The HEMO study - where do we go from here?

Himmelfarb, Jonathan

doi:10.1097/00041552-200311000-00003

Cited by 7 publications

(9 citation statements)

References 27 publications

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“…Several explanations for the failure of the HEMO Study's high-dose treatment to improve outcomes have been considered. [9][10][11] One is that increasing Kt/V urea does not sufficiently reduce the plasma levels of toxic solutes. This study assessed the effect of the HEMO Study's 30% difference in Kt/V urea on a variety of small solutes.…”

Section: Discussionmentioning

confidence: 99%

Kt/Vurea and Nonurea Small Solute Levels in the Hemodialysis Study

Meyer

Sirich

Fong

et al. 2016

JASN

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The Hemodialysis (HEMO) Study showed that high-dose hemodialysis providing a single-pool Kt/V of 1.71 provided no benefit over a standard treatment providing a single-pool Kt/V of 1.32. Here, we assessed whether the high-dose treatment used lowered plasma levels of small uremic solutes other than urea. Measurements made ≥3 months after randomization in 1281 patients in the HEMO Study showed a range in the effect of high-dose treatment compared with that of standard treatment: from no reduction in the level of p-cresol sulfate or asymmetric dimethylarginine to significant reductions in the levels of trimethylamine oxide (-9%; 95% confidence interval [95% CI], -2% to -15%), indoxyl sulfate (-11%; 95% CI, -6% to -15%), and methylguanidine (-22%; 95% CI, -18% to -27%). Levels of three other small solutes also decreased slightly; the level of urea decreased 9%. All-cause mortality did not significantly relate to the level of any of the solutes measured. Modeling indicated that the intermittency of treatment along with the presence of nondialytic clearance and/or increased solute production accounted for the limited reduction in solute levels with the higher Kt/V In conclusion, failure to achieve greater reductions in solute levels may explain the failure of high Kt/V treatment to improve outcomes in the HEMO Study. Furthermore, levels of the nonurea solutes varied widely among patients in the HEMO Study, and achieved Kt/V accounted for very little of this variation. These results further suggest that an index only on the basis of urea does not provide a sufficient measure of dialysis adequacy.

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Section: Discussionmentioning

confidence: 99%

Kt/Vurea and Nonurea Small Solute Levels in the Hemodialysis Study

Meyer

Sirich

Fong

et al. 2016

JASN

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“…One of the investigators noted that ‘[The results] do indicate that for patients receiving thrice weekly treatments lasting 2.5–4.5 h each we have reached or neared the maximum benefit that can be attained when the benefit is viewed in the traditional dose–response sigmoid curve. This is not to say that future technological advances in dialysis may not provide new solutions or that either longer or more frequent dialysis will not improve outcomes ’[my italics] 56 . Another noted that ‘the results do not support conventional attempts to lower the high morbidity and mortality in haemodialysis patients.…”

Section: Longer or More Frequent Haemodialysismentioning

confidence: 99%

“…Another noted that ‘the results do not support conventional attempts to lower the high morbidity and mortality in haemodialysis patients. Current efforts are being focused on increasing dialysis time and/or frequency, improving phosphate control, and lowering traditional and non‐traditional risk factors for adverse cardiovascular events in this patient population’ 56 …”

Section: Longer or More Frequent Haemodialysismentioning

confidence: 99%

“…This is not to say that future technological advances in dialysis may not provide new solutions or that either longer or more frequent dialysis will not improve outcomes ' [my italics]. 56 Another noted that 'the results do not support conventional attempts to lower the high morbidity and mortality in haemodialysis patients. Current efforts are being focused on increasing dialysis time and/or frequency, improving phosphate control, and lowering traditional and non-traditional risk factors for adverse cardiovascular events in this patient population'.…”

Section: Longer or More Frequent Haemodialysismentioning

confidence: 99%

“…Current efforts are being focused on increasing dialysis time and/or frequency, improving phosphate control, and lowering traditional and non-traditional risk factors for adverse cardiovascular events in this patient population'. 56 There are now a number of glowing reports in the world literature on the benefits of both short daily and long nightly haemodialysis, and these have helped contribute to the revival of interest in home haemodialysis because home is the obvious place to do this. [57][58][59][60][61][62][63] However, home haemodialysis does not necessarily need to be synonymous with daily or nightly haemodialysis to be better than conventional centre treatment.…”

Section: Longer or More Frequent Haemodialysismentioning

confidence: 99%

See 2 more Smart Citations

Home haemodialysis: ‘home, home, sweet, sweet home!’ (Review Article)

Blagg

2005

Nephrology

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SUMMARY: Home haemodialysis was first developed 40 years ago as a means of treating more patients with the limited funds then available. It soon became obvious that the treatment worked well and subsequent studies and experience have confirmed that it improves both mortality and morbidity and provides the best quality of life and other benefits for dialysis patients. The present review describes the history of the development of home haemodialysis in Seattle and elsewhere and the lessons learned about its benefits in the early days, which are just as relevant today. The advantages and disadvantages are discussed, as are the issues of which patients are candidates for this treatment and what is required of a home haemodialysis training and support programme. The decline in use of home haemodialysis in the USA and elsewhere is described and the actions that may already be beginning to reverse this trend. The role of home haemodialysis in giving the opportunity for longer hours of dialysis three times a week or on alternate nights is important. There is discussion of the relationship of home haemodialysis and peritoneal dialysis and its important future role as the means to enable treatment with more frequent short daily and long nightly haemodialysis.

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Management of Diabetic End-Stage Renal Disease With Dialysis

Passadakis

Oreopoulos

2006

The Diabetic Kidney

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The HEMO study - where do we go from here?

Cited by 7 publications

References 27 publications

Kt/Vurea and Nonurea Small Solute Levels in the Hemodialysis Study

Kt/Vurea and Nonurea Small Solute Levels in the Hemodialysis Study

Home haemodialysis: ‘home, home, sweet, sweet home!’ (Review Article)

Management of Diabetic End-Stage Renal Disease With Dialysis

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