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Author Topic: In-Center Hemodialysis 6x per Week vs 3x, new studies in NEJM  (Read 1821 times)
greg10
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« on: November 22, 2010, 08:23:30 PM »

http://www.nejm.org/doi/full/10.1056/NEJMoa1001593#t=abstract

Just- released findings of the Frequent Hemodialysis Network (FHN) Daily Trial that compared in-center hemodialysis administered under a three times per week schedule ("conventional dialysis") versus six shorter sessions per week ("short daily dialysis"). The FHN Daily Trial, published in the New England Journal of Medicine, was a landmark, randomized, controlled study sponsored by the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK) and the Centers for Medicare and Medicaid Services (CMS).

Frequent hemodialysis was associated with improved control of hypertension and hyperphosphatemia. There were no significant effects of frequent hemodialysis on cognitive performance, self-reported depression, serum albumin concentration, or use of erythropoiesis-stimulating agents.

In the chart below, LV mass is  left ventricular mass.  When a patient has adequate dialysis, he is more likely to have lower weight gain and therefore lesser chance of an enlarged LV mass.
"the lower weight gain between dialysis sessions in the frequent-hemodialysis group may be responsible for some of the benefit that we observed with respect to left ventricular mass. Although frequent hemodialysis is far from perfect, it may more closely approximate the capacity of a native or transplanted kidney to regulate extracellular volume and solute composition."
« Last Edit: November 22, 2010, 08:34:19 PM by greg10 » Logged

Newbie caretaker, so I may not know what I am talking about :)
Caretaker for my elderly father who has his first and current graft in March, 2010.
Previously in-center hemodialysis in national chain, now doing NxStage home dialysis training.
End of September 2010: after twelve days of training, we were asked to start dialyzing on our own at home, reluctantly, we agreed.
If you are on HD, did you know that Rapid fluid removal (UF = ultrafiltration) during dialysis is associated with cardiovascular morbidity?  http://ihatedialysis.com/forum/index.php?topic=20596
We follow a modified version: UF limit = (weight in kg)  *  10 ml/kg/hr * (130 - age)/100

How do you know you are getting sufficient hemodialysis?  Know your HDP!  Scribner, B. H. and D. G. Oreopoulos (2002). "The Hemodialysis Product (HDP): A Better Index of Dialysis Adequacy than Kt/V." Dialysis & Transplantation 31(1).   http://www.therenalnetwork.org/qi/resources/HDP.pdf
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