weekly In-Center Hemodialysis: A Cross-sectional Online Survey. Kidney Medicine Journal. https://doi.org/10.1016/j.xkme.2019.10.010. Published December 19, 2019. Accessed February 21, 2023. 

⁶ Alvarez L, Hu D, Brown D. Intradialytic Symptoms and Recovery Time in Patients on Thrice-Weekly In-Center Hemodialysis: A Cross-sectional Online Survey. Kidney Medicine Journal. https://doi.org/10.1016/j.xkme.2019.10.010. Published December 19, 2019. Accessed February 21, 2023. 

⁷  Hellebrand AM, Bellin EY, Kaplan SM. Epidemiology of nursing home dialysis patients- A hidden population. Wiley Online Library. https://onlinelibrary.wiley.com/doi/10.1111/hdi.12943. Published June 16, 2021. Accessed February 21, 2023. 

⁸ More Frequent Dialysis Improves Health of Kidney Patients. National Institutes of Health. https://www.nih.gov/news-events/nih-research-matters/more-frequent-dialysis-improves-health-kidney-patients. Published July 6, 2015. Accessed February 21, 2023. 

⁹ Garg AX, Suri RS, Eggers P. Patients receiving frequent hemodialysis have better health-related quality of life compared to patients receiving conventional hemodialysis. Kidney International. https://doi.org/10.1016/j.kint.2016.10.033. Published January 14, 2017. Accessed February 21, 2023. 

¹⁰ Hellebrand AM, Kaplan SM, Ledvina JG, Markis WT, Levin NW, Kaufman AM. Post-dialysis recovery time in ESRD patients receiving more frequent hemodialysis in skilled nursing facilities. Hemodialysis International. International Symposium on Home Hemodialysis. https://onlinelibrary.wiley.com/doi/10.1111/hdi.13012. Published April 6, 2022. Accessed February 28, 2023. 

¹¹ Hellebrand AM, Kaplan SM, Ledvina JG, Markis WT, Levin NW, Kaufman AM. Post-dialysis recovery time in ESRD patients receiving more frequent hemodialysis in skilled nursing facilities. Hemodialysis International. International Symposium on Home Hemodialysis. https://onlinelibrary.wiley.com/doi/10.1111/hdi.13012. Published April 6, 2022. Accessed February 28, 2023. 

About the Author

Alice Hellebrand, DNP, RN, CNN has been with Dialyze Direct since its inception in 2015 and is responsible for overseeing the design and implementation of patient care delivery, clinical staff education, and clinical quality improvement. She has authored many journal publications and her expertise has been sought as a presenter nationally and internationally at nephrology, dialysis, and skilled nursing conferences. Her continued dedication to the Dialyze Direct model of dialysis care gives her unique insights into this pioneering approach to treatment.