Cardiovascular Outcomes Associated with Frequent Hemodialysis

Hemodialysis (HD) patients suffer from significantly shorter life expectancy when compared to matched population without end-stage kidney disease (ESKD). According to United States Renal Data System (USRDS) data, cardiovascular diseases accounted for 42% of all ESKD deaths in 2018 (United States Renal Data System. 2020 USRDS annual data report: epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, 2020). More frequent hemodialysis (FHD) has demonstrated improved surrogate markers of cardiovascular disease in the ESKD population. These modifiable factors include improved blood pressure control, reduced intradialytic weight pain, reduced ultrafiltration volumes per session, and regression of left ventricular hypertrophy. In addition, FHD has better control of markers of chronic kidney disease-mineral bone disease axis, which is associated with cardiovascular sequelae. Lastly, increased frequency of HD attenuates large deviations and rapid corrections of electrolytes and extracellular fluid status, which is directly linked to our patients’ morbidities and mortality.