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
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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.
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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
More filters
Journal ArticleDOI
Potential Impact of Nutritional Intervention on End-Stage Renal Disease Hospitalization, Death, and Treatment Costs
TL;DR: Nutritional interventions that increase serum albumin by > or = 0.2 g/dL (e.g., via oral nutritional supplements) may lead to considerable improvements in mortality, hospitalization, and treatment costs.
Journal ArticleDOI
Confounding effect of comorbidity in survival studies in patients on renal replacement therapy
Jeannette G. van Manen,Paul C. W. van Dijk,Vianda S. Stel,Friedo W. Dekker,Montse Clèries,Ferruccio Conte,Terry Feest,Reinhard Kramar,Torbjørn Leivestad,J. Douglas Briggs,Bénédicte Stengel,Kitty J. Jager +11 more
TL;DR: Comorbidity is an important predictor for mortality, however, after adjustment for age, gender, primary renal disease, treatment modality and country, when comparing outcomes between patient groups the influence of comorbidities may be less important than expected.
Journal ArticleDOI
In-center Nocturnal Hemodialysis: Another Option in the Management of Chronic Kidney Disease
Ann Bugeja,Niki Dacouris,Alison Thomas,Rosa M. Marticorena,Philip A. McFarlane,Sandra Donnelly,Marc Goldstein +6 more
TL;DR: Overall, quality of life, sleep, intradialytic cramps, appetite, and energy level all improved significantly on INHD, which offers an effective form of HD for long-term dialysis patients who are unable to perform home HD.
Journal ArticleDOI
Patient preferences for in-center intense hemodialysis.
Nirupama Ramkumar,Srinivasan Beddhu,Srinivasan Beddhu,Paul W. Eggers,Lisa Pappas,Alfred K. Cheung,Alfred K. Cheung +6 more
TL;DR: Most patients would undergo DHD for symptomatic or survival benefits, but not ND3 or ND6, and success of DHD program would depend on arrangements for transportation to dialysis unit.
Journal ArticleDOI
Daily and nocturnal hemodialysis: how do they stack up?
Eduardo Lacson,Jose A. Diaz-Buxo +1 more
TL;DR: To reach a level of evidence that will be widely acceptable, the renal community needs to partner with such government institutions as the National Institutes of Health and the Health Care Financing Administration to study systematically the outcomes and costs associated with using more frequent hemodialysis.
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