Kids & dialysis: daily and nocturnal hd have benefits

Imagine being a child and having to limit sodium, phosphorus, and fluids. A new article about pediatric HD reports outcomes from a program in France. Children using daily HD needed no fluid or diet limits except potassium, while those on nocturnal HD had no limits at all.

Read the abstract » | (added 2011-02-24)

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Predialysis education increases use of home therapies

In a randomized, controlled study done in Canada, of the patients who were assigned to see a 15-minute video on self-care dialysis, read booklets, and attend a 90-minute small group session, 82.1% chose a home dialysis option. Among the "usual care" group, only 50% did. (So, even usual care in Canada far surpasses what we do in the US!)

Read the abstract » | (added 2011-02-24)

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Intensive hemo helps heart health

After a year of short daily home HD 6 days/week or nocturnal home HD 3.5 nights/week, patients had no change in 24 hour blood pressure vs. controls on standard in-center HD. But those getting "intensive" (longer or more frequent) HD needed fewer blood pressure pills, their left ventricular mass decreased, and they had better phosphate control with fewer binders. Those who stayed on standard HD did worse in each area.

Read the abstract » | (added 2011-02-24)

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Nocturnal HD improves cognitive function

Fuzzy thinking on in-center HD? A new study suggests that nocturnal HD can help. Patients who switched to nocturnal HD had a 22% fewer cognitive symptoms and 32% better attention and working memory after 6 months.

Read the abstract » | (added 2011-02-24)

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Switching from standard to nocturnal HD improves vitamin D levels

In 35 patients who did nocturnal HD for 6 months or more, levels of active vitamin D rose significantly. The study patients had no diet limits, and their serum phosphorus levels fell after the switch from in-center HD. Normalizing phosphorus levels may help the body to produce more active vitamin D.

Read the abstract » | (added 2011-02-24)

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Nocturnal HD helps bone mineral status

Doing nocturnal home HD every other night helps bone minerals stay at more normal levels than standard treatments, say researchers from Australia in a new study. After 26 patients switched from standard (home) to nocturnal HD, their serum phosphorus and calcium-phosphorus products fell, most needed no binders, and bone mineral density was stable. Plus, blood vessel calcification improved or at least was stable in 87.5%.

Read the abstract » | (added 2011-02-24)

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New study finds better survival with short daily home hemo

Compared to USRDS survival figures for conventional (3 times a week) in-center hemo, 117 people using short daily home hemo had a significantly lower standardized mortality rate, found a study by Drs. Blagg, Kjellstrand, Ting, and Young.

Read the abstract » | (added 2011-02-24)

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Redefining HD adequacy based on phosphorus

High phosphorus levels in dialyzors cause a host of life-threatening problems—but a higher HD dose based on urea clearance doesn't save lives. An article in Seminars in Dialysis suggests that we use phosphorus removal as a marker instead. Daily and nocturnal HD both remove more phosphorus than standard HD. It's time to give another marker a try.

Read the abstract » | (added 2011-02-24)

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Lying down during dialysis beats sitting up, new study suggests

When we lie down, our blood plasma volume expands, and when we sit up, it contracts. A new study concludes that nocturnal dialysis causes smaller day-to-day shifts in hemoglobin and serum albumin (protein) than standard, seated treatments.

Read the abstract » | (added 2011-02-24)

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More dialysis, longer life

In 2003, researchers from the 12-nation Dialysis Outcomes and Practice Patterns (DOPPS) study found that HD treatments shorter than 3.5 hours had a 33% higher risk of death. A new DOPPS paper reports that each extra 30 minutes of HD reduces the relative risk of death by 7%. Unfortunately, this study also documented mean US in-center treatment times of...3.5 hours.

Read the abstract » | (added 2011-02-24)

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