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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Nocturnal, every-other-day, online haemodiafiltration: an effective therapeutic alternative
Francisco Maduell,Marta Arias,C.E. Durán,Manel Vera,Néstor Fontseré,Manel Azqueta,Nayra Rico,Nuria S. Pérez,Alexis Sentís,Montserrat Elena,Néstor Rodríguez,Carola Arcal,Bergadá E,Aleix Cases,José Luis Bedini,Josep M. Campistol +15 more
TL;DR: Nocturnal every-other-day OL-HDF could be an excellent therapeutic alternative since good tolerance and occupational rehabilitation, marked improvement in dialysis dose, nutritional status, LVH, phosphate and hypertension control and a substantial reduction in drug requirements were observed.
Journal ArticleDOI
Extended-hours hemodialysis is associated with lower mortality risk in patients with end-stage renal disease.
Matthew B. Rivara,Scott V. Adams,Scott V. Adams,Sooraj Kuttykrishnan,Kamyar Kalantar-Zadeh,Onyebuchi A. Arah,Alfred K. Cheung,Ronit Katz,Miklos Z. Molnar,Vanessa A. Ravel,Melissa Soohoo,Elani Streja,Jonathan Himmelfarb,Rajnish Mehrotra +13 more
TL;DR: In this large nationally representative cohort of patients initiating maintenance dialysis in the United States, treatment with extended-hours hemodialysis was associated with a lower risk for mortality compared to treatment with conventional in-center therapy.
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Effect of a sustained difference in hemodialytic clearance on the plasma levels of p-cresol sulfate and indoxyl sulfate.
Orlando Camacho,Maria Carmela Rosales,Tariq Shafi,Jonathan Fullman,Natalie S. Plummer,Timothy W. Meyer,Tammy L. Sirich +6 more
TL;DR: It is suggested that an increase in PCS generation prevents plasma levels from falling when the dialytic clearance is increased, and suppression of solute generation may be required to reduce plasma PCS levels in dialysis patients.
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Hemodialysis treatment time: a fresh perspective.
TL;DR: It is suggested that a new treatment paradigm should consider a minimum adequate dialysis treatment time of 4 hours for the majority of patients, with anything shorter becoming the exception rather than the rule.
Journal ArticleDOI
The Association Between Conversion to In-centre Nocturnal Hemodialysis and Left Ventricular Mass Regression in Patients With End-Stage Renal Disease
Ron Wald,Ron Wald,Marc Goldstein,Marc Goldstein,Jeffrey Perl,Jeffrey Perl,Mercedeh Kiaii,Darren A. Yuen,Darren A. Yuen,Rachel M. Wald,Ziv Harel,Ziv Harel,Jordan Weinstein,Jordan Weinstein,Baruch D. Jakubovic,Howard Leong-Poi,Anish Kirpalani,Jonathon Leipsic,Niki Dacouris,Myles Wolf,Andrew T. Yan,Andrew T. Yan +21 more
TL;DR: Compared with continuation of CHD, conversion to INHD was associated with significant LVM regression and reduction in serum phosphate concentration at 1 year, and there was a trend toward a larger drop in systolic blood pressure among INHD recipients.
References
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Journal ArticleDOI
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
TL;DR: Patients undergoing hemodialysis thrice weekly appear to have no major benefit from a higher dialysis dose than that recommended by current U.S. guidelines or from the use of a high-flux membrane.
Journal ArticleDOI
Longer treatment time and slower ultrafiltration in hemodialysis: associations with reduced mortality in the DOPPS.
Rajiv Saran,Jennifer L. Bragg-Gresham,Nathan W. Levin,Zbylut J. Twardowski,Volker Wizemann,Akira Saito,Naoki Kimata,Brenda W. Gillespie,Christian Combe,Jürgen Bommer,T. Akiba,Donna Mapes,Eric W. Young,Friedrich K. Port +13 more
TL;DR: Longer TT and higher Kt/V were independently as well as synergistically associated with lower mortality, and a randomized clinical trial of longer dialysis sessions in thrice-weekly HD is warranted.
Journal ArticleDOI
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.
Journal ArticleDOI
The Intensity of Hemodialysis and the Response to Erythropoietin in Patients with End-Stage Renal Disease
TL;DR: In patients with end-stage renal disease, inadequate hemodialysis is associated with a suboptimal response to erythropoietin therapy and increasing the intensity of dialysis in patients with anemia who are receiving inadequate dialysis results in a significant increase in the hematocrit.
Journal ArticleDOI
Frequent Hemodialysis Network (FHN) randomized trials: study design.
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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