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 more | (added Aug 24, 2011)

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 more | (added Feb 24, 2011)

Nocturnal HD improves melatonin rhythm for better sleep

Is sleep better or worse on nocturnal HD, since it is done at night? A new study of 13 people who switched from standard HD to nocturnal found that standard HD disrupts the normal rhythm of melatonin (the hormone that helps you sort out day from night). After 6 months of night-time treatments, this rhythm was partly restored—and sleep was much better.

Read more | (added Feb 24, 2011)

Children on dialysis have good survival prospects

Some of the longest survivors of ESRD were children or teens when their kidneys failed. A new study finds that 5-year survival of this group after they reach age 18 was 95.1%, with an average life expectancy of age 63 with a transplant—or age 38 with standard dialysis. Of course, two recent studies have found that survival with longer and/or more frequent HD rivals that of transplant.

Read more | (added Feb 24, 2011)

If you can’t beat ‘em, zap ‘em!

Fibrils of amyloid can build up in the joints and soft tissues when too-little beta-2 microglobulin (B2m) is removed from the blood during dialysis. Longer and more frequent treatments remove more B2m. But what if we could remove fibrils that have already occurred? A new study suggests that laser treatments can destroy existing fibrils and slow the rate of new ones.

Read more | (added Feb 24, 2011)

Lower B2m levels predict better survival

More frequent—and especially longer—HD remove much more beta-2 microglobulin, a toxin that causes dialysis-related amyloidosis (DRA), with waxy protein deposits in bones, joints, and sometimes soft tissues. Since a new study has found that lower levels of B2m on dialysis predict survival, getting more dialysis is a plus!

Read more | (added Feb 24, 2011)

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 more | (added Feb 24, 2011)

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 more | (added Feb 24, 2011)

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 more | (added Feb 24, 2011)

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 more | (added Aug 24, 2011)

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