Quotidian dialysis – update 2005

Pierratos, Andreas; McFarlane, Phil; Chan, Christopher T.

doi:10.1097/00041552-200503000-00006

Cited by 32 publications

(21 citation statements)

References 72 publications

(56 reference statements)

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“…These findings are consistent with those reported with other intensive dialysis regimens (21,22). Improved phosphate control should lead to reductions in PTH and AP.…”

Section: Discussionsupporting

confidence: 93%

In-center Nocturnal Hemodialysis

Bugeja

Dacouris²,

Thomas³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Results: After conversion to INHD, median values for phosphorus decreased from 5.9 to 3.7 mg/dl (P < 0.01), alkaline phosphatase level increased from 84 to 161 U/L (P < 0.01), and percentage reduction in urea increased from 74 to 89% (P < 0.01). The mean number of antihypertensive drugs prescribed declined from 2.0 to 1.5 (P < 0.05) during the course of INHD, and the mean daily dosage of phosphate binders declined from 6.2 to 4.9 at study end (P < 0.05). There was a significant reduction in erythropoietin-stimulating agent use of 1992 U/wk (P < 0.01). There was no significant change in median hemoglobin, iron saturation, corrected calcium, or parathyroid hormone levels. Overall, quality of life, sleep, intradialytic cramps, appetite, and energy level all improved significantly on INHD.Conclusions: INHD offers an effective form of HD for long-term dialysis patients who are unable to perform home HD.

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“…These findings are consistent with those reported with other intensive dialysis regimens (21,22). Improved phosphate control should lead to reductions in PTH and AP.…”

Section: Discussionsupporting

confidence: 93%

In-center Nocturnal Hemodialysis

Bugeja

Dacouris²,

Thomas³

et al. 2009

Clinical Journal of the American Society of Nephrology

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“…Nocturnal hemodialysis (NHD), which provides 8 to 10 h of renal replacement therapy during sleep, 3 to 7 nights per week, delivers augmented uremic clearance (5). We postulate that minimization of the uremic milieu leads to restoration of a more hospitable maternal environment.…”

mentioning

confidence: 99%

Successful Pregnancies on Nocturnal Home Hemodialysis

Barua¹,

Hladunewich²,

Keunen³

et al. 2008

Clinical Journal of the American Society of Nephrology

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203

137

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Background and objectives: Women of childbearing age on conventional hemodialysis (CHD) have decreased fertility when compared with the general population. Even in women who conceived, maternal morbidity and fetal mortality remained elevated. We hypothesized that nocturnal hemodialysis (NHD) (3 to 6 sessions per week, 6 to 8 h per treatment), by augmenting uremic clearance, leads to a more hospitable maternal environment and therefore superior outcomes in fertility and pregnancy compared with CHD.Design, setting, participants, and measurements: This is a descriptive cohort study of all female patients achieving pregnancy and delivering a live infant while on NHD at the University Health Network, St. Michael's Hospital, and Humber River Regional Hospital from 2001 to 2006 in Toronto, Canada. Our primary objective was to describe maternal and fetal outcomes in addition to the changes in biochemical parameters after conception in our cohort.Results: Our cohort included five patients (age range, 31 to 37 yr) who had seven pregnancies while on NHD and delivered six live infants. All had previously been on CHD, but none conceived during that time. In all patients, the amount of hemodialysis was increased (from a weekly mean of 36 ؎ 10 to 48 ؎ 5 h; P < 0.01) after pregnancy was diagnosed. Mean predialysis blood urea and mean arterial BP were maintained within normal physiological parameters. The mean gestational age of the cohort was 36.2 ؎ 3 wk and the mean birth weight was 2417.5 ؎ 657 g. The maternal and fetal complications observed in the cohort included intrauterine growth restriction or small for gestational age (n ‫؍‬ 2), preterm delivery (<32 wk) (n ‫؍‬ 1), and shortened cervix threatened labor (n ‫؍‬ 1). Anemia was accentuated during pregnancy, and intravenous iron and erythropoietin requirements were increased. To maintain normal physiological indices for plasma phosphate, an augmented dialysate phosphate supplementation regimen was required.Conclusions: NHD may allow for improved fertility. Delivering a live infant at a mature gestational age is feasible for patients on NHD. Our cohort tended to have fewer maternal and fetal complications compared with historical controls. Hemoglobin and phosphate levels must be monitored with treatment adjusted accordingly.

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“…The Frequent Haemodialysis Network (FHN) trials have suggested that more frequent dialysis, up to 6 times a week, either overnight or for short (2e3) hours daily may improve general well-being and survival. 10,12,19 Dry weight and hypertension The removal of the excess fluid accumulated between sessions is a vital function of dialysis. The 'dry weight' concept assumes that there are two components of body weight: a dry or target weight, at which body fluid compartments are normal; and excess weight, resulting from accumulated fluid that expands fluid compartments, elevates blood pressure, and contributes to excess cardiovascular morbidity and mortality.…”

Section: Optimizing the Haemodialysis Prescription E Frequency And Dumentioning

confidence: 99%

Haemodialysis

Wong¹,

Farrington²

2015

Medicine

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The haemodialysis population continues to increase and is becoming more elderly and dependent. Despite major advances in technology, long-term clinical outcomes are disappointing, even in low-risk patients. Current definitions of dialysis adequacy, based on urea clearance, need to be broadened to encompass parameters such as b 2 -microglobulin clearance, salt and water balance, and phosphate control. Haemodiafiltration provides improved b 2 -microglobulin clearance over haemodialysis, and may improve survival. There is a trend towards individualizing haemodialysis dose to the needs of the patient. Patients with significant residual kidney function may require less dialysis. For others without residual function, more frequent treatments may be necessary to adequately control uraemia and volume status, and to improve survival. Home-based treatment can facilitate more frequent treatments for a proportion of patients, although centre-based therapy remains the default for the majority.

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Quotidian dialysis – update 2005

Cited by 32 publications

References 72 publications

In-center Nocturnal Hemodialysis

In-center Nocturnal Hemodialysis

Successful Pregnancies on Nocturnal Home Hemodialysis

Haemodialysis

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