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      Clinical Results of Daily Hemofiltration

      Blood Purification
      S. Karger AG
      Daily hemodialysis, Daily hemofiltration, Home dialysis

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          Various types of daily hemodialysis (HD) have been developed. However, a water treatment system is essential for HD, which markedly prevents daily home HD. Hemofiltration (HF) can be simply performed only with substitution fluid without a water treatment system. This advantage is applied to daily HF. To perform this procedure at home, a simple system is needed. A system in which a dialyzer was combined with a circuit as one cartridge with bag-type substitution fluid was developed by NxStage Inc. This system facilitates not only HF via a supply of 15 l of bag-type substitution fluid, but also automatic washing/priming of the circuit and returning which can be achieved by applying the current CAPD management system. This daily HF may contribute to routine home HD in the future.

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          Most cited references7

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          Improvement of sleep apnea in patients with chronic renal failure who undergo nocturnal hemodialysis.

          Sleep apnea is common in patients with chronic renal failure and is not improved by either conventional hemodialysis or peritoneal dialysis. With nocturnal hemodialysis, patients undergo hemodialysis seven nights per week at home while sleeping. We hypothesized that nocturnal hemodialysis would correct sleep apnea in patients with chronic renal failure because of its greater effectiveness. Fourteen patients who were undergoing conventional hemodialysis for four hours on each of three days per week underwent overnight polysomnography. The patients were then switched to nocturnal hemodialysis for eight hours during each of six or seven nights a week. They underwent polysomnography again 6 to 15 months later on one night when they were undergoing nocturnal hemodialysis and on another night when they were not. The mean (+/-SD) serum creatinine concentration was significantly lower during the period when the patients were undergoing nocturnal hemodialysis than during the period when they were undergoing conventional hemodialysis (3.9+/-1.1 vs. 12.8+/-3.2 mg per deciliter [342+/-101 vs. 1131+/-287 micromol per liter], P<0.001). The conversion from conventional hemodialysis to nocturnal hemodialysis was associated with a reduction in the frequency of apnea and hypopnea from 25+/-25 to 8+/-8 episodes per hour of sleep (P=0.03). This reduction occurred predominantly in seven patients with sleep apnea, in whom the frequency of episodes fell from 46+/-19 to 9+/-9 per hour (P= 0.006), accompanied by increases in the minimal oxygen saturation (from 89.2+/-1.8 to 94.1+/-1.6 percent, P=0.005), transcutaneous partial pressure of carbon dioxide (from 38.5+/-4.3 to 48.3+/-4.9 mm Hg, P=0.006), and serum bicarbonate concentration (from 23.2+/-1.8 to 27.8+/-0.8 mmol per liter, P<0.001). During the period when these seven patients were undergoing nocturnal hemodialysis, the apnea-hypopnea index measured on nights when they were not undergoing nocturnal hemodialysis was greater than that on nights when they were undergoing nocturnal hemodialysis, but it still remained lower than it had been during the period when they were undergoing conventional hemodialysis (P=0.05). Nocturnal hemodialysis corrects sleep apnea associated with chronic renal failure.
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            Survival as an index of adequacy of dialysis.

            To examine how patient survival substantiates dialysis adequacy, 20-year actuarial survival experience was calculated for 445 unselected hemodialysis (HD) patients (97 patients accepted on a temporary basis--and usually kept on their regular dialysis scheme--were left out). The dose of dialysis has been the same and unchanged for all patients since beginning: 24 square meter hours of Kiil dialysis (cuprophane) per week with acetate buffered dialysate. KT/V mean (SD) was 1.67 (0.41). Six months after starting dialysis, 98% of patients were normotensive and off all blood pressure (BP) medication. The mean population hematocrit, excluding the only 6 patients receiving erythropoietin supplementation, was 28%. Survival rate was 87% at 5 years, 75% at 10 years, 55% at 15 years, and 43% at 20 years of HD. The satisfactory control of BP without using potentially toxic BP drugs and the higher than usual dose of dialysis are two possible explanations for survival data better than usually reported. We suggest that patient survival should be considered as the best overall index of adequacy of dialysis.
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              Patient quality of life on quotidian hemodialysis.

              Studies have shown improved quality of life for hemodialysis (HD) patients after changing from conventional thrice-weekly HD treatment to more frequent HD. In the London Daily/Nocturnal Hemodialysis Study, 23 patients (11 patients, short daily HD; 12 patients, long nocturnal HD) were compared with 22 conventional thrice-weekly HD patients serving as controls. All patients completed 3 sets of quality-of-life assessment tools: (1) a locally developed renal disease-specific questionnaire that assessed dialysis symptoms, uremic symptoms, psychosocial stress, and social-leisure activity; (2) the generic Medical Outcomes Survey 36-Item Short Form (SF-36); and (3) the global Health Utilities Index (HUI). As a supplement to the HUI, a subset of patients was asked to complete the Time Trade-Off assessment. Overall, the reduction in symptoms shows better fluid management because quotidian HD patients reported experiencing fewer and less severe cramping during dialysis, fewer headaches, less hypotension, fewer episodes of dizziness, decreased fluid restrictions, fewer blood pressure problems, decreased interdialytic weight gains, fewer episodes of shortness of breath, and a reduction in the sensation of easily feeling cold. HUI results showed that quotidian HD patients maintained functionality throughout the study period, whereas control patients showed a significant loss. Given the choice, all patients chose to remain on quotidian HD therapy after switching from conventional HD therapy. The Time Trade-Off analysis indicated that study patients were willing to trade far less time on quotidian HD therapy and much more time on conventional HD therapy in exchange for "perfect" health. As more studies focus on improved patient outcomes and appropriate funding mechanisms are established, more frequent home HD treatment should become a standard treatment option for patients with end-stage renal disease.

                Author and article information

                Blood Purif
                Blood Purification
                S. Karger AG
                January 2005
                27 January 2005
                : 22
                : Suppl 2
                : 8-13
                Akane-Foundation Tsuchiya General Hospital, Hiroshima, Japan
                81867 Blood Purif 2004;22(suppl 2):8–13
                © 2004 S. Karger AG, Basel

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                Page count
                Figures: 5, Tables: 2, References: 16, Pages: 6
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                Current Topics

                Cardiovascular Medicine,Nephrology
                Home dialysis,Daily hemofiltration,Daily hemodialysis
                Cardiovascular Medicine, Nephrology
                Home dialysis, Daily hemofiltration, Daily hemodialysis


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