Outcomes Associated with In-Center Nocturnal Hemodialysis from a Large Multicenter Program
Eduardo Lacson,Weiling Wang,Keith Lester,Norma J. Ofsthun,J. Michael Lazarus,Raymond M. Hakim +5 more
TLDR
Patients who were on INHD exhibited excellent quality indicators, with better survival and lower hospitalization rates, and the relative contributions of patient selection versus effect of therapy on outcomes remain to be elucidated in prospective clinical trials.Abstract:
Background and objectives: The objective of this study was to evaluate epidemiology and outcomes of a large in-center nocturnal hemodialysis (INHD) program.
Design, setting, participants, & measurements: This case-control study compared patients who were on thrice-weekly INHD from 56 Fresenius Medical Care, North America facilities with conventional hemodialysis patients from 244 facilities within the surrounding geographic area. All INHD cases and conventional hemodialysis control subjects who were active as of January 1, 2007, were followed until December 31, 2007, for evaluation of mortality and hospitalization.
Results: As of January 1, 2007, 655 patients had been on INHD for 51 ± 73 d. Patients were younger, there were more male and black patients, and vintage was longer, but they had less diabetes compared with 15,334 control subjects. Unadjusted hazard ratio was 0.59 for mortality and 0.76 for hospitalization. After adjustment for case mix and access type, only hospitalization remained significant. Fewer INHD patients were hospitalized (48 versus 59%) with a normalized rate of 9.6 versus 13.5 hospital days per patient-year. INHD patients had greater interdialytic weight gains but lower BP. At baseline, hemoglobin values were similar, whereas albumin and phosphorus values favored INHD. Mean equilibrated Kt/V was higher in INHD patients related to longer treatment time, despite lower blood and dialysate flow rates.
Conclusions: Patients who were on INHD exhibited excellent quality indicators, with better survival and lower hospitalization rates. The relative contributions of patient selection versus effect of therapy on outcomes remain to be elucidated in prospective clinical trials.read more
Citations
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Journal ArticleDOI
Home Hemodialysis and Mortality Risk in Australian and New Zealand Populations
Mark R. Marshall,Carmel M. Hawley,Peter G. Kerr,Kevan R. Polkinghorne,Roger Marshall,John W M Agar,John W M Agar,Stephen P. McDonald,Stephen P. McDonald +8 more
TL;DR: There is an emerging HD dose-effect in Australia and New Zealand, with lower mortality risks associated with some of the more intensive HD regimens in these countries.
Journal ArticleDOI
Intensive Hemodialysis Associates with Improved Survival Compared with Conventional Hemodialysis
Gihad Nesrallah,Robert M. Lindsay,Meaghan S. Cuerden,Amit X. Garg,Amit X. Garg,Friedrich K. Port,Peter C. Austin,Louise Moist,Andreas Pierratos,Christopher T. Chan,Deborah Zimmerman,Robert S. Lockridge,Cécile Couchoud,Charles Chazot,Norma J. Ofsthun,Adeera Levin,Michael Copland,Mark Courtney,Andrew W. Steele,Philip A. McFarlane,Denis F. Geary,Robert P. Pauly,Paul Komenda,Rita S. Suri +23 more
TL;DR: There is a strong association between intensive home hemodialysis and improved survival, but whether this relationship is causal remains unknown.
Journal ArticleDOI
Survival with Three-Times Weekly In-Center Nocturnal Versus Conventional Hemodialysis
Eduardo Lacson,Jianglin Xu,Rita S. Suri,Gihad Nesrallah,Robert M. Lindsay,Amit X. Garg,Keith Lester,Norma J. Ofsthun,Michael Lazarus,Raymond M. Hakim +9 more
TL;DR: Conversion to treatment with nocturnal hemodialysis associates with favorable clinical features, laboratory biomarkers, and improved survival compared with propensity score-matched controls, notwithstanding the possibility of residual selection bias.
Journal ArticleDOI
Comparison of 4- and 8-h dialysis sessions in thrice-weekly in-centre haemodialysis: A prospective, case-controlled study
Ercan Ok,Soner Duman,Gulay Asci,Murat Tumuklu,Özen Önen Sertöz,Meral Kayıkçıoğlu,Huseyin Toz,Siddik Momin Adam,Mümtaz Yilmaz,Halil Zeki Tonbul,Mehmet Ozkahya +10 more
TL;DR: In this paper, the authors compared the clinical and laboratory outcomes of 8-and 4-h thrice-weekly HD patients and found that the NHD treatment was associated with a 72% risk reduction for overall mortality compared to the CHD treatment.
Journal ArticleDOI
Effect of Lowering Dialysate Sodium Concentration on Interdialytic Weight Gain and Blood Pressure in Patients Undergoing Thrice-Weekly In-center Nocturnal Hemodialysis: A Quality Improvement Study
TL;DR: Prolonged exposure to higher than required dialysate sodium concentrations may drive IDWG and counteract some of the purported benefits of "go-slow" (longer session length) hemodialysis.
References
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Control of serum phosphate without any phosphate binders in patients treated with nocturnal hemodialysis
Istvan Mucsi,Gavril Hercz,Robert Uldall,Michaelene Ouwendyk,Robert Francoeur,Andreas Pierratos +5 more
TL;DR: NHD is more effective in controlling serum phosphate levels than CHD, allowing patients to discontinue their phosphate binders completely and to ingest a more liberal diet.
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The Intensity of Hemodialysis and the Response to Erythropoietin in Patients with End-Stage Renal Disease
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TL;DR: The Frequent Hemodialysis Network Trials Group is conducting two multicenter randomized trials of 250 subjects each, comparing conventional three times weekly HD with (1) in-center daily HD and (2) home nocturnal HD, during which feasibility of randomization, ability to deliver the interventions, and adherence will be evaluated.
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