Treatment length matters (we knew that!)

Even when the same number of blood liters are processed, long, slow dialysis does a better job of removing toxins. In a study where patients on HD were dialyzed for 4, 6, or 8 hours, the longer treatments removed significantly more urea, creatinine, phosphorus, and beta-2 microglobulin. The authors conclude that Kt/V should not be the only measure of dialysis adequacy.

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

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Finally, data! Buttonhole Technique causes fewer fistula problems than site rotation

A new study compares 75 HD patients using the Buttonhole technique for fistula needles with 70 patients using the "standard" technique of "rope ladder" needle site rotation. Buttonhole users had fewer missed cannulations, bruises, and aneurysms, and needed less angioplasty. Infection precautions are vital: there was a higher infection rate.

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

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Poor sleep on standard in-center HD

Good sleep on dialysis improves survival. A new study compared sleep quality on standard in-center HD and a control group matched for age, sex, body mass index, and race. The in-center HD patients had significantly worse sleep.

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

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Consistent aspirin use associated with improved AVF survival among incident HD patients in the DOPPS

A new paper from the Dialysis Outcomes & Practice Patterns Study (DOPPS) reports that people who took aspirin had significantly less fistula failure than those who didn't. (Talk to your doctor about whether a baby aspirin or an adult aspirin might benefit you.)

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

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Secondary arteriovenous fistulas: Converting prosthetic AV grafts to autogenous dialysis access

Dialysis fistulas tend to have fewer clots, infections, and hospital stays than grafts. Switching from a graft to a fistula was highly (90%+) successful after 2 years in a new study.

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

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New study: Survival benefit for nocturnal HD

Researchers from the U.S. and Canada matched each of 94 people on nocturnal HD and 43 on short daily HD to 10 controls on standard HD. Even using the "proportional hazards model", they found a significantly lower risk of hospitalization and death on nocturnal, and a lower (but not significant) risk for daily, too.

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

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Daily HD survival compares to transplant

A study by Kjellstrand et. al. pooling data from 1006 short daily HD patient years (415 patients, both at home and in-center) found 2–3 times better survival than on standard in-center HD. In fact, survival with daily HD was similar to that of deceased donor transplant. (Interesting that no-one disputes that survival is better with transplant than standard HD—though patients are selected for it (just as for home HD) and no randomized controlled trial has been done.)

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

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Nocturnal HD survival matches that of deceased donor transplant

A new study used data from two Canadian programs and the USRDS (1994 to 2006) and randomly matched each of 177 people doing nocturnal HD to three people who'd had transplants. During up to 12 years of follow-up, 14.7% of the nocturnal dialyzors died, vs. 14.3% of those who'd had deceased donor transplants, and 8.5% of those who'd had living donor transplants.

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

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Travel time to HD predicts HRQOL, adherence, & death

A new paper from the Dialysis Outcomes and Practice Patterns (DOPPS) study of 20,994 patients reports that patents whose one-way travel to HD was longer than 60 minutes had significantly higher mortality and lower quality of life. Patients noted, "I feel as if it rules all my time." The authors suggest home dialysis as an option for those who live far from the nearest center.

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

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No kidding: daily HD has better quality of life than standard in-center HD

Okay, we're not surprised to find that a meta-analysis of 17 papers comparing daily HD to standard HD found that folks using daily treatment had fewer access problems, better blood pressure control, less LVH, better anemia control, needed fewer phosphate binders—and had better quality of life.

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

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