Long, Slow Dialysis

Charra, Bernard; Chazot, Charles; Jean, G.; Laurent, Guy

doi:10.1159/000057480

Cited by 46 publications

(50 citation statements)

References 15 publications

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“…As a consequence, adequate hemodialysis with a low ultrafiltration rate should be the preferable treatment. This is also in accordance with the good results in terms of morbidity and mortality rates obtained by long, slow hemodialysis with gentle ultrafiltration [23]. More attention should be given to the reduction of thirst [24] and dietary sodium intake in patients with high interdialytic body weight gain, especially when they suffer from cardiac diseases or diabetes [20].…”

Section: Discussionsupporting

confidence: 80%

Changes in Heart Rate Variability in Chronic Uremic Patients during Ultrafiltration and Hemodialysis

Galetta

Cupisti²,

Franzoni³

et al. 2001

Blood Purif

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Background: The analysis of heart rate variability (HRV) is a useful tool to evaluate cardiac autonomic modulation, which is frequently impaired in chronic uremia. Aims: The aim of this study was to evaluate HRV in chronic uremics and to separately investigate the acute changes induced by volume depletion and solute removal during a hemodialysis session. Methods: Fourteen uremic patients (8 males and 6 females, aged 50 ± 15 years) on maintenance hemodialysis and 14 sex- and age-matched healthy controls were studied. Both groups underwent ambulatory electrocardiogram monitoring to evaluate the HRV time and frequency domain indices. The hemodialysis session was performed by 1 h of high-rate isolated ultrafiltration followed by 3 h of bicarbonate diffusive procedure. Results: In uremic patients, the overall variability in the frequency [low-frequency power (LF): 505 ± 473, vs. 1,446 ± 654; high-frequency power (HF): 133 ± 162 vs. 512 ± 417; p < 0.001] and time domain indices (standard deviation of normal R-R intervals: 101.9 ± 33.3 vs. 181.7 ± 44.1 ms; p < 0.001) was markedly reduced compared to controls, whereas mean heart rate (83 ± 12.4 vs. 60.9 ± 8.8 bpm; p < 0.001) and LF/HF ratio (5.8 ± 3.5 vs. 2.2 ± 0.8; p < 0.001) were increased. Isolated ultrafiltration produced a marked further decrease in HRV indices, but the subsequent diffusive hemodialysis procedure, with a low ultrafiltration rate, made HRV increase again. Conclusions: Chronic uremics showed abnormal autonomic modulation with sympathetic-vagal imbalance. The unbalanced hypersympathetic response to body fluid depletion is related to the ultrafiltration rate. Low interdialytic weight gain and a low ultrafiltration rate, associated with adequate hemodialysis, should be the preferable strategy for uremic patients with autonomic dysfunction.

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Section: Discussionsupporting

confidence: 80%

Changes in Heart Rate Variability in Chronic Uremic Patients during Ultrafiltration and Hemodialysis

Galetta

Cupisti²,

Franzoni³

et al. 2001

Blood Purif

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“…In spite of a single death in 247 months of experience (4.8 events/year/100 patients), confirmation of the excellent survival results obtained by other groups [1,2] is impossible in view of the nonrandomized patient selection and our limited experience.…”

Section: Discussionmentioning

confidence: 76%

“…These disadvantages and the excellent survival and rehabilitation results reported with long dialysis time [1][2][3] led us to set up a long nocturnal dialysis (LND) schedule. This paper analyzes our experience and assesses the role of LND among the different treatment options for end-stage renal disease.…”

Section: Introductionmentioning

confidence: 99%

Long Nocturnal Dialysis

Alloatti¹,

Molino²,

Mañes³

et al. 2002

Blood Purif

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Background/Aims: The continuous growth of the dialysis pool in our unit induced us to organize a third long nocturnal dialysis (LND) session, considering the excellent survival and rehabilitation results reported with this method. This paper analyzes the results and assesses the role of LND among the different dialytic treatment options. Methods: Out of 18 patients on LND, 13 (12 males and 1 female, mean age 52 ± 13 years, time on dialysis 21.8 ± 23.8 months) with >6 months’ experience were studied, and 9 underwent a further metabolic evaluation. LND was performed using 1- to 1.4-m² Hemophan membranes, bicarbonate buffer, 200–250 ml/min blood flow, and 300–500 ml/min dialysate flow, 8 h three times a week. Kt/V and protein catabolic rate (3-point classic urea kinetics), postdialytic weight, serum albumin, total protein, hemoglobin, Ca²⁺, phosphate, intact parathyroid hormone, bioimpedance body water, blood pressure, and drug use (antihypertensives, phosphate binders, erythropoietin, vitamin D, hypnotics) were evaluated in each patient during hemodialysis and LND. In the metabolic study (done twice), sodium (compared with the Kimura model), potassium, phosphate, and urea were analyzed in blood and inlet and outlet dialysate after 0, 2, 4, 6, and 8 h. Results: The mortality was low (1 death every 247 patient-months). After 19 ± 8.1 months of LND, the postdialytic weight rose from 68.5 ± 9.6 to 70.8 ± 10.7 kg (p ≤ 0.01), and the hemoglobin concentration rose from 10.8 ± 2.2 to 11.8 ± 1.8 g/dl (p ≤ 0.05); phosphate dropped from 5.6 ± 2.0 to 4.4 ± 1.3 mg/ dl (p ≤ 0.01) and the systolic blood pressure from 152 ± 15 to 143 ± 19 mm Hg (p ≤ 0.05). In the metabolic study, the sodium profile was significantly lower during the last 4 h than in the Kimura model. The potassium concentration, stable between 4 and 6 h, rose against the gradient during the last 2-hour period. The behavior of sodium and potassium during the last part of the dialysis session can be taken to indicate exhaustion of the sodium/potassium pump. Phosphate showed a gradual reduction with no intradialytic and only a moderate postdialytic rebound. The postdialytic urea rebound was 23.4%. Conclusions: LND is a useful additional tool for nephrologists in treating chronic renal failure, it is easy to organize, and it shows overall good results. Together with other dialysis methods, this schedule permits individualized treatment for each uremic patient.

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“…Using their ‘probing for dry weight' concept in combination with dietary salt restriction in a stringent way permits as many as 90% of HD patients to be maintained without antihypertensive medication [22]. Excellent survival results are also associated with this practice, not only in patients on ‘long, slow dialysis' [23], but also when strict volume control is applied with conventional dialysis times [24]. …”

Section: Extracellular Volume Expansion and The Dry Weight Conceptmentioning

confidence: 99%

Significance of Interdialytic Weight Gain versus Chronic Volume Overload: Consensus Opinion

et al. 2013

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Predialysis volume overload is the sum of interdialytic weight gain (IDWG) and residual postdialysis volume overload. It results mostly from failure to achieve an adequate volume status at the end of the dialysis session. Recent developments in bioimpedance spectroscopy and possibly relative plasma volume monitoring permit noninvasive volume status assessment in hemodialysis patients. A large proportion of patients have previously been shown to be chronically volume overloaded predialysis (defined as >15% above ‘normal' extracellular fluid volume, equivalent to >2.5 liters on average), and to exhibit a more than twofold increased mortality risk. By contrast, the magnitude of the mortality risk associated with IDWG is much smaller and only evident with very large weight gains. Here we review the available evidence on volume overload and IDWG, and question the use of IDWG as an indicator of ‘nonadherence' by describing its association with postdialysis volume depletion. We also demonstrate the relationship between IDWG, volume overload and predialysis serum sodium concentration, and comment on salt intake. Discriminating between volume overload and IDWG will likely lead to a more appropriate management of fluid withdrawal during dialysis. Consensually, the present authors agree that this discrimination should be among the primary goals for dialysis caretakers today. In consequence, we recommend objective measures of volume status beyond mere evaluations of IDWG.

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Long, Slow Dialysis

Cited by 46 publications

References 15 publications

Changes in Heart Rate Variability in Chronic Uremic Patients during Ultrafiltration and Hemodialysis

Changes in Heart Rate Variability in Chronic Uremic Patients during Ultrafiltration and Hemodialysis

Long Nocturnal Dialysis

Significance of Interdialytic Weight Gain versus Chronic Volume Overload: Consensus Opinion

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