Previous observational and uncontrolled studies of daily hemodialysis have shown mixed results in regards to vascular access outcomes with the majority showing no difference in access outcomes and some showing a trend toward improved access outcomes.4,10–12 The randomized-controlled Frequent Hemodialysis Network Trial (FHN) study of daily, in-center, hemodialysis
showed no significant differences in access outcomes, but a trend toward more access procedures with similar patency rates.13 Importantly, no controlled studies have addressed this issue over a long-term follow-up of greater than 1 year. A potential source of morbidity and possibly mortality from daily hemodialysis is vascular access failure as vascular access complications can have grave consequences;14,15 therefore, it is important to determine the
effects of frequent cannulation on the vascular access.
Arteriovenous grafts may be especially susceptible to early
failure because punctures in the grafted material may
weaken and eventually undermine the integrity of the
access. A secondary consideration is the potential for
increased medical costs if daily dialysis increases the
number of access procedures necessary to maintain access
patency. Patient acceptance of daily dialysis therapies may
be impaired if the effects on vascular access patency are
unknown because access complications are also a signifi-
cant source of patient morbidity through pain associated
with procedures and increased hospitalizations because
of access failure. Finally, because arteriovenous fistulae
are associated with improved survival in epidemiological
studies,16 failure of the arteriovenous access may lead to
increased mortality rates.
This particular study aimed to investigate the impact
of daily dialysis on vascular access complications. We
hypothesized that frequent dialysis cannulation would be
associated with either increased or similar rates of vascular
access complications. To test this hypothesis we performed
a nonrandomized, prospective cohort study with
contemporary control of daily hemodialysis vs. conventional
hemodialysis and examined vascular access
outcomes. With increased adoption of daily dialysis regimens,
it is important to determine the long-term effects of
daily hemodialysis on access survival, because little is
known regarding the potential for vascular access harm
related to frequent cannulation