Establishing a Home Nocturnal Hemodialysis Program: “Starting From Scratch”

Abstract

Atherosclerotic lesion of coronary artery frequently accompanies intimal hyperplasia of radial artery. We have reported that the lesion of radial artery (intimal hyperplasia) in hemodialysis (HD) patients is associated with early access failure (EAF) as well as ischemic heart disease (IHD) (Am J Kidney Dis. 2003; 41: 422-428). Objective: This study was designed to determine the impact of IHD on the EAF in nondiabetic HD patients. Methods: This study enrolled 125 nondiabetic HD patients who received radiocephalic arteriovenous fistula operation for the first time. We evaluated IHD before the operation through clinical symptoms and electrocardiography and then investigated EAF within 1 year after the operation. We analyzed the access patency rates between the patients with and without IHD, using Kaplan-Meier method and log-rank test. Multiple regression analysis was performed to identify independent risk factors of the EAF. Results: The mean age of the patients was 48 AE 14 years, and the number of females was 54 (43.2%). Of the total 125 patients, 19 patients (15.4%) had IHD before the operation. The EAF developed in 23 patients (18.4%) within 1 years after the operation. The access patency rate in the patients with IHD was lower than that in the patients without IHD (39.7 vs. 88.3%, p < 0.001). IHD and old age were independent risk factors of the EAF in nondiabetic HD patients. But sex, smoking history, hypertension, and the levels of hemoglobin, serum creatinine, albumin, and total cholesterol checked before the operation were not associated with the EAF. Conclusion: This study suggests that IHD is closely associated with EAF in nondiabetic HD patients. Dialysis Staff Time and SupplyCost for the LifeSite System vs. Hemodialysis Catheters D. Shore, S. Vega. West Palm Dialysis --Preferred Medical Group, West Palm Beach, FL, U.S.A.The LifeSite System is a new subcutaneous vascular access option for hemodialysis patients. As the procedure for accessing the Life-Site differs from hemodialysis catheters, we prospectively studied the differences in time required to initiate and discontinue treatments for LifeSite patients compared to patients with hemodialysis catheters. We also collected data on the cost of supplies and the number of alarms during dialysis for both groups. 5 LifeSite and 5 catheter patients were chosen at random for participation in the study. The time required for the ON and OFF procedures was recorded for 3 consecutive dialysis sessions for each patient for a total of 15 observations/group. The average staff time required per session for supply preparation, ON/OFF procedure, dressing changes, and responding to alarms was 15.9 min for the LifeSite and 16.9 min for catheters. Catheter patients experienced 4.5Background: Hemodialysis is often complicated by cardiovascular instability (CVI). We studied factors contributing to