Mind the gap

In the UK, "mind the gap" means watch your step as you get off the train. For in-center HD, the gap is the 2-day dialysis weekend. It turns out that switching randomly chosen patients from 3x/week to every other day HD for 12 months reduced blood pressure, left ventricular mass, EPO dose, urea rebound, and symptoms. Of course; it's more physiological!

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

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Get drier: Live longer

A 3.5 year long study of 269 people on HD has found that folks who had more water removed from the blood (tested with a body composition monitor) lived significantly longer than those who stayed water-logged. (Drier is better, and doing longer and/or more frequent HD makes that possible.)

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

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HD frequency vs. length: Which matters most?

For toxin removal, are you better off with more frequent HD, or longer treatments? Turns out that longer HD removes significantly more creatinine and methylguanidine than standard or more frequent treatments—but the combination of BOTH was best. (You knew we'd say that!)

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

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Switching from standard to nocturnal HD has many benefits

We bet you won't be surprised to learn that the 13 patients studied had much lower BP (with fewer drugs), higher hemoglobins (with fewer ESAs), better nutritional status, and lower calcium-phosphorus product. (PTH rose in some, though.)

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

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In-center nocturnal—another good option

Canada found that folks switched from standard in-center HD to nocturnal in-center HD (3 nights/week) used less EPO and had better sleep, quality of life, appetite, and energy. They also had fewer cramps.

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

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First report from the Frequent Hemodialysis Network studies!

There are two FHN studies. One compares 6-days-a-week in-center HD to 3-days-a-week. The other looks at 6-nights-a-week home nocturnal vs. 3 standard home HD treatments. So far, the study shows that more-frequent HD really is a LOT more dialysis—enough that the results should be able to prove whether more is truly better.

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

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The WAK is back...

The wearable artificial kidney (WAK) is still in development. In this most recent article, the developers have learned that a pulsing, rather than steady, flow of dialysate improves clearance of wastes. Activated charcoal is used to absorb Beta-2 microglobulin (which can cause dialysis-related amyloidosis). A dialyzer with a larger surface area and higher dialysate pH are also being tested.

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

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Nocturnal HD normalizes smooth muscle cells

Blood vessel calcification is an all-too-common problem among people on dialysis. On standard HD, fewer smooth muscle cells grow inside the blood vessels, and more of them die. Switching from standard to nocturnal restored normal cell growth—and also lowered blood pressure, and PTH and phosphate levels.

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

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To reduce inflammation: Get rid of your HD catheter

Even with no infection, an HD catheter can still trigger inflammation. In a new study, people who got a fistula and had a catheter removed had an 82% lower c-reactive protein (CRP) level 6 months later. Those who kept the catheter had a 16% higher CRP.

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

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Better nutrition with nocturnal HD

A new study found better appetites, more energy, and higher protein intake in people doing 6 nights/week nocturnal HD. Even though they ate more foods high in phosphorus, their blood levels stayed good without binders. They were able to drink more fluids, too.

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

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