Is single-needle hemodialysis still a good treatment in end-stage renal disease?

Background: Single-needle (SN) dialysis has been accepted as one of the alternative modes of renal replacement therapy. Despite its advantages it is not widely practiced due to the belief of underdialysis by this technique. However, it is used routinely in many hemodialysis units. We therefore aimed to study the efficacy and determine parameters that reflect the dialysis efficiency. The complications and adverse events were also evaluated. The times required to achieve maximal adequacy of dialysis were compared between 4-, 4.5-and 5.0-hour dialysis sessions.

Methods: Ten stable end-stage renal disease patients who regularly used the standard hemodialysis technique with double-needle (DN) dialysis were switched to SN dialysis for three consecutive dialysis session times (4, 4.5 and 5.0 h, respectively) for 3 weeks in each period. The following parameters including Kt/V, percent recirculation, calcium, phosphorus, hematocrit, and LDH level were studied at the start and end of each period.

Results: After switching to the SN mode, the Kt/V did not change significantly from the baseline value. However, in the subgroup analysis, only the thrice-weekly group achieved the target Kt/V. Kt/V declined insignificantly in the twice-weekly group but did not reach the recommended level. The other parameters were not different from the DN group. The 4-hour group had a similar Kt/V to the other groups and had less recirculation. There were no major complications during the SN phase. The outcome of the fistulas was excellent.

Conclusion: The thrice-weekly SN hemodialysis with 4-hour session time has the same efficacy as the conventional DN technique with no more adverse events. Therefore, the SN hemodialysis system may be suitable for routine thrice-weekly hemodialysis in the selected group of patients.