“…Nineteen studies met the inclusion criteria [4,5,7,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25]. Three studies were excluded because the vascular access event rates were not reported [26,27] or because of missing demographic data [28].…”
Background: Frequent hemodialysis (HD) may be associated with an increased risk of vascular access complications. Studies addressing vascular access outcomes in frequent HD show conflicting results. Methods: We searched Medline for trials looking at vascular access outcomes in frequent HD. Results: Nineteen studies met the inclusion criteria; only studies with a control group were included for analysis (n = 15). The vascular access event rate was higher in intensive HD as compared to conventional HD (difference of 6.7 events per 100 patient-years, p = 0.009). Overall event rates were not significantly different between conventional and intensive HD when stratified for access type, but were notably higher in the arteriovenous grafts and catheter group as compared to the arteriovenous fistula (AVF) group. Conclusion: Intensive HD is associated with an increased risk of vascular access complications. Overall reported event rates were lower in the AVF group. Further controlled studies should investigate whether a ‘fistula first' strategy may be recommended also for intensive HD.
“…Nineteen studies met the inclusion criteria [4,5,7,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25]. Three studies were excluded because the vascular access event rates were not reported [26,27] or because of missing demographic data [28].…”
Background: Frequent hemodialysis (HD) may be associated with an increased risk of vascular access complications. Studies addressing vascular access outcomes in frequent HD show conflicting results. Methods: We searched Medline for trials looking at vascular access outcomes in frequent HD. Results: Nineteen studies met the inclusion criteria; only studies with a control group were included for analysis (n = 15). The vascular access event rate was higher in intensive HD as compared to conventional HD (difference of 6.7 events per 100 patient-years, p = 0.009). Overall event rates were not significantly different between conventional and intensive HD when stratified for access type, but were notably higher in the arteriovenous grafts and catheter group as compared to the arteriovenous fistula (AVF) group. Conclusion: Intensive HD is associated with an increased risk of vascular access complications. Overall reported event rates were lower in the AVF group. Further controlled studies should investigate whether a ‘fistula first' strategy may be recommended also for intensive HD.
“…Recent data from a number of investigators reveal that thrice-weekly HD may not be optimal for adults [6][7][8]. This concept may be applicable to children as well.…”
Recent evidence from adult hemodialysis (HD) patient studies reveal improved biochemical control and reported health-related quality of life after transition from conventional thrice weekly to daily home maintenance HD treatment. Published pediatric frequent dialysis experiences demonstrate similar improvement but all used conventional HD machines, which employ a treated municipal water supply, thereby frequently exposing patients to proinflammatory components. We report our pediatric experience with six-times-weekly HD using the NxStage system, which uses sterile dialysis fluid to provide dialysis in the home or center setting. Four patients (weight range 38-61.4 kg) completed the 16-week study. Patients exhibited progressive reductions in casual pretreatment systolic and diastolic blood pressures, discontinuation of antihypertensive medications, and decreased blood pressure load by ambulatory blood pressure monitoring. Mean serum phosphorus improved without change in phosphorus binder medication, and all three patients with a normalized protein catabolic rate <1 g/kg per day at the beginning of the study improved to a normalized protein catabolic rate (nPCR) of >1.1 g/kg per day. Patients reported no adverse effects. Variable changes in proinflammatory cytokine levels were observed. We suggest that frequent HD with the NxStage system be considered for children who would benefit from home-based maintenance dialysis.
“…A previous study pointed out that 43% of the patients on SDHD would like to continue with this modality while 35% would prefer to discontinue treatment due to inability to go to the dialysis facility [8] . Another investigation reported that 57% would like to continue, but 28% considered SDHD a very invasive modality [10] . It can therefore be concluded that a relatively high percentage of patients on a daily schedule would be reluctant to continue on it.…”
Section: Discussionmentioning
confidence: 99%
“…Other studies have assessed the QoL of patients in SDHD [8][9][10][17][18][19][20] . Most of them found similar results to the present study, although they used different scales and methodologies to measure QoL.…”
Section: Discussionmentioning
confidence: 99%
“…Some reviews stated that daily hemodialysis might be a more physiological treatment than the other two alternatives [5][6][7] and several observational studies are consistent with a better quality of life (QoL) for SDHD [8][9][10] . If these results were to be confirmed, SDHD might gradually replace CHD in hemodialysis units and hospitals.…”
Background: End-stage renal disease is a major health problem worldwide nowadays. Although conventional hemodialysis is the most widely used modality, short daily hemodialysis has been proposed as a more physiologic treatment. The objective of this article is to compare the quality of life of patients on each hemodialysis modality. Methods: A multicentric cross-sectional study was performed in 9 Spanish hospitals. Patients treated for at least 3 months with conventional or short daily hemodialysis were included and quality of life measured using the Euroqol-5D quality of life questionnaire. Bayesian models were used for analyzing quality of life results. Results: Ninety-three patients were included, 27 were on daily hemodialysis and 66 on conventional hemodialysis. All models demonstrated a better quality of life for daily hemodialysis versus conventional hemodialysis. Only 14% of the patients on conventional hemodialysis were willing to change to a daily schedule. Conclusions: Short daily hemodialysis shows a better quality of life than conventional hemodialysis with all Bayesian approaches considered.
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