Experience with Long-term Intermittent Hemodialysis

Schupak, Eugene; Merrill, John P.

doi:10.7326/0003-4819-62-3-509

Cited by 57 publications

(17 citation statements)

References 8 publications

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“…In the first paper on shorter dialysis duration, Schupak and Merrill [7] reported a markedly higher rate of hypertension problems than in the early reports with longer dialysis [5,6] . The French Dialysis Registry reported a gradual decrease in hemodialysis duration during the 1970s and a higher rate of hypotensive episodes [25] .…”

Section: Early Reportsmentioning

confidence: 99%

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Treatment Time and Ultrafiltration Rate Are More Important in Dialysis Prescription than Small Molecule Clearance

Twardowski

2006

Blood Purif

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Chronic hemodialysis sessions, as developed in Seattle in the 1960s, were long procedures with minimal intra- and interdialytic symptoms. Over the next three decades, dialysis duration was shorten to 4, 3, even 2 h in thrice weekly schedules. This method spread rapidly, particularly in the United States, after the National Cooperative Dialysis Study suggested that the time of dialysis is of minor importance as long as urea clearance multiplied by dialysis time and scaled to total body water (Kt/V_urea) equals 0.95–1.0. This number was later increased to 1.3, but the assumption that hemodialysis time is of minimal importance remained unchanged. However, Kt/V_urea measures only the removal of low molecular weight substances and does not consider the removal of larger molecules. Nor does it correlate with the other important function of hemodialysis, namely ultrafiltration. Rapid ultrafiltration is associated with cramps, nausea, vomiting, headache, fatigue, hypotensive episodes during dialysis, and hangover after dialysis; patients remain fluid overloaded with subsequent poor blood pressure control leading to left ventricular hypertrophy, diastolic dysfunction, and high cardiovascular mortality. Kt/V_urea should be abandoned as a measure of dialysis quality. The formula suggests that it is possible to decrease t as long as K is proportionately increased, but this is not true. Time of dialysis should be adjusted in such a way that patients would not suffer from symptoms related to rapid ultrafiltration, would not have other uremic symptoms and most patients would have blood pressure controlled without antihypertensive drugs.

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Section: Early Reportsmentioning

confidence: 99%

“…Schupak and Merrill [7] indicated that shorter dialysis sessions (total duration of 12-16 h/week with the use of coil dialyzers) achieved biochemical control similar to that achieved on Kiil dialyzers with longer dialysis durations.…”

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confidence: 99%

Treatment Time and Ultrafiltration Rate Are More Important in Dialysis Prescription than Small Molecule Clearance

Twardowski

2006

Blood Purif

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“…Early reports indicated that the prevalence of itching among patients with chronic renal failure was be tween 0 and 33% [1][2][3][4][5][6]. More recent studies of nondialyzed chronic renal failure patients indicate a prevalence as high as 40% [7], While itching was almost always present among patients on chronic hemodialysis in the 1960s [8][9][10][11][12], its prevalence seems to have declined to a lower yet still significant level in that population [13,14].…”

Section: Introductionmentioning

confidence: 99%

Dialysis Efficacy and Itching in Renal Failure

Masi

Cohen²

1992

Nephron

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Itching in nondialyzed uremic subjects and patients on dialysis remains incompletely explained and poorly treated. We evaluated our chronic hemo- and peritoneal dialysis patients for this symptom and synthetically reviewed previous reports on itching and renal failure. We found no biochemical correlates of itching but did find that itching was less with better dialysis as defined by urea kinetic modelling. We conclude that improved dialysis techniques will continue to reduce the prevalence of itching in end-stage renal disease patients.

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“…Effective haemodialysis is generally agreed to improve or stabilise the neuropathy and in some early cases complete recovery can occur.59-62 A few reports suggest that haemodialysis is ineffective. 63 Occasional worsening of neuropathy following haemodialysis probably reflects inadequate dialysis and suggests that dialysis time should be increased.65 66 Increasing dialysis frequency without increasing dialysis time is ineffective.6768 A recent report suggests that in addition to dialysis time the mean blood urea level should be considered.69 Deficiency of vitamin B,2 with dialysis must also be suspected in dialysis failure.6' A few reports raise the issue that lack of removal of "middle molecules" may result in persistence of symptoms.70 7' Peritoneal dialysis, and in particular, continuous ambulatory peritoneal dialysis, may be superior to haemodialysis in controlling uraemic neuropathy. 72 Renal transplantation has produced a clear cut improvement in virtually all cases in a period of six to twelve months.73-75 One study has demonstrated that modifying the diet by reducing protein and fluid intake will allow reduction in the frequency of dialysis without deleterious effect on the neuropathy.62 Recently, biotin is showing some promise as a therapeutic agent.76…”

mentioning

confidence: 99%

Treatment of peripheral neuropathies.

Hallett

Tandon²,

Berardelli³

1985

Journal of Neurology, Neurosurgery & Psychiatry

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SUMMARY There are three general approaches to treatment of peripheral neuropathy. First, an attempt should be made to reverse the pathophysiological process if its nature can be elucidated. Second, nerve metabolism can be stimulated and regeneration encouraged. Third, even if the neuropathy itself cannot be improved, symptomatic therapy can be employed. This review outlines the options available for each approach.

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Experience with Long-term Intermittent Hemodialysis

Cited by 57 publications

References 8 publications

Treatment Time and Ultrafiltration Rate Are More Important in Dialysis Prescription than Small Molecule Clearance

Treatment Time and Ultrafiltration Rate Are More Important in Dialysis Prescription than Small Molecule Clearance

Dialysis Efficacy and Itching in Renal Failure

Treatment of peripheral neuropathies.

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