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
More Dialysis Has Not Proven Much Better.
TL;DR: Patients maintained on standard three times weekly hemodialysis have a high mortality rate and a limited quality of life, and it is natural to suppose that their health could be improved by increasing the intensity of dialysis treatment, but evidence that such improvement can be obtained is generally lacking.
Journal ArticleDOI
Evaluating the clinical experience of a regional in-center nocturnal hemodialysis program: The patient and staff perspective.
Katherine L. Hull,Katherine L. Hull,Niamh Quann,Suzanne Glover,Coral Wimbury,Darren R Churchward,Darren R Churchward,Warren Pickering,Rob Preston,Richard J. Baines,Matthew P M Graham-Brown,Matthew P M Graham-Brown,James O. Burton,James O. Burton,James O. Burton +14 more
TL;DR: In-center nocturnal hemodialysis (INHD) has been shown to be beneficial in observational studies as mentioned in this paper, and patients continue with INHD due to increased social time and perceived health benefits.
Journal ArticleDOI
Investigating the effects of 6 months extended duration, in-centre nocturnal versus conventional haemodialysis treatment: a non-randomised, controlled feasibility study.
Darren R Churchward,Matthew P M Graham-Brown,Matthew P M Graham-Brown,Robert Preston,Warren Pickering,Gerry P McCann,James O. Burton,James O. Burton +7 more
TL;DR: This feasibility study aims to gather sufficient data on numerous outcome measures to inform the design of a multicentre randomised controlled trial that will establish the potential benefits of INHD and increase the availability of this service nationally and internationally.
References
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Effect of Dialysis Dose and Membrane Flux in Maintenance Hemodialysis
Garabed Eknoyan,Gerald J. Beck,Alfred K. Cheung,John T. Daugirdas,Tom Greene,John W. Kusek,Michael Allon,James L. Bailey,James A. Delmez,Thomas A. Depner,Johanna T. Dwyer,Andrew S. Levey,Nathan W. Levin,Edgar L. Milford,Daniel B. Ornt,Michael V. Rocco,Gerald Schulman,Steve J. Schwab,Brendan P. Teehan,Robert D. Toto +19 more
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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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Rita S. Suri,Amit X. Garg,Glenn M. Chertow,Nathan W. Levin,Michael V. Rocco,Tom Greene,Gerald J. Beck,Jennifer J. Gassman,Paul W. Eggers,Robert A. Star,Daniel B. Ornt,Alan S Kliger +11 more
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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