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home hemo dialysis

Theodore I Steinman
The mean age of the ESRD population continues to increase, with the 2011 USRDS Annual Data report noting it to be 62.6 years among a prevalent chronic dialysis population (both hemo- and peritoneal dialyses) of approximately 399,000. As with previous reports, the greatest growth rate per million population in the ESRD cohort occurs in age range >75 years. Entering the ESRD pool >75 years of age are about 5,000 patients/million population; in contrast, the number is about 2,100/million population that falls in the age range 45-65 years...
November 2012: Seminars in Dialysis
John B Stokes
The average life expectancy of a person on hemodialysis is less than 3 years and hasn't changed in 20 years. The Hemodialysis (HEMO) trial, a randomized trial to determine whether increasing urea removal to the maximum practical degree through a 3-times-a-week schedule, showed no difference in mortality in the treatment and control groups. Investigators speculated that the increment in functional waste removal in the HEMO study was too small to produce improvements in mortality. To test this hypothesis, the NIDDK funded the Frequent Hemodialysis Network, a consortium of centers testing whether patients randomized to intensive dialysis would demonstrate improved (reduced) left ventricular LV mass and quality of life...
2011: Transactions of the American Clinical and Climatological Association
Enric Vilar, Ken Farrington, Chris Bates, Carol Mumford, Roger Greenwood
Over the last 40 years the technical obstacles which prevented a convective contribution to diffusive dialysis have been overcome. Hemodiafiltration represents a natural evolution of intermittent extracorporeal blood purification and the technology is now available to offer this as standard treatment in-center. The first randomized control trial of dialysis dose (National Cooperative Dialysis Study) showed that for three times weekly dialysis a critical level of urea clearance was necessary to ensure complication-free survival, the effect being noticeable by 3 months...
2011: Contributions to Nephrology
Tom Greene, John T Daugirdas, Thomas A Depner, Frank Gotch, Martin Kuhlman
BACKGROUND: The Frequent Hemodialysis Network (FHN) is conducting 2 randomized clinical trials, a daytime in-center trial ("daily") comparing 6 versus 3 treatments/wk, and a home nocturnal trial comparing 6 nocturnal treatments versus 3 conventional treatments/wk. The goal of this study was to project separation between the treatment and control arms of these studies for measures of dialysis dose by using simulations based on 2-compartment variable-volume models. SETTING & PARTICIPANTS: Data from the most recent hemodialysis treatment in 100 patients dialyzed 3 times/wk at facilities of the Renal Research Institute in New York and from 2 data sets (n = 154 and 115 patients) from the Hemodialysis (HEMO) trial...
May 2009: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Micheal V Rocco
The National Institutes of Health (NIH) sponsored HEMO Study did not demonstrate that an increase in dialysis dose was associated with an improvement in patient mortality rates. Despite this negative result, there is ongoing interest in determining if still higher doses of dialysis may be of benefit to patients receiving chronic hemodialysis therapy. Testing this hypothesis requires the use of more fre-quent hemodialysis and/or a much longer duration for each dialysis session. "Short daily hemodialysis", actually six times per week hemodialysis for 1...
January 2009: Saudi Journal of Kidney Diseases and Transplantation
L Tartaglia, B Infante, G Stallone, P Cirillo, M Liuzzi, M Ktena, M Forcella, M Querques, R Perulli, D A Procaccini, L Gesualdo
The interest of investigators in intensified dialysis regimens has been growing in recent years, especially since the HEMO Study Group showed that a higher dose of thrice-weekly hemodialysis fails to reduce mortality and morbidity but improves clinical outcomes. Alternative hemodialysis strategies including short daily hemodialysis (SDHD), long hemodialysis (LHD) and nocturnal daily hemodialysis (NDHD) have been developed in the hope to improve patients' outcomes. A growing number of investigators are studying patients on alternative dialysis regimens and most publications in this field have reported significant improvements in clinical outcomes including left ventricular hypertrophy, blood pressure control, anemia, calcium-phosphate metabolism, and fluid and electrolyte balance; all of these parameters can be considered as indirect signs of improvement in quality of life...
November 2008: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Robert M Lindsay, Shannon Carter, Christian Awaraji, Rita S Suri, Gihad Nesrallah
Outcomes from conventional thrice-weekly hemodialysis (CHD) are disappointing for a life-saving therapy. The results of the HEMO Study show that the recommended minimum dose (Kt/V) for adequacy is also the optimum attainable with CHD. Interest is therefore turning to alternative therapies exploring the effects of increased frequency and time of hemodialysis (HD) treatment. The National Institutes of Health have sponsored 2 randomized prospective trials comparing short hours daily in-center HD and long hours slow nightly home HD with CHD...
July 2008: Hemodialysis International
Robert S Lockridge, Mary Pipkin
When hemodialysis first started in the United States in the 1960s, a large percentage of patients performed their treatments at home. However, because of reimbursement issues, home hemodialysis (HHD) gradually succumbed to an in-center approach and eventually a mindset. Since the introduction of nightly HHD by Uldall and Pierratos in 1993, there has been a resurgence of interest in HHD. This paper describes the different types of home hemodialysis being performed as of December 31, 2007 in this country. Because neither the United States Renal Data System (USRDS) nor the End Stage Renal Disease (ESRD) Networks break down home dialysis into the different modalities, a provider questionnaire was sent out to 2 major providers, a number of mid-level providers and other providers known to do HHD...
July 2008: Hemodialysis International
M C Sghirlanzoni, G Mingardi
After the negative results of the HEMO study there is renewed interest in alternative, more ''physiological'' dialysis schemes, such as short daily or nocturnal dialysis. Considerable experience has been acquired with short daily hemodialysis, especially in Italy and the Netherlands. Nocturnal daily hemodialysis is mostly performed in Canada, the USA and Australia. Long hemodialysis three times a week is used in Tassin, France. Many observational studies and the prospective controlled London Study have suggested improvements in many intermediate patient outcomes such as dialysis-related symptoms, blood pressure and volume control, phosphate control (only for nocturnal daily dialysis), nutritional status, and quality of life...
March 2008: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Michael V Rocco
An increase in the length of the standard in-center hemodialysis treatment by 30 to 45 minutes per session was not associated with an improvement in mortality in long-term hemodialysis patients enrolled in the HEMO study. Testing the possibility that delivering still higher doses of hemodialysis may have a beneficial effect on patient outcomes will require the use of more frequent hemodialysis or a much longer duration for each dialysis session. "Short-daily hemodialysis," actually 6 times per week hemodialysis for 1...
July 2007: Advances in Chronic Kidney Disease
A Pierratos, P McFarlane, C T Chan, S Kwok, G Nesrallah
The need to improve the dialysis outcomes, the negative results from the HEMO and ADEMEX studies as well reports of clinical benefits have rekindled the interest in daily hemodialysis. Although no randomized controlled studies have been published, a large number of manuscripts have described significant benefits from both the short or nocturnal forms of daily (quotidian) dialysis or hemo(dia)filtration. They include improved quality of life, hemodynamic stability, blood pressure control with minimal number of medications, anemia control, regression of cardiac hypertrophy and improved nutrition...
June 2006: Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology
Giorgina B Piccoli, Elisabetta Mezza, Manuel Burdese, Valentina Consiglio, Silvia Vaggione, Claudia Mastella, Alberto Jeantet, Emanuela Maddalena, Guido Martina, Massimo Gai, Daria Motta, Giuseppe Paolo Segoloni, Giuseppe Piccoli
BACKGROUND: Predialysis care is vital for the patient and is crucial for dialysis choice: empowered, early referred patients tend to prefer out-of-hospital and self-care treatment; despite these claims, early referral remains too often a program more than a reality. Aim of the study was to evaluate the pattern and reasons for RRT choice in patients treated in a long-standing outpatient network, presently following 850 chronic patients (about 80% diabetics), working with an early referral policy and offering a wide set of dialysis options (home hemo and PD; self care and limited care hemodialysis; hospital hemodialysis)...
May 2005: Journal of Nephrology
Andreas Pierratos, Phil McFarlane, Christopher T Chan
PURPOSE OF REVIEW: The interest in quotidian hemodialysis has increased further after the HEMO study reported that high-dose thrice-weekly hemodialysis failed to improve clinical outcomes. This, in combination with a significant volume of newly published data, made a review of the topic of quotidian hemodialysis timely. RECENT FINDINGS: The published research has revealed further evidence of cardiovascular and quality-of-life improvements as well as financial benefits with quotidian hemodialysis...
March 2005: Current Opinion in Nephrology and Hypertension
J J Keys
No abstract text is available yet for this article.
November 1999: Nephrology News & Issues
M Misra, K D Nolph
A vital conceptual difference between intermittent and continuous dialysis therapies is the difference in the relationship between Kt/V urea and dietary protein intake. For a given level of protein intake the intermittent therapies require a higher Kt/V urea due to the reasons mentioned above. The recently released adequacy guidelines by DOQI for intermittent and continuous therapies are based on these assumptions. The link between adequacy targets and patient survival is well documented for an intermittent therapy like HD...
2000: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
S B Smith, D G Wombolt, R L Hurwitz, J R Wheeler, M Goldberg
We report our experience with the subclavian vein as a route for temporary vascular access. By modifying the technique described by Uldall one can place these catheters at the bedside without the need of a separate exit tunnel. They are easily maintained in place and allow for early discharge home while awaiting permanent vascular access maturation. The results of approximately 600 dialysis treatments showed adequate clearence with a mean postdialysis drop in creatinine of 5.0mg./dl. and BUN of 46mg./dl. Complication rates were minimal with no hemo or pneumothorax...
1981: Clinical and Experimental Dialysis and Apheresis
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