Use of 3‐hour daily hemodialysis and paricalcitol in patients with severe secondary hyperparathyroidism: A case series

Severe hyperparathyroidism is a challenge on hemodialysis. The definition of dialysate calcium (Ca) is a pending issue with renewed importance in cases of individualized dialysis schedules and of portable home dialysis machines with low-flow dialysate. Direct measurement of calcium mass transfer is complex and is imprecisely reflected by differences in start-to-end of dialysis Ca levels. The study was performed in a dialysis unit dedicated to home hemodialysis and to critical patients with wide use of daily and tailored schedules. The Ca-phosphate (P)-parathyroid hormone (PTH) profile includes creatinine, urea, total and ionized Ca, albumin, sodium, potassium, P, PTH levels at start, mid, and end of dialysis. "Severe" secondary hyperparathyroidism was defined as PTH > 300 pg/mL for ≥3 months. Four schedules were tested: conventional dialysis (polysulfone dialyzer 1.8-2.1 m(2) ), with dialysate Ca 1.5 or 1.75 mmol/L, NxStage (Ca 1.5 mmol/L), and NxStage plus intradialytic Ca infusion. Dosages of vitamin D, calcium, phosphate binders, and Ca mimetic agents were adjusted monthly. Eighty Ca-P-PTH profiles were collected in 12 patients. Serum phosphate was efficiently reduced by all techniques. No differences in start-to-end PTH and Ca levels on dialysis were observed in patients with PTH levels < 300 pg/mL. Conversely, Ca levels in "severe" secondary hyperparathyroid patients significantly increased and PTH decreased during dialysis on all schedules except on Nxstage (P < 0.05). Our data support the need for tailored dialysate Ca content, even on "low-flow" daily home dialysis, in "severe" secondary hyperparathyroid patients in order to increase the therapeutic potentials of the new dialysis techniques.

Section: Introductionmentioning

confidence: 99%

Calcium‐phosphate and parathyroid intradialytic profiles: A potential aid for tailoring the dialysate calcium content of patients on different hemodialysis schedules

Ferraresi¹,

Pia²,

Guzzo³

et al. 2015

“…There has been increased interest in more frequent and intensive dialysis therapies as a means of improving these outcomes in the hope that this will reduce mortality among dialysis patients. Daily hemodialysis (DHD) has been associated with improved survival, nutrition, and mineral metabolism 10–20 . Improvements in quality of life have also been associated with DHD 21–25 .…”

Section: Introductionmentioning

confidence: 99%

“…Daily hemodialysis (DHD) has been associated with improved survival, nutrition, and mineral metabolism. [10][11][12][13][14][15][16][17][18][19][20] Improvements in quality of life have also been associated with DHD. [21][22][23][24][25] Cardiovascular benefits include improved blood pressure control, higher hemoglobin levels, and regression of left ventricular hypertrophy.…”

Section: Introductionmentioning

confidence: 99%

Long term reduction of cardiovascular risk factors associated with three hour daily dialysis: A prospective, cohort study

Achinger

Ayus

2023

Self Cite

Introduction: Daily hemodialysis (DHD) compared to conventional hemodialysis (CHD) leads to improvements in left ventricular hypertrophy and mineral metabolism at 1-year follow-up. However, there is no information from prospective studies on the long terms effects of DHD on these key cardiovascular risk factors.Methods: We conducted a 4 year, prospective cohort study of 26 DHD and 51 matched CHD patients on the effect of DHD (six sessions/week Â 3 h) versus CHD (three sessions/week Â 4 h), 15 DHD, and 26 CHD patients completed 4-years follow-up. Measures of left ventricular mass index (LVMI), blood pressures, hemoglobin, and mineral metabolism markers were performed. Results: Systolic and diastolic blood pressures were significantly lower in the DHD group than the CHD group at 4-year follow-up, 128 mmHg (95% CI, 111-143) versus 148 mmHg (95% CI, 137-158) (p < 0.05) and 60 mmHg (95% CI, 56-63) versus 71 mmHg (95% CI, 64-76) (p < 0.05). DHD was associated with fewer patients taking any anti-hypertensive drug therapy than CHD, 50% versus 80% (p < 0.05). DHD was associated with improved attainment of mineral metabolism goals for phosphorus (adjusted HR 3.6, p = 0.002) and calcium Â phosphorus product (adjusted HR 3.66, p = 0.001) at 4-years follow-up compared to CHD. At 4 years, there was a nonsignificant trend toward lower LVMI in the DHD than in the CHD group: 116 g/m 2 (95% CI, 97-136) versus 138 g/m 2 (95% CI, 115-172) (p = 0.23). Similarly, improvements in hemoglobin also persisted at 4 years follow-up. Conclusion: DHD is associated with long-term (4 year) improvements in key cardiovascular risk factors: blood pressure, mineral metabolism, and anemia with trends toward improved LVMI.

“…Daily hemodialysis has been associated with favorable surrogate markers of improved survival among hemodialysis patients. These outcomes include improvements in left ventricular mass index, chronic inflammation, nutritional markers and mineral metabolism markers . There is currently no study that directly addresses the impact of daily dialysis on vascular access outcomes over long‐term follow‐up.…”

Section: Introductionmentioning

confidence: 99%

“…These outcomes include improvements in left ventricular mass index, chronic inflammation, nutritional markers and mineral metabolism markers. [1][2][3][4][5] There is currently no study that directly addresses the impact of daily dialysis on vascular access outcomes over longterm follow-up. Previous observational and uncontrolled studies of daily hemodialysis have shown mixed results in regards to vascular access outcomes with the majority showing no difference in access outcomes [5][6][7][8][9] and some showing a trend toward improved access outcomes.…”

Section: Introductionmentioning

confidence: 99%

Long‐term effects of daily hemodialysis on vascular access outcomes: A prospective controlled study

Achinger

İkizler

Bian

et al. 2012

Self Cite

Background Daily hemodialysis has been associated with surrogate markers of improved survival among hemodialysis patients. A potential disadvantage of daily hemodialysis is that frequent vascular access cannulations may affect long term vascular access patency. Methods The study design was a four-year, non-randomized, contemporary control, prospective study of 77 subjects in either 3 hour daily hemodialysis (6 dialysis treatments weekly of 3 hours each; n = 26) or conventional dialysis (3 dialysis treatments weekly of 4 hours each; n = 51). Outcomes of interest were vascular access procedures (fistulagram, thrombectomy and access revision). Results Total access procedures (fistulagram, thrombectomy and access revision) were 543.2 (95%CI: 432.9, 673.0) per 1000 person-years in the conventional dialysis group versus 400.8 (95%CI: 270.2, 572.4) per 1000 person-years in the daily hemodialysis dialysis group (incidence rate ratio= 0.74 with 95%CI: from 0.40 to 1.36, P = 0.33), after adjusting for age, gender, diabetes status, serum phosphorus, hemoglobin level and erythropoietin dose, there was no significant differences in incidence rate of total access procedures (P value >0.05). There was no difference in time to first access revision between the daily dialysis and the conventional dialysis groups after adjustment for covariates (hazard ratio=0.99 95% CI: 0.42, 2.36, P = 0.96). Conclusions Daily hemodialysis is not associated with increased vascular access complications, or increased vascular access failure rates.