Journal watch: HD

Home HD beliefs of patients and care partners in Italy

Home HD is underused in Italy. Interviews found three positive themes: flexibility/freedom, comfort in familiar surroundings, and altruistic motivation to be an example for others. Four negative themes were also found: disrupted sense of normality, family burden, housing constraints, and healthcare by "professionals", not "amateurs".

Mortality patterns in PD & home HD differ from standard in-center HD

In the Australian dialysis database (ANZDATA), 4,298 deaths on PD and 10,338 on HD were analyzed for patterns. Patients who did PD, home HD, or in-center HD more than 3 days per week were equally likely to die on any day of the week. Not so for standard in-center HD patients: they were significantly more likely to die from heart-related reasons on Monday, after the 2-day no-treatment weekend.

Review: survival on intensive HD vs. transplant

Canadian researcher Robert Pauly reviews the literature on survival with short daily and nocturnal HD, and compares it to kidney transplant survival.

Read more | (added Jan 25, 2013)

Can more fluid removal mean needing less toxin removal?

Makers of a wearable ultrafiltration (UF; water removal) device wanted to know if daily UF could be a way to cut back on the need for dialysis toxin removal. For 4 weeks, 13 in-center patients had 4 days a week of UF plus 2 days a week of HD. Then they did 4 weeks of standard, 3x week HD. Daily UF lowered blood pressure and weight gain between treatments significantly—while Kt/V rose.

Read more | (added Jan 25, 2013)

PD: Better survival than standard in-center HD

DaVita followed 23,718 patients new to dialysis for 2 years. Those who chose PD (1,358) were nine times more likely to switch treatment options and three times more likely to get a transplant than those who chose standard in-center HD. The PD patients also had 48% better survival than those who did standard in-center HD.

Read more | (added Jan 25, 2013)

If at first you don’t succeed with PD…it still costs less than in-center HD

A 4-year Canadian study has found that over a 3-year period, the cost of starting on PD and then switching to HD ($114,503) is still much less than doing standard in-center HD ($175,996). But starting and continuing PD is the lowest cost dialysis option ($58,724).

Read more | (added Jan 25, 2013)

Community house home hemodialysis in Australia and New Zealand

Not everyone who wants to dialyze at home is able to. In Australia and New Zealand unstaffed, non-medical community homes fill a gap to make "home" treatments possible. This observational study compared mortality among 113 community home dialyzers to 5,591 people on PD, 1,532 on home HD, and 5,647 on in-center HD. Community house HD was safe and effective.

Phosphate is a blood vessel toxin

High levels of phosphorus in the blood is linked with blood vessel calcification, thickened blood vessel walls, arterial stiffness, and heart damage—and may even cause premature aging.

Modality choice is a factor in AV fistula creation

Canadian researchers compared the predialysis modality preferences of 508 people to their actual modality, and looked at their vascular accesses. The chance of having a fistula was much less in those who chose PD but started HD (39%), or who made no choice (50%), than in those who preferred HD and started on HD (79%).

Home HD for obese patients

In Australia, a 215 Kg man has successfully dialyzed at home for 8 years, after training by a program that has trained 23 obese (BMI >30) people to date. Home HD is a cost effective option with good outcomes in this group.

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