Journal watch: HD

Long-term effects of daily HD on vascular access

Does more frequent use of a vascular access create problems for those who do short daily HD? A new 4-year prospective, randomized study of 77 people says NO. Patients did six 3-hour HD sessions per week (n=26) or three 4-hour sessions (n=51). There were fewer access procedures in the daily group (543.2 per 1000 patient years, vs. 400.8), though this difference was not significant. There was also no difference in time to first access revision or access failure.

How to overcome barriers and set up a successful home HD program

Want to establish a home HD program, but don't know how to overcome the barriers? Look no further. This review article by giants in the field will help you get started.

Bone density better in PD than in standard HD

A study compared bone density X-rays in 56 people on standard HD and 23 on PD to 79 healthy people matched for age, gender, BMI, and menopausal status. The healthy people had higher bone density than those on dialysis. But, those on standard HD had significantly lower bone density than those on PD.

Reasons why patients prefer more HD

An in-depth, interview study of 10 short daily or nocturnal HD patients in Canada found four main reasons why they liked their choice. 1) They felt better physically and mentally. 2) They felt more in control of their time. 3) They didn't feel "sick" and were more able to work. 4) They had the support they needed to succeed.

Longer or more-frequent HD normalizes mortality patterns

It has long been known that those on PD have an equal chance of dying on any day of the week—while standard in-center HD are much more likely to die on a Monday (or Tuesday with Tue-Thu-Sat treatments). A new study looking at 14,636 Australian registry deaths found that those who got more than 3 standard in-center treatments per week or did home HD were no more likely to die on a Monday (or Tuesday) than any other day.

Are infections requiring hospitalization more common with PD or standard HD?

A study in Canada paired 910 people on PD with people on HD, matched by age, race, smoking, BMI, comorbid conditions, and lab data. After 2 years, researchers found that those on PD were more likely to be in the hospital for peritonitis—but less likely to have sepsis or pneumonia than those on standard HD.

Metaanalysis: More HD boosts heart health

A metaanalysis of 46 studies concluded that switching from standard in-center HD to longer and/or more frequent HD significantly reduced left ventricular mass and improved blood pressure and the cardiac ejection fraction.

Read more | (added Aug 16, 2012)

Metaanalysis: Later dialysis start is better for HD

Starting dialysis at a lower GFR allows more time for access placement and options education. But the U.S. trend has been to start earlier. A new metaanalysis of 17 studies found that starting dialysis at a higher GFR was linked with a significantly higher risk of all-cause mortality—in HD, but not PD. The mortality risk was lower when GFR was calculated than when it was estimated.

Read more | (added Aug 16, 2012)

Intensive HD survival 50% better than standard in-center HD

A new study comparing 420 patients in the International Quotidian Dialysis Registry with 338 matched standard in-center HD patients from the DOPPS study found that only 13% of patients who did at least 5.5 hours of HD at least three times a week died—vs. 21% who did standard treatments.

Read more | (added Aug 16, 2012)

Short daily HD survival 13% better than than standard in-center HD

When 1,873 short daily home HD patients were matched with 9,365 standard in-center HD patients, those who did more frequent HD had a better chance of living longer.

Read more | (added Aug 16, 2012)

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