Intensive Hemodialysis: Time to Give the Therapy Greater Consideration

Collins, Allan J.; Chan, Christopher T.

doi:10.1053/j.ajkd.2016.05.027

Cited by 7 publications

(3 citation statements)

References 40 publications

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“…The RECAP is a two-year retrospective cohort study reporting the results and patient experience of 94 kidney disease patients who received IHHD (i.e., short daily, low flow) with the Physidia S 3 system. The RECAP study confirms the clinical benefits of IHHD and enlarges our knowledge by analyzing a relatively large dialysis population presenting with various clinical and metabolic profiles having used the same S 3 device with a similar protocol, reducing care variations and then providing homogeneous findings [ 3 , 4 , 5 , 17 , 18 , 19 ].…”

Section: Discussionsupporting

confidence: 57%

Two Years’ Experience of Intensive Home Hemodialysis with the Physidia S3 System: Results from the RECAP Study

Fessi

Nicoud²,

Serrato³

et al. 2023

JCM

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The RECAP study reports results and outcomes (clinical performances, patient acceptance, cardiac outcomes, and technical survival) achieved with the S3 system used as an intensive home hemodialysis (HHD) platform over a three-year French multicenter study. Ninety-four dialysis patients issued from ten dialysis centers and treated more than 6 months (mean follow-up: 24 months) with S3 were included. A two-hour treatment time was maintained in 2/3 of patients to deliver 25 L of dialysis fluid, while 1/3 required up to 3 h to achieve 30 L. The additional convection volume produced by means of the SeCoHD tool (internal filtration backfiltration) was 3 L/session, and the net ultrafiltration produced to achieve dry weight was 1.4 L/session. On a weekly basis, an average 156 L of dialysate corresponding to 94 L of urea clearance when considering 85% dialysate saturation under low flow conditions was delivered. Such urea clearance was equivalent to 9.2 [8.0–13.0] mL/min weekly urea clearance and a standardized Kt/V of 2.5 [1.1–4.5]. The predialysis concentration of selected uremic markers remained remarkably stable over time. Fluid volume status and blood pressure were adequately controlled by means of a relatively low ultrafiltration rate (7.9 mL/h/kg). Technical survival on S3 was 72% and 58% at 1 and 2 years, respectively. The S3 system was easily handled and kept by patients at home, as indicated by technical survival. Patient perception was improved, while treatment burden was reduced. Cardiac features (assessed in a subset of patients) tended to improve over time. Intensive hemodialysis relying on the S3 system offers a very appealing option for home treatment with quite satisfactory results, as shown in the RECAP study throughout a two-year follow-up time, and offers the best bridging solution to kidney transplantation.

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Section: Discussionsupporting

confidence: 57%

Two Years’ Experience of Intensive Home Hemodialysis with the Physidia S3 System: Results from the RECAP Study

Fessi

Nicoud²,

Serrato³

et al. 2023

JCM

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“…Globally, there is increased clinical interest and uptake of therapies that have increased removal of uremic toxins relative to high flux HD. The currently available methods for doing so include more intensive HD [7, 8], leakier dialyzer membranes [9, 10], or greater convective clearance [11–19]. At the present time, greater convective clearance using hemodiafiltration (HDF) is the most commonly applied means for extending uremic solute clearance in routine clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study

et al. 2019

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BackgroundGlobally, there is increased clinical interest and uptake of hemodiafiltration (HDF) for increased removal of uremic toxins. To date, there has been no epidemiological analysis of HDF in China. We present HDF practice patterns and associated mortality risk in Shanghai.MethodsThis is an observational, prospectively collected, retrospective analysis of 9351 Chinese patients initiating hemodialysis in Shanghai from 2007 to 2014. The primary exposure was hemodialysis sub-modality at inception, classified into hemodiafiltration (HDF) and hemodialysis (HD), with adjustment for concommitant hemoperfusion. The primary outcome was patient mortality. We used Cox proportional hazards regression and Fine and Gray’s proportional subhazards regression, with multiple imputation of missing co-variates by the chained equation method, adjusting for demographic and clinical variables.ResultsOverall, patients in the cohort were younger, with a more males, and with a lower body mass index when compared to corresponding non-Asian cohorts. Mortality rate was low although it doubled over the period of observation. HDF utilization increased from 7% of patients in 2007 to 42% of patients in 2014. The majority of patients received HDF once a week. The adjusted hazard ratio of death (95% confidence intervals) for HDF versus HD was 0.85 (0.71–1.03), and corresponding sub-hazard ratio 0.86 (0.71–1.03). There was strong effect modification by age. In those aged 40–60 years, the hazard ratio (95% confidence intervals) was 0.65 (0.45–0.94), and sub-hazard ratio also 0.65 (0.45–0.95).ConclusionsOur study has certain limitations resulting from the limited number of co-variates available for modelling, missing data for some co-variates, and the lack of verification of data against source documentation. Notwithstanding, there is evidence of clinical benefit from HDF in China, and potential to improve patient outcomes through the greater removal of middle and larger uremic solutes.Electronic supplementary materialThe online version of this article (10.1186/s12882-019-1219-z) contains supplementary material, which is available to authorized users.

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“…week. It is valuable to note that the popularity of thriceweekly HD is not based on the superiority of clinical outcomes but emerged as a consequence of a triad of technology advancement, financial burden and post hoc analysis of the National Cooperative Dialysis Study (11) .…”

Section: Introductionmentioning

confidence: 99%

Impact of Hemodialysis Time Prolongation on Blood Pressure Control

Teama

Soliman²,

ElSharkawy

et al. 2021

The Egyptian Journal of Hospital Medicine

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Introduction: Hypertension prevalence among end-stage renal disease (ESRD) patients range from 76% to 90%. Increasing the duration of dialysis time, either by longer session hours or increased sessions, aiming at reducing the dry weight to achieve euvolemia, may be beneficial for individuals who failed to achieve target BP or ideal volume status during standard HD prescription hours. Objective: We aimed to study the effect of increasing hemodialysis session time on blood pressure control. Methods: This observational study was conducted on 50 hypertensive prevalent HD patients on thrice-weekly maintenance HD. Patients were divided into 2 groups: (A) 25 patients who received longer hemodialysis session (4.5 hours) and (B) 25 patients HD who received the usual 4 hours session. They were followed up for a period of 6 months to assess changes of pre-dialysis blood pressure to monitor response. Results: Ultrafiltration volume declined significantly with longer HD sessions compared to conventional sessions (pvalue < 0.001 versus 0.523). Longer HD session time group was associated with highly significant decline in mean SBP, (p-value < 0.001). Moreover, longer HD session time group was associated with highly statistically significant decline in mean DBP, (p-value < 0.001). The decline in mean perdialysis SBP & DBP was-17.27 &-9 mmHg respectively and the rate of decline of postdialysis SBP & DBP was-6.45 &-12.38 mmHg respectively at 6 th month compared to values in 1 st month of follow up period. Conclusion: Longer HD session duration is associated with better improvement in UF volume, mean SBP & DBP, predialysis SBP & DBP and post-dialysis SBP & DBP as well.

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Intensive Hemodialysis: Time to Give the Therapy Greater Consideration

Cited by 7 publications

References 40 publications

Two Years’ Experience of Intensive Home Hemodialysis with the Physidia S3 System: Results from the RECAP Study

Two Years’ Experience of Intensive Home Hemodialysis with the Physidia S3 System: Results from the RECAP Study

Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study

Impact of Hemodialysis Time Prolongation on Blood Pressure Control

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