Short daily Dialysis and Access Issues

[obsidianom]

This study showed that daily dialysis does NOT increase access /fistula or graft damage and interventions.

Daily HD does not harm accesses – a prospective, controlled study
 
A 4-year study was done of 51 on standard HD (3x4 hours) vs 23 on daily HD (6x3 hours). The standard HD group had 543.2 access procedures/1000 patient years; the daily group had 400.8. Adjusting for age, gender, diabetes, phosphorus level, and anemia, there were no significant differences in number of procedures or time to first access revision.
 
Read the abstract » | (added 04/29/2013)

[Dman73]

The problem with most of these studies is that they are usually of short duration (4 yrs).
I don't think that you are going to see any significant change(s) during that time.

My first fistula lasted 14 years and was working well until some time after my transplant where it finally clotted off.

There a a lot of benefits of running short 6 day/wk schedules as it better approximates the normal kidney function.

The two drawbacks that I see are the time involved with that schedule and having twice as many sticks/yr on the fistula that will develop during longer time periods 10-15 years as opposed to what the studies show.   

concerning LVH ==>

Effect of green tea extract on cardiac hypertrophy following 5/6 nephrectomy in the rat.
Priyadarshi S1, Valentine B, Han C, Fedorova OV, Bagrov AY, Liu J, Periyasamy SM, Kennedy D, Malhotra D, Xie Z, Shapiro JI.
Author information
Abstract
BACKGROUND:
Left ventricular hypertrophy commonly complicates chronic renal failure. We have observed that at least one pathway of left ventricular hypertrophy appears to involve signaling through reactive oxygen species (ROS). Green tea is a substance that appears to have substantial antioxidant activity, yet is safe and is currently widely used. We, therefore, studied whether green tea supplementation could attenuate the development of left ventricular hypertrophy in an animal model of chronic renal failure.
METHODS:
Male Sprague-Dawley rats were subjected to sham or remnant kidney surgery and given green tea extract (0.1% and 0.25%) or plain drinking water for the next 4 weeks. Heart weight, body weight, and cardiac Na-K-ATPase activity were measured at the end of this period. To further test our hypothesis, we performed studies in cardiac myocytes isolated from adult male Sprague-Dawley rats. We measured the generation of ROS using the oxidant sensitive dye dichlorofluorescein (DCF) as well as (3H)phenylalanine incorporation following exposure to cardiac glycosides with and without green tea extract.
RESULTS:
Administration of green tea extract at 0.25% resulted in attenuation of left ventricular hypertrophy, hypertension, and preserved cardiac Na-K-ATPase activity in rats subjected to remnant kidney surgery (all P < 0.01). In subsequent studies performed in isolated cardiac myocytes, both ouabain and marinobufagenin (MBG) were both found to increase ROS production and (3H)phenylalanine incorporation at concentrations substantially below their inhibitor concentration (IC) 50 for the sodium pump. Addition of green tea extract prevented increases in ROS production as well as (3H)phenylalanine incorporation in these isolated cardiac myocytes.
CONCLUSION:
Green tea extract appears to block the development of cardiac hypertrophy in experimental renal failure. Some of this effect may be related to the attenuation of hypertension, but a direct effect on cardiac myocyte ROS production and growth was also identified. Clinical studies of green tea extract in chronic renal failure patients may be warranted.


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What all this comes down to is what is more important ? Quality or Quantity.

Quality being short term 6 day/wk schedule with fistula wear being problem long term D

Quantity 3 day/wk w/ longer(4hrs) & slower(350 flow) schedule resulting in longer fistula survival along with other drawbacks (not feeling as well especially on weekends and greater attention to phosphorus levels).

[obsidianom]

I am not convinced you have to give up quantity for quality. Running 5 days per week like NXstage gives excellant quality.  Looking at fistula survival, the key still appears to be blood speed. In Australia where Dr. Agar is, they run under 350 . They also have some patients running 6 days per week. Yet they have fewer fistula issues then even we do in the US running just 3 days per week.   It is more likely blood speed that damages fistulas, not over use.
I am noticing my wifes fistula getting bigger and the pressures at the same blood speed are lower now after 1 year using it 5 days per week at 340 blood speed. Also we do rotating sites and I am noticing the fistula is feeling firmer inside as it gets tougher which makes sense. Wolfs Law says this should occur as the more it is used the larger and stronger it gets, just like a muscle.  Tapping it more and using it more may actually be beneficial as long as the blood speed is low and the pressures are low. The body is designed to get stronger as it is used as it compensates for the added stresses put on it. that is what makes the human body such a marval. It all comes down to Wolfs Law.    (just ask a weight lifter)

[Simon Dog]

This study showed that daily dialysis does NOT increase access /fistula or graft damage and interventions.

Daily HD does not harm accesses – a prospective, controlled study

Once again, a thank you for your valuable contributions.

[Speedy1wrc]

As a data point, my fistula is 8 years old and other than a slow start has never had a problem. It went 1 1/2 years in center as good or bad as that is. Then 6 years off. Then a year back in center. Now a little over a year with button holes at home. It's huge but never any pressure or issues whatsoever. Knocking hard on wood.

[Dman73]

The New England Journal of Medicine has an article concerning In-Center Hemodialysis Six Times per Week versus Three Times per Week.

*link=http://www.nejm.org/doi/full/10.1056/NEJMoa1001593

BACKGROUND
In this randomized clinical trial, we aimed to determine whether increasing the frequency of in-center hemodialysis would result in beneficial changes in left ventricular mass, self-reported physical health, and other intermediate outcomes among patients undergoing maintenance hemodialysis.
Full Text of Background...

METHODS
Patients were randomly assigned to undergo hemodialysis six times per week (frequent hemodialysis, 125 patients) or three times per week (conventional hemodialysis, 120 patients) for 12 months. The two coprimary composite outcomes were death or change (from baseline to 12 months) in left ventricular mass, as assessed by cardiac magnetic resonance imaging, and death or change in the physical-health composite score of the RAND 36-item health survey. Secondary outcomes included cognitive performance; self-reported depression; laboratory markers of nutrition, mineral metabolism, and anemia; blood pressure; and rates of hospitalization and of interventions related to vascular access.
Full Text of Methods...

RESULTS
Patients in the frequent-hemodialysis group averaged 5.2 sessions per week; the weekly standard Kt/Vurea (the product of the urea clearance and the duration of the dialysis session normalized to the volume of distribution of urea) was significantly higher in the frequent-hemodialysis group than in the conventional-hemodialysis group (3.54±0.56 vs. 2.49±0.27). Frequent hemodialysis was associated with significant benefits with respect to both coprimary composite outcomes (hazard ratio for death or increase in left ventricular mass, 0.61; 95% confidence interval [CI], 0.46 to 0.82; hazard ratio for death or a decrease in the physical-health composite score, 0.70; 95% CI, 0.53 to 0.92). Patients randomly assigned to frequent hemodialysis were more likely to undergo interventions related to vascular access than were patients assigned to conventional hemodialysis (hazard ratio, 1.71; 95% CI, 1.08 to 2.73). 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.
Full Text of Results...

CONCLUSIONS
Frequent hemodialysis, as compared with conventional hemodialysis, was associated with favorable results with respect to the composite outcomes of death or change in left ventricular mass and death or change in a physical-health composite score but prompted more frequent interventions related to vascular access. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; ClinicalTrials.gov number, NCT00264758.)