Phosphate and Calcium Control in Short Frequent Hemodialysis with the NxStage System One Cycler: Mass Balance Studies and Comparison with Standard Thrice-Weekly Bicarbonate Dialysis

Brunati, C; Gervasi, Francesca; Casati, Costanza; Querques, Maria Luisa; Montoli, Alberto; Colussi, Giacomo

doi:10.1159/000487123

Cited by 11 publications

(12 citation statements)

References 25 publications

(27 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The absence of a significant decline in serum phosphorus contrasts with the effect of intensive hemodialysis in the FHN Daily Trial [ 30 ]. It is possible that while dialytic clearance of phosphorus increased after HHD initiation [ 31 ], dietary intake of phosphorus also increased; to that point, serum albumin increased significantly. Mean serum potassium declined after initiation of HHD, although the 10th–90th percentile range was unchanged.…”

Section: Discussionmentioning

confidence: 99%

Home hemodialysis treatment and outcomes: retrospective analysis of the Knowledge to Improve Home Dialysis Network in Europe (KIHDNEy) cohort

et al. 2018

Self Cite

View full text Add to dashboard Cite

BackgroundUtilization of home hemodialysis (HHD) is low in Europe. The Knowledge to Improve Home Dialysis Network in Europe (KIHDNEy) is a multi-center study of HHD patients who have used a transportable hemodialysis machine that employs a low volume of lactate-buffered, ultrapure dialysate per session. In this retrospective cohort analysis, we describe patient factors, HHD prescription factors, and biochemistry and medication use during the first 6 months of HHD and rates of clinical outcomes thereafter.MethodsUsing a standardized digital form, we recorded data from 7 centers in 4 Western European countries. We retained patients who completed ≥6 months of HHD. We summarized patient and HHD prescription factors with descriptive statistics and used mixed modeling to assess trends in biochemistry and medication use. We also estimated long-term rates of kidney transplant and death.ResultsWe identified 129 HHD patients; 104 (81%) were followed for ≥6 months. Mean age was 49 years and 66% were male. Over 70% of patients were prescribed 6 sessions per week, and the mean treatment duration was 15.0 h per week. Median HHD training duration was 2.5 weeks. Mean standard Kt/Vurea was nearly 2.7 at months 3 and 6. Pre-dialysis biochemistry was generally stable. Between baseline and month 6, mean serum bicarbonate increased from 23.1 to 24.1 mmol/L (P = 0.01), mean serum albumin increased from 36.8 to 37.8 g/L (P = 0.03), mean serum C-reactive protein increased from 7.3 to 12.4 mg/L (P = 0.05), and mean serum potassium decreased from 4.80 to 4.59 mmol/L (P = 0.01). Regarding medication use, the mean number of antihypertensive medications fell from 1.46 agents per day at HHD initiation to 1.01 agents per day at 6 months (P < 0.001), but phosphate binder use and erythropoiesis-stimulating agent dose were stable. Long-term rates of kidney transplant and death were 15.3 and 5.4 events per 100 patient-years, respectively.ConclusionsIntensive HHD with low-flow dialysate delivers adequate urea clearance and good biochemical outcomes in Western European patients. Intensive HHD coincided with a large decrease in antihypertensive medication use. With relatively rapid training, HHD should be considered in more patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Home hemodialysis treatment and outcomes: retrospective analysis of the Knowledge to Improve Home Dialysis Network in Europe (KIHDNEy) cohort

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…Two patients underwent both BHD and NSO studies, and 4 patients HDF and BHD studies at different times. NSO and BHD patients in this study were part of a previous report [11]. Clinical data are shown in Table 1.…”

Section: Methodsmentioning

confidence: 99%

Single Session and Weekly Beta 2-Microglobulin Removal with Different Dialytic Procedures: Comparison between High-Flux Standard Bicarbonate Hemodialysis, Post-Dilution Hemodiafiltration, Short Frequent Hemodialysis with NxStage Technology and Automated Peritoneal Dialysis

Brunati¹,

Gervasi

Cabibbe³

et al. 2019

Blood Purif

Self Cite

View full text Add to dashboard Cite

Background: NxStage System One cycler (NSO) is a widespread system for home daily dialysis. Few data are available on the impact of this “low dialysate volumes system” on the removal rate of poorly diffusible, time-dependent solutes like β₂-microglobulin (β₂M). Methods: Single-session and weekly balances of β₂M were performed and compared in 12 patients on daily NSO, 13 patients on standard high-flux bicarbonate dialysis (BHD), 5 patients on standard post-dilution on line hemodiafiltration (HDF), and 13 patients on automated peritoneal dialysis (APD). Results: Intradialytic fall of plasma water β₂M levels (corrected for rebound) was 65.2 ± 2.6% in HDF, 49.8 ± 9.1% in BHD, and 32.3 ± 6.4% in NSO (p < 0.001 between all groups). Single treatment dialysate removal was much less in APD (19.4 ± 20.4 mg, p < 0.001) than in any extracorporeal technologies, and was less in NSO (126.2 ± 35.6 mg, p < 0.001) than in BHD (204.9 ± 53.4 mg) and HDF (181.9 ± 37.6 mg), with no differences between the latter 2; however weekly removal was higher in NSO (757.3 ± 213.7 mg, p < 0.04) than in BHD (614.8 ± 160.3 mg) and HDF (545.8 ± 112.8 mg). Extrapolated β2M adsorption to the membrane was negligible in BHD, 14.7 ± 9.5% of total removal in HDF and 18.3 ± 18.5% in NSO. Integration of single session data into a weekly efficiency indicator (K × t) showed total volume of plasma cleared in NSO (33.4 ± 7.7 L/week) to be higher than in BHD (26.9 ± 7.2 L/week, p < 0.01) and not different than in HDF (36.2 ± 4.7 L/week); it was negligible (3.2 ± 1.0) in APD. Conclusions: Weekly β₂M removal efficiency proved equal and highest in HDF and NSO (at a 6/week prescription), slightly lesser in BHD and lowest in APD.

show abstract

“…Brunati et al [27] showed short, frequent home hemodialysis with Nx Stage System One cycler, on a six days per week-based prescription that allows higher weekly Phosphate removal than standard bicarbonate dialysis. The findings of the present study suggested adequate Phosphate removal with intermittent hemodialysis in all patient groups, even though dialysis was performed three times per week as compared to 6 times per week by them.…”

Section: Discussionmentioning

confidence: 99%

Portable Hemodialysis Machine for Chronic Hemodialysis in Hospital—Advantages and Future Uses

Alhazmi¹,

Bilal²,

Khamis³

2020

OJNeph

View full text Add to dashboard Cite

Introduction: Nx stage one machine results can help to enhance the clinical efficiency and shortage concerning the use of home hemodialysis. Therefore, the study investigates effectiveness of Nx stage machine for intermittent conventional hemodialysis in hospital for inpatients and outpatients to replace conventional hemodialysis in stable chronic hemodialysis patients. Methods: Prospective observatory study was conducted in Nephrology Division, King Fahd General Hospital from April 1 to June 1 2018. Patients with ESRD, who were dependent on dialysis and maintained on regular hemodialysis were recruited. Fifty-two sessions of hemodialysis were performed. The patients were given intermittent dialysis using Nx stage one machine. Pre and Post dialysis investigations and body weight were taken, and patients were observed for any complications during or post-dialysis. Findings: The primary endpoint ultrafiltration with a goal to remove 1 -4 kg was achieved without any technical difficulty. Secondary endpoint for potassium reduction levels was achieved with mean SD post-dialysis 3.53 ± 0.3, and the tertiary endpoint was achieved in a patient less than 50 kg weight with spKt/V above 1.2. It was difficult to achieve spKt/V in patients with weight more than 60 kg due to limitations in the duration of sessions or dialysate volume. Target spkT/V was achieved for patients with body weight less than 50 kg; however, it was not achieved among the patients with body weight more than 60 kg. Discussion: Nx stage one machine can replace conventional intermittent dialysis in terms of ultrafiltration and Potassium correction; however, further investigation is needed for urea clearance.

show abstract

Phosphate and Calcium Control in Short Frequent Hemodialysis with the NxStage System One Cycler: Mass Balance Studies and Comparison with Standard Thrice-Weekly Bicarbonate Dialysis

Cited by 11 publications

References 25 publications

Home hemodialysis treatment and outcomes: retrospective analysis of the Knowledge to Improve Home Dialysis Network in Europe (KIHDNEy) cohort

Home hemodialysis treatment and outcomes: retrospective analysis of the Knowledge to Improve Home Dialysis Network in Europe (KIHDNEy) cohort

Single Session and Weekly Beta 2-Microglobulin Removal with Different Dialytic Procedures: Comparison between High-Flux Standard Bicarbonate Hemodialysis, Post-Dilution Hemodiafiltration, Short Frequent Hemodialysis with NxStage Technology and Automated Peritoneal Dialysis

Portable Hemodialysis Machine for Chronic Hemodialysis in Hospital—Advantages and Future Uses

Contact Info

Product

Resources

About