Research Viewpoints What Determines Recovery Time of Hemodialysis Sessions?

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Bossola M, Di Stasio E, Monteburini T, Parodi E, Ippoliti F, Cenerelli S, Santarelli S, Nebiolo PE, Sirolli V, Bonomini M, Antocicco M, Zuccalà G, Laudisio A: Recovery Time after Hemodialysis Is Inversely Associated with the Ultrafiltration Rate. doi.org/10.1159/000492919

Patients with ESRD undergoing renal replacement therapy (averaging about 4 hours each) frequently complain of fatigue, sluggishness, weakness and other constitutional symptoms during the immediate post-dialysis treatment period, usually lasting one to several hours. The dialysis recovery time (DRT) is variable and the determinants of this subjective symptom complex is an under-studied area.

Bossola and colleagues carried out an observational study to better define the correlations of DRT with patient characteristics and intra-dialytic parameters in 210 prevalent hemodialysis patients. They used a patient completed survey instrument to determine the per-patient DRT, but it is unclear how many times this survey was completed on a per-patient basis during the conduct of the study, nor is the timing of administration of the survey instrument clearly defined. The overall aim was to determine the relationship between ultra-filtration rate (UFR) and DRT.

The median DRT was 180 minutes (60 – 240 minutes) and 45 % of the patients had DRT ≥ the median value. Frail patients with limitations in daily living activities had a shorter DRT and those with a lower UFR had had a longer DRT. Thus, DRT was inversely related to UFR. Dialysate Na+ concentration, Kt/V and dialysate temperature were not associated with DRT. Changes in serum K+ concentration during and after dialysis was not studied. Prior studies have suggested a “U” shaped relationship between DRT and UFR. The design of this study precludes any mechanistic connection between UFR and DRT. These findings do not mean that UFR should be intentionally increased to reduce DRT, but they do illustrate the complex relationships between the subjective complaints of patients following dialysis and what is done to them during the dialysis session itself.