Six years' experience with short daily hemodialysis: Do the early improvements persist in the mid and long term?

Traeger, J; Galland, Roula; Delawari, Ehsan; Arkouche, Walid; Hadden, R.

doi:10.1111/j.1492-7535.2004.01089.x

Cited by 38 publications

(47 citation statements)

References 14 publications

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“…Health-related quality of life improved in some studies but not in others. Improvements were seen in hematocrit, hemoglobin, or erythropoietin dose in 7 of 11 studies (14,16,17,22,24,29,31). Albumin increased in 5 of 10 studies (11,16,18,22,29).…”

Section: Outcomes With Dhdmentioning

confidence: 97%

“…Decreases in systolic or mean arterial BP were reported in 10 of 11 studies (10,14,16,17,(22)(23)(24)27,29,31), whereas six of eight studies found no statistically significant change in phosphate or phosphate binder dose with DHD at 3 to 24 mo of follow-up (12,14,16,24,26,27). Health-related quality of life improved in some studies but not in others.…”

Section: Outcomes With Dhdmentioning

confidence: 97%

“…Six cohorts enrolled only patients who were "medically stable" or able to undergo home or out-of-hospital HD (7,15,21,24,27,31), whereas five cohorts also included patients with a specific medical indication for DHD, such as uncontrolled hypertension, intradialytic hypotension on conventional HD, malnutrition, etc. (14,16,17,19,24). One cohort was selected solely on the basis of medical indication (23), and indications were not specified for one cohort (22).…”

Section: Patient and Treatment Characteristicsmentioning

confidence: 99%

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Daily Hemodialysis

Suri

Nesrallah

Mainra

et al. 2006

Clinical Journal of the American Society of Nephrology

172

145

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Several studies have reported improved outcomes with daily hemodialysis (DHD), but the strength of this evidence has not been evaluated. The published evidence on DHD was synthesized and its quality rated to inform need and sample size calculations for a randomized trial. Citations were identified in MEDLINE and EMBASE using validated search strategies. Dialysis journals that were not indexed and bibliographies of relevant articles were hand-searched. Two authors reviewed all citations. Articles that reported original data on five or more adults who were receiving DHD (1.5 to 3 h, 5 to 7 d/wk) for >3 mo were included. Twenty-five articles reporting 14 unique populations with 268 patients (five to 72 per study) met inclusion criteria. Of the 14 cohorts, 13 were studied with an observational design, 10 were studied prospectively, and four had parallel control groups. Mean age ranged form 41 to 64 yr, mean time on dialysis was 2 to 11 yr, 0 to 28% of patients had diabetes, >90% had arteriovenous fistulae, and >50% were dialyzed at home. Most data were described at <12 mo of follow-up. Outcomes included quality of life, cardiovascular disease, erythropoiesis, nutritional status, hospitalizations, and vascular access failures. Reporting was too heterogeneous to allow pooling of data. Ten of 11 studies suggested improvements in blood pressure; findings for other outcomes varied. Discontinuation of DHD occurred in 0 to 57% in-center and 0 to 15% home patients. Studies of DHD are limited by small sample size, nonideal control groups, selection and dropout biases, and paucity of data on potential risks. Randomized trials with adequate statistical power are required to establish the efficacy and the safety of DHD.

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Section: Outcomes With Dhdmentioning

confidence: 97%

Section: Outcomes With Dhdmentioning

confidence: 97%

Section: Patient and Treatment Characteristicsmentioning

confidence: 99%

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Daily Hemodialysis

Suri

Nesrallah

Mainra

et al. 2006

Clinical Journal of the American Society of Nephrology

172

145

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“…[2][3][4] In recent years, several hemodialysis centers in the United States, Canada, and Europe have explored strategies of more frequent hemodialysis in selected patients. Published reports on frequent he-modialysis (five or six times per week with variable session lengths) have suggested improvements in health-related quality of life, [5][6][7] along with other benefits that might be expected to enhance survival, including a reduction in left ventricular hypertrophy 8,9 ; correction of sleep apnea 10 ; and improved control of hypertension, mineral metabolism, endocrine abnormalities, and anemia. 11,12 These observations have been criticized on the basis of the selection of study subjects and the unblinded assessment of outcomes, some of which are highly subjective, although published (and unpublished) reports were compelling enough to prompt the National Institutes of Health and the Centers for Medicare and Medicaid Services to sponsor two randomized clinical trials comparing frequent (in-center and home nocturnal) and conventional hemodialysis (http://www.clinicaltrials.gov/ct/show/NCT00271999).…”

mentioning

confidence: 99%

Cost-Effectiveness of Frequent In-Center Hemodialysis

Lee¹,

Zenios²,

Chertow³

2008

Journal of the American Society of Nephrology

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Published evidence suggests that frequent hemodialysis (more than three times per week) for patients with ESRD may improve health-related quality of life and has the potential to increase longevity and reduce hospitalization and other complications. Here, a Monte Carlo simulation model was used to compare varying combinations of in-center hemodialysis frequency (three to six treatments per week) and session length (2 to 4.5 h per session) with regard to unadjusted and quality-adjusted life-years and total lifetime costs for a cohort of 200,000 patients, representing the prevalent ESRD population. The incremental cost-effectiveness ratio was calculated for the various regimens relative to a conventional hemodialysis regimen (three treatments per week, 3.5 h per session). Using conservative assumptions of the potential effects of more frequent hemodialysis on outcomes, most strategies achieved a costeffectiveness ratio of Ͻ$125,000, although all had a cost-effectiveness ratio of Ͼ$75,000. The costeffectiveness ratio increased with the frequency of hemodialysis. More frequent in-center hemodialysis strategies could become cost-neutral if the cost per hemodialysis session could be reduced by 32 to 43%. No other change in model assumptions achieved cost neutrality. In conclusion, given the extraordinarily high costs of the ESRD program, the viability of more frequent hemodialysis strategies depends on significant improvements in the economic model underlying the delivery of hemodialysis.

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“…Observational studies of frequent dialysis have shown salutary effects on BP (8)(9)(10)(11) and LV mass index (12)(13)(14)(15) and impressive survival rates (8,16). Moreover, LV hypertrophy has regressed in patients with ESRD who have baseline LV hypertrophy when aggressive management of BP and anemia was added to a thrice-weekly dialysis regimen (17,18).…”

mentioning

confidence: 99%

The Effects of Frequent Hemodialysis on Left Ventricular Mass, Volumes, and Geometry

Mishra

Dubin

2013

Clinical Journal of the American Society of Nephrology

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Left ventricular (LV) remodeling is defined as ''the genomic expression resulting in molecular, cellular, and interstitial changes that are manifested clinically as changes in size, shape, and function of the heart after cardiac injury" (1). In ESRD, LV remodeling manifests features of both concentric and eccentric LV hypertrophy, resulting from enlarged LV volumes and increased LV wall thickness (2). As we discuss here, LV mass can change because of a change in LV wall thickness, LV cavity size, or both. Increased LV mass, increased LV end-diastolic volume (LVEDV), and changes in LV geometry (LV mass/LVEDV) are all associated with poor prognosis in these patients (3,4). The Frequent Hemodialysis Network (FHN) trial is the first large-scale randomized controlled trial of frequent daily and nocturnal dialysis versus conventional dialysis (5). FHN investigators previously demonstrated that, compared with conventional hemodialysis, frequent daily hemodialysis results in a significantly greater reduction in LV mass, as determined by cardiac magnetic resonance imaging (MRI) (6). In this issue of CJASN, this group reports that frequent daily dialysis resulted in greater reductions in LV and right ventricular (RV) volumes without significant changes in LV geometry (7). In addition, reductions in both LV mass and LVEDV with frequent dialysis were significantly correlated with reductions in predialysis systolic BP (6,7). Here we present a brief overview of the literature on the effects of dialysis on LV remodeling, discuss likely mechanisms underlying the findings of the current study, and reflect on implications for future investigation.Observational studies of frequent dialysis have shown salutary effects on BP (8-11) and LV mass index (12-15) and impressive survival rates (8,16). Moreover, LV hypertrophy has regressed in patients with ESRD who have baseline LV hypertrophy when aggressive management of BP and anemia was added to a thrice-weekly dialysis regimen (17,18). One such study shows that LV hypertrophy may regress without a change in relative wall thickness, another measure of LV geometry (18). In several studies, including the FHN trial, lowering BP was strongly associated with regression of LV hypertrophy (9,10,(12)(13)(14). Prior studies of frequent dialysis that evaluated LV size in addition to mass did not specifically address LV geometry (10,13).LV mass and volume are linked mathematically, physiologically, and empirically. Cardiac MRI is widely considered to be the gold standard for determining LV volume and mass, while M-mode echocardiography overestimates LV mass in patients with ESRD undergoing hemodialysis because of its geometric assumptions (19). In cardiac MRI, LV mass is calculated as myocardial volume multiplied by the specific density of the myocardium (20). Myocardial volume, in turn, is the difference between the enddiastolic epicardial volume and end-diastolic endocardial volume, excluding the papillary muscles (LVEDV). Thus, while MRI-determined LV mass is free of geometric assumptions, it ...

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Six years' experience with short daily hemodialysis: Do the early improvements persist in the mid and long term?

Cited by 38 publications

References 14 publications

Daily Hemodialysis

Daily Hemodialysis

Cost-Effectiveness of Frequent In-Center Hemodialysis

The Effects of Frequent Hemodialysis on Left Ventricular Mass, Volumes, and Geometry

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