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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On dialysis and want a baby? Think about nocturnal HD

The numbers are very small—but in a new study, 5 women ages 31–37 had 7 pregnancies between them and 6 live infants while receiving 43–53 hours of nocturnal HD per week. Two of the infants were small for gestational age, and one was premature. None of the women (from Toronto) had conceived while doing standard HD.

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

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More blood pressure meds + standard HD doesn't = better BP

Both daily and nocturnal HD can aid blood pressure control and reduce the need for BP meds. But do more BP meds on their own help blood pressure in patients on standard therapy? A new study says NO. Among 106 ESRD patients, those who took 4+ BP pills had no better blood pressure than those who took 2–3 or 0–1.

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

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High ultrafiltration (UF) rates stress the heart

Standard in-center HD requires high UF rates to remove fluid. A 5-year prospective study of 287 dialyzors from 2007 found this is a BAD idea. During the study, 149 patients died—69% due to heart problems. Survival was better with UF less than 12.37 ml/h/kg—which is much more doable at home.

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

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Fewer heart problems with nocturnal HD

A new 2-year study from Canada looked at 42 folks on standard HD and 32 on nocturnal HD. Hospital stays for heart problems dropped in those using nocturnal, but stayed the same for the standard dialyzors. Lower phosphorus and better anemia control were also found in those using nocturnal.

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

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Stable hemoglobin levels predict survival in HD

An analysis of 34,963 dialyzors found that variations in hemoglobin were harmful. In fact each 1 g/dL increase in hemoglobin variability raised the risk of death by 33%—even after adjusting for many other factors. Good anemia management can help you live longer.

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

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Human trial reports on wearable artificial kidney (WAK) in UK

The competition for better home HD gets even hotter! The December 2007 edition of Lancet includes an article about use of the WAK in 5 men and 3 women, who tried the device for 4–8 hours. There were no adverse heart, electrolyte, or acid-base events—though some access problems did occur, and dialysis itself is not yet optimal. It's still cool, though.

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

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