Dr Nasrulla Abutaleb is a Consultant Nephrologist, Diaverum Hemodialysis centers, Jeddah. He served as a Head of Nephrology section at KFSHD, Dammam from 2013-2016. He was a Senior Consultant Nephrologist, King Abdulaziz Military Hospital, Tabuk, K.S.A; Head of renal unit in the period between first of Aug 1999 and June 2005.
The reasons for freeing our hemodialysis therapy (HD) from the thrice weekly schedule with its obligatory long weekend interval are overwhelming. Shifting toward every other day schedule (EOD) is the most simple, practical, logical and rewarding step to improve the outcomes of hemodialysis therapy. Eliminating the odd weekly long inter-dialysis interval would mean eliminating significant related morbidities and mortalities (M&M). Such M&M are related to the effects of the biochemical and hemodynamic stresses that occur over the weekend intervals on both acute and chronic cumulative basis. In fact, the reported rise in M&M after the weekend intervals just reflect the adverse effects of these pathological processes on the acute basis alone. The reported figures for the rise in all-cause mortality ranged from 23% (R. N. Foley et al (1)) to 41% (Zhang H et al (2)). Higher figures up to 260% were even reported for the rise in the rates of cardiac mortality and hospitalization after the weekend interval (3, 4, 5). Such M & M peaks are not seen on abolishing the long weekend HD intervals (5, 6). The mechanisms accounting for such rises in the M &M seems mostly related to the peaks in serum K level and volume status after the long weekend intervals. The effects of the weekend peaks in the levels of the other pathological parameters as BP, serum phosphate & calcium, metabolic acidosis, other ‘uremic toxins’ and repeated subclinical volume overload states with secondary need for high ultrafiltration rates are chronic and cumulative. The potential harms related to these latter abnormalities are obviously accelerated during their peaks with higher overall exposure or the AUC (area under the curve) within the third day of the weekly long inter-dialysis interval. It is impossible to estimate the contribution of such latter abnormalities to the already high M & M of the HD population. It is then, obvious that the benefits from eliminating the long weekly inter-dialysis would not be limited to the elimination of above reported weekend rises in M & M. We can speculate that the bulk of the benefits associated with quotidian HD can still be reaped with the more efficient EOD hemodialysis.