Survival with Three-Times Weekly In-Center Nocturnal Versus Conventional Hemodialysis
Citations
722 citations
Cites background from "Survival with Three-Times Weekly In..."
...The Work Group also recognizes that cost or staffing considerations may affect the ability of an individual dialysis center to provide in-center short frequent HD. Finally, these recommendations do not apply to short home HD therapies or to dialysis prescriptions that are substantially dissimilar (eg, slow dialysate flow rates) to the FHN Daily Study prescriptions....
[...]
...This study’s findings were refuted by the same authors some years later with a newer analysis showing that all types of kidney transplantation had superior survival compared to home long frequent HD.121 Preliminary data from extended follow-up of participants in the FHN Nocturnal Trial showed no survival benefit, and possibly an increase in mortality with home long frequent HD.116 It is difficult to interpret these mortality data given the high nonadherence rate with home long frequent treatment, as well as the large percentage of crossovers in both arms after the main trial ended.116 Additional data on causes of death and hospitalization in this extended follow-up period have not yet been reported....
[...]
...Mean differences in these variables (frequent minus conventional groups) were: 213.8 g, 10.1 mm Hg, 20.64 medications per day, 20.46 mg/dL, and 21.35 g equivalent phosphate-binder doses per day).9,99,100 On the other hand, there were no improvements in serum albumin levels,101 cognitive function as measured by the Trailmaking Test Part B,102 depression as measured by the Beck Depression Inventory, mental health as measured by the mental health composite of the RAND,103 or objective measures of physical performance.104 Hemoglobin levels decreased by a mean of 0.29 mg/dL in the conventional group compared to a stable hemoglobin level in the more frequent group (P 5 0.03), while there was no difference in doses of erythropoiesis-stimulating agents (ESAs).105 The FHN Daily Trial also identified certain risks associated with in-center short frequent HD. Compared with patients receiving conventional HD, 904 patients randomized to in-center short frequent HD had a statistically significant increased risk of vascular access repairs (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.13-2.51; P 5 0.01), primarily driven by increased vascular access repairs in the subgroup of patients with AV accesses at baseline.106 All types of repairs appeared to be more prevalent with frequent compared to conventional HD, including angioplasties, thrombectomies, and surgical revisions....
[...]
...To date, just 1 randomized trial of short frequent HD has been completed.9 The Work Group is unaware of any randomized trials of home short frequent HD and thus the group developed guideline statements only for in-center short frequent HD....
[...]
...The Work Group for the KDIGO Controversies Conference on “Novel Techniques and Innovation in Blood Purification” noted that there is no uniform nomenclature to describe the different types of intensive or more frequent HD.91 Given the multitude of terms in the literature (eg, daily, nocturnal, short daily, daily nocturnal, quotidian, frequent, and intensive), it is often difficult to identify studies evaluating similar HD prescriptions....
[...]
181 citations
125 citations
Cites background from "Survival with Three-Times Weekly In..."
...Despite considerable amounts of healthcare budgets spent on renal replacement therapy [3,4], mortality of dialysis patients remains high [5,6] and their overall health related quality of life low [7]....
[...]
106 citations
81 citations
References
1,670 citations
"Survival with Three-Times Weekly In..." refers background or methods in this paper
...using two-sided t tests in two ways: (1) changes relative to the baseline...
[...]
...Among these patients, 435 (60%) contributed data to all three distinct time periods: (1) 90-day baseline on CHD before conversion to INHD, (2) during the first 90 days of INHD, and (3) during the period from 91 to 180 days on INHD....
[...]
...(1) We modified patient inclusion criteria as solely based on initial (i....
[...]
878 citations
"Survival with Three-Times Weekly In..." refers background in this paper
...Among these patients, 435 (60%) contributed data to all three distinct time periods: (1) 90-day baseline on CHD before conversion to INHD, (2) during the first 90 days of INHD, and (3) during the period from 91 to 180 days on INHD....
[...]
866 citations
490 citations
391 citations