A One-Year Trial of In-Center Daily Hemodialysis with an Emphasis on Quality of Life

Reynolds, Jeffrey T; Homel, Peter; Cantey, L.; Evans, Ellen; Harding, Pamela; Gotch, Frank A.; Wuerth, Diane; Finkelstein, Susan H.; Levin, Nathan W.; Kliger, Alan S.; Simon, David B.; Finkelstein, Fredric O.

doi:10.1159/000079186

Cited by 36 publications

(33 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An early study by Bonomini et al [35] in 1972 noted that in six patients who had uremic-type symptoms despite increasing the time on dialysis from 22 to 30 h per week, changing patients to short daily dialysis (3-4 h for 5 days per week) led to resolution of signs and symptoms of advanced uremia such as anorexia, amenorrhea, severe anemia, impotence, insomnia, polyneuropathy, pruritus and restless leg syndrome. Improvements in these symptoms of uremia, as well as in blood pressure control and left ventricular hypertrophy, were noted by other investigators in both Europe and North America [40,41,42,43]. …”

Section: More Frequent Hemodialysissupporting

confidence: 56%

Chronic Hemodialysis Therapy in the West

Rocco¹

2015

Kidney Dis

View full text Add to dashboard Cite

Background: Chronic hemodialysis (HD) in the 1960s encompassed a wide variety of prescriptions from twice weekly to five times per week HD. Over time, HD prescriptions in the West became standardized at three times per week, 2.5-4 h per session, with occasional additional treatments for volume overload. Summary: When clinical trials of dialysis dose failed to show significant benefit of extending time compared with the traditional dialysis prescription, interest in more frequent HD was renewed. Consequently, there has been growth in home HD therapies as well as alternative dialysis prescriptions. Data from recent randomized clinical trials have demonstrated the benefits and risks of these more frequent therapies, with surprising differences in outcomes between short daily HD and long nocturnal HD. More frequent therapies improve control of both hypertension and hyperphosphatemia, but at the expense of increased vascular access complications and, at least for nocturnal HD, a faster loss of residual renal function. Key Messages: In the West, the standard HD prescription is three treatments per week with a minimal time of 3.0 h and dialysis is performed in an outpatient dialysis center. A minority of patients will have a fourth treatment per week for volume issues. Alternative HD prescriptions, although rare, are more available compared to the recent past. Facts from East and West: (1) While developed Western and Asian countries provide end-stage renal disease patients full access to HD, healthcare systems from South and South-East Asia can offer access to HD only to a limited fraction of the patients in need. Even though the annual costs of HD are much lower in less developed countries (for instance 30 times lower in India compared to the US), patients often cannot afford costs not covered by health insurance. (2) The recommended dialysis pattern in the West is at least three sessions weekly with high-flux dialyzers. Studies from Shanghai and Taiwan might however indicate a benefit of twice versus thrice weekly sessions. In less developed Asian countries, a twice weekly pattern is common, sometimes with dialyzer reuse and inadequate water treatment. A majority of patients decrease session frequency or discontinue the program due to financial constraint. (3) As convective therapies are gaining popularity in Europe, penetration in Asia is low and limited by costs. (4) In Asian countries, in particular in the South and South-East, hepatitis and tuberculosis infections in HD patients are higher than in the West and substantially increase mortality. (5) Progress has recently been made in countries like Thailand and Brunei to provide universal HD access to all patients in need. Nevertheless, well-trained personnel, reliable registries and better patient follow-up would improve outcomes in low-income Asian countries.

show abstract

Section: More Frequent Hemodialysissupporting

confidence: 56%

Chronic Hemodialysis Therapy in the West

Rocco¹

2015

Kidney Dis

View full text Add to dashboard Cite

show abstract

“…Whereas the traditional cardiovascular risk factors do not account for the increased mortality in CKD patients (3,4), measures of mineral and bone disorders (MBD), including hyperphosphatemia, are associated with increased death risk (5)(6)(7)(8)(9). Hyperphosphatemia may be involved in the pathogenesis of vascular calcification (10)(11)(12). Hence, prevention and correction of hyperphosphatemia and dietary phosphorus burden are major components of the management of CKD.…”

mentioning

confidence: 99%

Association of Dietary Phosphorus Intake and Phosphorus to Protein Ratio with Mortality in Hemodialysis Patients

Noori¹,

Kalantar-Zadeh²,

Kövesdy³

et al. 2010

Clinical Journal of the American Society of Nephrology

196

127

View full text Add to dashboard Cite

Background and objectives: Epidemiologic studies show an association between higher predialysis serum phosphorus and increased death risk in maintenance hemodialysis (MHD) patients. The hypothesis that higher dietary phosphorus intake and higher phosphorus content per gram of dietary protein intake are each associated with increased mortality in MHD patients was examined.Design, setting, participants, & measurements: Food frequency questionnaires were used to conduct a cohort study to examine the survival predictability of dietary phosphorus and the ratio of phosphorus to protein intake. At the start of the cohort, Cox proportional hazard regression was used in 224 MHD patients, who were followed for up to 5 years (2001 to 2006).Results: Both higher dietary phosphorus intake and a higher dietary phosphorus to protein ratio were associated with significantly increased death hazard ratios (HR) in the unadjusted models and after incremental adjustments for case-mix, diet, serum phosphorus, malnutrition-inflammation complex syndrome, and inflammatory markers. The HR of the highest (compared with lowest) dietary phosphorus intake tertile in the fully adjusted model was 2.37. Across categories of dietary phosphorus to protein ratios of <12, 12 to <14, 14 to <16, and >16 mg/g, death HRs were 1.13, 1.00 (reference value), 1.80, and 1.99, respectively. Cubic spline models of the survival analyses showed similar incremental associations.Conclusions: Higher dietary phosphorus intake and higher dietary phosphorus to protein ratios are each associated with increased death risk in MHD patients, even after adjustments for serum phosphorus, phosphate binders and their types, and dietary protein, energy, and potassium intakes.

show abstract

“…Nineteen studies met the inclusion criteria [4,5,7,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25]. Three studies were excluded because the vascular access event rates were not reported [26,27] or because of missing demographic data [28].…”

Section: Resultsmentioning

confidence: 99%

Vascular Access Vulnerability in Intensive Hemodialysis: A Significant Achilles' Heel?

Cornelis¹,

Usvyat

Tordoir

et al. 2014

Blood Purif

View full text Add to dashboard Cite

Background: Frequent hemodialysis (HD) may be associated with an increased risk of vascular access complications. Studies addressing vascular access outcomes in frequent HD show conflicting results. Methods: We searched Medline for trials looking at vascular access outcomes in frequent HD. Results: Nineteen studies met the inclusion criteria; only studies with a control group were included for analysis (n = 15). The vascular access event rate was higher in intensive HD as compared to conventional HD (difference of 6.7 events per 100 patient-years, p = 0.009). Overall event rates were not significantly different between conventional and intensive HD when stratified for access type, but were notably higher in the arteriovenous grafts and catheter group as compared to the arteriovenous fistula (AVF) group. Conclusion: Intensive HD is associated with an increased risk of vascular access complications. Overall reported event rates were lower in the AVF group. Further controlled studies should investigate whether a ‘fistula first' strategy may be recommended also for intensive HD.

show abstract

A One-Year Trial of In-Center Daily Hemodialysis with an Emphasis on Quality of Life

Cited by 36 publications

References 21 publications

Chronic Hemodialysis Therapy in the West

Chronic Hemodialysis Therapy in the West

Association of Dietary Phosphorus Intake and Phosphorus to Protein Ratio with Mortality in Hemodialysis Patients

Vascular Access Vulnerability in Intensive Hemodialysis: A Significant Achilles' Heel?

Contact Info

Product

Resources

About