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  • International Use of HD—Including Home HD

    A new survey of stakeholders in 182 countries (with respondents from 160 countries) found a use rate for HD of 298.4 per million. Among incident dialysis patients, the HD rate was 98.0. Standard in-center HD was available among 27% of low-income countries (and these patients paid more of the costs); home HD was available in 36% of high-income countries. Monitoring of patient-reported outcomes was done in 61% of countries, while 60% monitored bone minerals and patient survival, and 51% monitored technique survival. Just 5% of countries initiated patients on HD with arteriovenous access.

    Read the abstract » | (added 2020-09-11)

    Tags: Hemodialysis, Homedialysis, HD

  • PD and Bone Mineral Disorders vs. HD

    Body composition, nutritional status, DEXA, and bone mineral disease (BMD) biomarkers were assessed at baseline and one year in 242 ESRD patients starting either PD (n=138) or HD (n=104). Among HD patients, BMD decreased significantly—but not in PD patients. Preservation of BMD was associated with significantly lower all-cause mortality, with cortical bone preservation more predictive than trabecular bone preservation.

    Read the abstract » | (added 2020-09-11)

    Tags: End stage Renal Disease, Bone Mineral Density, Dialysis

  • How longer HD treatments affect bone minerals

    The ACTIVE study randomized 200 people to do 24+ hours of HD per week vs. standard (<18 hours per week) HD. Long HD treatments reduced serum phosphate levels, but did not change PTH or serum calcium. In a second analysis of the data, those who did longer HD needed fewer phosphate binders as well.

    Read the abstract » | (added 2019-07-15)

    Tags: HD Duration, Long Hd Treatment, Serum Phospate, Mineral Metabolism, Phosphate Binders

  • Bone Mineral Balance in Short Daily HD: A Cautionary Tale

    A new case report suggests that bone mineral balance may need extra attention for those doing short daily HD. A patient who had multiple fractures and bone pain severe enough to require a wheelchair for more than a year was found on biopsy to have osteomalacia, likely due to chronically low levels of serum phosphorus and calcium. Increasing these minerals in the dialysate enabled the patient to leave the wheelchair and walk pain-free.

    Read the abstract » | (added 2017-09-15)

    Tags: Education Issues: For Patients And Professionals

  • Nocturnal HD Protects Bones Better Than Standard HD

    Compared to 52 patients on conventional HD, 36 patients on nocturnal HD had better bone mineral density at the lumbar spine, femoral neck, and hip after one year.

    Read the abstract » | (added 2016-06-08)

    Tags: Hemodialysis

  • Mineral balance in long HD

    A metaanalysis from Canada of 21 studies concluded that keeping dialysate calcium ≥1.5 mmol/L for most patients on long/long-frequent HD prevents an increase in PTH levels and a decline in bone mineral density—without raising the risk of calcification. Adding phosphate to the dialysate for those with a low predialysis level or very low level makes sense.

    Read the abstract » | (added 2013-08-22)

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  • Alternate-night HD improves bone minerals &amp; blood pressure

    Among 63 people in Australia who switched from standard HD to alternate-night HD, bone mineral balance and blood pressure improved after 18–24 months. Left ventricular mass did not improve, but remained stable.

    Read the abstract » | (added 2011-11-28)

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  • Nocturnal HD improves bone mineral levels

    Yes, we knew this—but this time, it's a randomized controlled trial of nocturnal (6 nights/week) vs. standard in-center HD (3 times/week). Compared to standard HD, those doing nocturnal had lower phosphorus—even without binders—lower PTH levels, and lower calcium-times-phosphorus products.

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

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  • Nocturnal HD helps bone mineral status

    Doing nocturnal home HD every other night helps bone minerals stay at more normal levels than standard treatments, say researchers from Australia in a new study. After 26 patients switched from standard (home) to nocturnal HD, their serum phosphorus and calcium-phosphorus products fell, most needed no binders, and bone mineral density was stable. Plus, blood vessel calcification improved or at least was stable in 87.5%.

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

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