Outcomes Associated with In-Center Nocturnal Hemodialysis from a Large Multicenter Program
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...Observational studies demonstrate that various forms of extended haemodialysis are associated with a range of improved biochemical and clinical outcomes [Lacson et al. 2010; van Eps et al. 2010; Walsh et al. 2005; Innes et al. 1999]....
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...However, it is widely recognized that patients who opt for such treatments have characteristics associated with better prognosis such that better outcomes would be expected even in the absence of a treatment effect [Lacson et al. 2010; van Eps et al. 2010; Powell et al. 2009; Innes et al. 1999]....
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"Outcomes Associated with In-Center ..." refers background or result in this paper
...Patients (n % ) 655 (4) 15,334 (96) Age (yr; mean SD) 51....
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...While results from the Frequent Hemodialysis Network on two randomized trials that evaluated outcomes from short daily in-center and long nightly home dialysis are pending (4), two recent publications renewed interest in the potential impact of longer hemodialysis session length, also referred to as treatment time (TT), to improve survival within the most prevalent practice of a thrice-weekly regimen....
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...The growth of INHD therapy is remarkable considering the barriers to implementing INHD in the United States: (1) Criticism that historical outcome data were skewed by highly selected patients; (2) competitive “modality choice” because many patients who are eligible for INHD are often also eligible for home dialysis options; (3) logistical issues facing clinic managers from accommodating longer TT for patients in outpatient dialysis units that are filled to capacity; (4) the constant struggle to convince patients to stay longer for in-center treatments, even by just a few minutes; (5) local staffing issues as a result of a variable supply of dialysis nurses and patient care technicians who are willing to do a night shift; and (6) increased cost of providing therapy without additional reimbursement, becoming apparent when patient participation falls below critical mass....
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