Vascular access survival and morbidity on daily dialysis: a comparative analysis of home and limited care haemodialysis

Piccoli, Giorgina Barbara; Bermond, Francesca; Mezza, Elisabetta; Burdese, Manuel; Fop, Fabrizio; Mangiarotti, G; Pacitti, A; Maffei, Stefano; Martina, G; Jeantet, A; Segoloni, Giuseppe; Piccoli, Giuseppe

doi:10.1093/ndt/gfh346

Cited by 25 publications

(22 citation statements)

References 15 publications

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“…Conversely, the improvements that were observed in some studies may have been exaggerated as a result of the use of nonideal control groups. Outcomes on DHD were compared with a concurrent control group for only four cohorts (7)(8)(9)(10)(11)(12)(13)21,(23)(24)(25), only one study of which used a randomized, crossover design (23). The rest were pre-post case series with analyses of changes in parameters from a baseline measurement on conventional HD to follow-up measurements after initiation of DHD.…”

Section: Discussionmentioning

confidence: 99%

“…In another cohort, there were decreased permanent access failures for arteriovenous fistulae, compared with patients who were on conventional HD (21). Conversely, the remaining five cohorts reported no statistically significant differences in vascular access dysfunction or permanent failures with DHD compared with conventional HD at a mean follow-up of 3 to 24 mo (7,14,17,25,29). There was a trend to increased access dysfunction for arteriovenous fistulae in two of these cohorts (7,14).…”

Section: Potential Risks Of Dhdmentioning

confidence: 91%

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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: Discussionmentioning

confidence: 99%

Section: Potential Risks Of Dhdmentioning

confidence: 91%

Daily Hemodialysis

Suri

Nesrallah

Mainra

et al. 2006

Clinical Journal of the American Society of Nephrology

172

145

View full text Add to dashboard Cite

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“…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

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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.

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“…Some hemodialysis machines cannot perform the single needle technique or are unacceptably loud when performing single-needle dialysis. Infectious and thrombotic access complications on intensified hemodialysis occur with a similar or slightly diminished frequency compared with conventional hemodialysis, but randomized controlled studies are missing [16,17].…”

Section: Blood Accessmentioning

confidence: 99%

Intensified hemodialysis regimens: neglected treatment options for children and adolescents

et al. 2008

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During recent years, the importance of intensified dialysis regimens has gathered increasing interest, especially after the Hemodialysis (HEMO) Study Group reported that a higher dose of thrice-weekly hemodialysis failed to improve clinical outcomes. Long nocturnal hemodialysis (three to six times per week) or short daily hemodialysis are the currently used forms of intensified dialysis. There is substantial evidence for cardiovascular and quality-of-life improvements as well as financial benefits with intensified hemodialysis. Preliminary experience with daily hemodialysis and hemodiafiltration in children has been reported. Given the continuing shortage of donor organs for kidney transplantation, the increasing incidence of end-stage renal disease (ESRD) and recognition of the deleterious effects of long-lasting ESRD, growth retardation, and poor social rehabilitation, more intensified dialysis regimens are a much-needed therapeutical option in both adults and children.

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Vascular access survival and morbidity on daily dialysis: a comparative analysis of home and limited care haemodialysis

Abstract: Although DHD did not appear as a risk factor for vascular access morbidity or failure at home or in a limited care centre setting, the setting of vascular access creation may influence its success.

Cited by 25 publications

References 15 publications

Daily Hemodialysis

Daily Hemodialysis

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

Intensified hemodialysis regimens: neglected treatment options for children and adolescents

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