Utility and Limitations of a Multicenter Nocturnal Home Hemodialysis Cohort

Copland, Michael A.; Komenda, Paul; Levin, Adeera; Pierratos, Andreas; Chan, Christopher T.

doi:10.2215/cjn.00890208

Cited by 4 publications

(5 citation statements)

References 30 publications

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“…28,62 RCTs are notably difficult to conduct in home dialysis cohorts as patients who have chosen to receive intensification of therapy at home do not wish to be randomized to an incentre or home CHD group. 63 Moreover, the low number of patients currently receiving IHHD has been highlighted as a factor that makes trials with adequate statistical power difficult to establish. 29 Strong medical evidence of the benefits of this therapy might not, therefore, be possible to obtain until the number of patients enrolled in IHHD pro grams increases.…”

Section: Physician-related Factorsmentioning

confidence: 99%

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Intensive home haemodialysis: benefits and barriers

2012

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Accumulating evidence of the benefits of intensive home haemodialysis has led to increased international interest in this modality as a viable option for renal replacement therapy. Until the late 1970s, haemodialysis was primarily performed at home; however, the development of in-centre and satellite dialysis units and the advent of peritoneal dialysis led to decreased numbers of patients being managed by home haemodialysis. Over the past decade, a move towards once again providing and supporting haemodialysis at home has emerged, due to a desire to offer a more convenient form of dialysis for the patient in a more cost-effective manner. This shift has generated clinical evidence indicating benefits both from receiving haemodialysis at home, and from the option to provide intensive dialysis treatment in this setting. With the development of new home haemodialysis programs, specific patient-related, physician-related and cost-related barriers to their introduction have been encountered, including patient fear of self-cannulation and lack of expert medical knowledge in the area. This Review discusses the benefits and barriers associated with intensive home haemodialysis.

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Section: Physician-related Factorsmentioning

confidence: 99%

“…29 Strong medical evidence of the benefits of this therapy might not, therefore, be possible to obtain until the number of patients enrolled in IHHD pro grams increases. 63 This factor limits the creation of new evidence based IHHD programs by nephrologists.…”

Section: Physician-related Factorsmentioning

confidence: 99%

Intensive home haemodialysis: benefits and barriers

2012

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“…Understanding patient and program characteristics that predict NHD success as well as technique failure is critical to developing protocols and procedures to identify patients who are appropriate for NHD and retain them once they have initiated this form of dialysis. Because NHD remains relatively novel, few dialysis programs have sufficient numbers of patients to examine adequately questions of patient and technique outcomes, leading us to establish the Canadian Slow Long nightly ExtEnded dialysis Programs (CAN-SLEEP) collaborative group (9). CAN-SLEEP is a multicenter Canadian NHD research network that brings together a larger cohort of NHD patients than would be possible for any individual program and collect data with granularity not typical of larger dialysis registries.…”

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confidence: 99%

Patient and Technique Survival among a Canadian Multicenter Nocturnal Home Hemodialysis Cohort

Pauly

Veugelers

Coppens

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: As a result of improved clinical and quality-of-life outcomes compared with conventional hemodialysis, interest in nocturnal home hemodialysis (NHD) has steadily increased in the past decade; however, little is known about the flow of patients through NHD programs or about patient-specific predictors of mortality or technique failure associated with this modality. This study addressed this gap in knowledge. Design, setting, participants, & measurements: This study included 247 NHD patients of the Canadian Slow Long nightly ExtEnded dialysis Programs (CAN-SLEEP) cohort from 1994 through 2006 inclusive. The association between program-and patient-specific variables and risk for adverse outcomes was determined using uni-and multivariable Cox regression.Results: A total of 14.6% of the cohort experienced death or technique failure. Unadjusted 1-and 5-year adverse event-free survival was 95.2 and 80.1%, respectively. Significant predictors of a composite of mortality and technique failure included advanced age (P < 0.001), diabetes (P < 0.001), central venous catheter use (P ‫؍‬ 0.01), and inability to perform NHD independently (P ‫؍‬ 0.009) and were adjusted for center effect. Weekly frequency of NHD was not predictive. Age and diabetes remained significant with multivariable analysis (hazard ratio 1.07 and 2.64, respectively). Unadjusted 1-and 5-year technique survival was 97.9 and 95.2%, respectively. Only age was a significant predictor of technique failure.Conclusions: NHD is associated with excellent adverse event-free survival. This study underscores the importance of modality-specific predictors in the success of home hemodialysis, as well as favorable baseline characteristics such as younger age and the absence of diabetes.

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“…In these types of studies, sleep outcomes among those not switched to NHD cannot be compared. Other drawbacks may include secular trends in treatment and passage of time [ 45 ]. However, for its inherent simplicity and accommodation of small sample sizes, this kind of self-control research methodology is commonly used to assess NHD effect in the literature [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of nocturnal hemodialysis on sleep parameters in patients with end-stage renal disease: a systematic review and meta-analysis

Tang

Kim

et al. 2018

PLoS ONE

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IntroductionRecently, a small but growing literature has depicted the beneficial effects of nocturnal hemodialysis (NHD) over conventional hemodialysis (CHD) in the fields of sleep disorders such as sleep apnea. The impact of various dialysis models on sleep disorders, however, has not been determined. The objective of our meta-analysis is to examine the potential effects of NHD, compared with CHD, on sleep disorders in HD patients.MethodsSeveral electronic databases including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and CNKI were searched, using the search terms “nocturnal” (or “nightly”) and “dialysis” (or “hemodialysis” or “renal dialysis”) from the earliest available date of indexing to March 2018. Two authors independently extracted data, evaluated the study quality, and conducted random-effects meta-analyses using STATA 12.0.ResultsOf 1789 potentially relevant citations, 9 fulfilled eligibility criteria, consisting of 6 single-arm studies (comparing pre- and post-intervention outcomes), 1 observational study, and 2 randomized controlled trials (a total of 286 participants). Regarding objective sleep assessments, conversion from CHD to NHD resulted in a significant reduction in the AHI (Mean difference was -14.90; 95% CI, -20.12 to -9.68), a significant increase of SaO2 (Mean difference was 1.38%; 95% CI, 0.35% to 2.42%), and a significant decrease of TST (Mean difference was -0.31; 95% CI, -0.47 to -0.15). The trends were even stronger in the HD patients with sleep disorders. However, regarding subjective sleep assessments, improved sleep quality was found in the prospective pre-post intervention studies and cohort studies, while no significant improvements were found in the randomized controlled trials.ConclusionAlthough a significant improvement of sleep apnea was observed by switching from CHD to NHD, it may not yield a net benefit in overall subjective sleep quality.

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Utility and Limitations of a Multicenter Nocturnal Home Hemodialysis Cohort

Cited by 4 publications

References 30 publications

Intensive home haemodialysis: benefits and barriers

Intensive home haemodialysis: benefits and barriers

Patient and Technique Survival among a Canadian Multicenter Nocturnal Home Hemodialysis Cohort

Effect of nocturnal hemodialysis on sleep parameters in patients with end-stage renal disease: a systematic review and meta-analysis

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