Proof Of the "Magic" 17 hours of Dialysis at Home

[obsidianom]

Tennankore KK1, Kim SJ2, Baer HJ3, Chan CT4.

"Canadian patients receiving intensive home hemodialysis (IHHD; ≥16 hours per week) have survival comparable to that of deceased donor kidney transplant recipients in the United States"

The above line is from an article on "intensive" home dialysis vs. kidney transplant.  They consider 16 hours per week to be the level of intensive dialysis.
Guess what folks---At this level it is comparable to transplant!!!!!    YES.!!!

Now for those who read my posts you will see that I have been repeating over and over the same concept of TIME on machine. I use Dr. Agars writings of 10% of time on machine , which interesting enough comes out to 16.8 hours per week. That is almost exactly what this study found. IT WORKS!!
(I have my wife on 17.5 hours).   So those that can get to this level whether it is at home or nocturnal can get the benefits of survival equal to a transplant.
For those on Nxstage remeber that I have been hounding all of you to get to 17 hours per week.  Now WE HAVE PROOF!!!

ITS ALL ABOUT TIME!!

[Zach]

This is quite interesting, Dr. O.
 

Here is the full abstract:

J Am Soc Nephrol. 2014 May 22. pii: ASN.2013111180. [Epub ahead of print]
Survival and Hospitalization for Intensive Home Hemodialysis Compared with Kidney Transplantation.
Tennankore KK¹, Kim SJ², Baer HJ³, Chan CT⁴.

Author information
¹Division of Nephrology, Dalhousie University, Halifax, Nova Scotia, Canada; ktennankore@gmail.com.
²Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada;
³Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; and Department of Epidemiology, Harvard School of Public Health, Boston Massachusetts.
⁴Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada;

Abstract
Canadian patients receiving intensive home hemodialysis (IHHD; ≥16 hours per week) have survival comparable to that of deceased donor kidney transplant recipients in the United States, but a comparison with Canadian kidney transplant recipients has not been conducted. We conducted a retrospective cohort study of consecutive, adult IHHD patients and kidney transplant recipients between 2000 and 2011 at a large Canadian tertiary care center. The primary outcome was time-to-treatment failure or death for IHHD patients compared with expanded criteria, standard criteria, and living donor recipients, and secondary outcomes included hospitalization rate. Treatment failure was defined as a permanent switch to an alternative dialysis modality for IHHD patients, and graft failure for transplant recipients. The cohort comprised 173 IHHD patients and 202 expanded criteria, 642 standard criteria, and 673 living donor recipients. There were 285 events in the primary analysis. Transplant recipients had a reduced risk of treatment failure/death compared with IHHD patients, with relative hazards of 0.45 (95% confidence interval [95% CI], 0.31 to 0.67) for living donor recipients, 0.39 (95% CI, 0.26 to 0.59) for standard criteria donor recipients, and 0.42 (95% CI, 0.26 to 0.67) for expanded criteria donor recipients. IHHD patients had a lower hospitalization rate in the first year of treatment compared with standard criteria donor recipients and in the first 3 months of treatment compared with living donor and expanded criteria donor recipients. In this cohort, kidney transplantation was associated with superior treatment and patient survival, but higher early rates of hospitalization, compared with IHHD.

Copyright © 2014 by the American Society of Nephrology.

http://www.ncbi.nlm.nih.gov/pubmed/24854268

[Zach]

But of course, there are different interpretations of the same study:

http://www.nephrologynews.com/articles/110239-study-finds-kidney-transplant-offers-longer-survival-compared-to-intensive-dialysis

Nephrology News & Issues magazine
Home Dialysis

Study finds kidney transplant offers longer survival compared to intensive dialysis
May 22, 2014

Compared with long and frequent home hemodialysis, kidney transplantation may allow kidney failure patients to be successfully treated and to live longer, but it may also increase their risk of being hospitalized within the first year, according to a new study published in the Journal of the American Society of Nephrology. The results support the need to encourage transplantation for potential candidates who are receiving home hemodialysis, but they also indicate that long and frequent home hemodialysis provides good outcomes for patients, the study authors said.

Karthik Tennankore, MD, FRCPC, from Dalhousie University, Christopher Chan, MD, FRCPC, from the University of Toronto, and their colleagues conducted a study to compare long and frequent home hemodialysis (at least 16 hours/week) with kidney transplantation. Their study included 173 home hemodialysis patients and 1,517 transplant recipients (673 living donor, 642 standard criteria donor, and 202 expanded criteria donor recipients) who received care between 2000 and 2011 in a Canadian medical center.

Among the major findings:

 … Kidney transplant patients had a 55% to 61% (depending on organ donor type) reduced risk of treatment failure or death during the study compared with patients on long and frequent home hemodialysis.
 … The risk of being admitted to the hospital and spending a longer time in the hospital was higher for some kidney transplant patients up to a year after transplantation, but lower in the long term compared with dialysis patients.

“This study tells us that we should continue to promote kidney transplantation to eligible patients receiving longer, more frequent home hemodialysis even if they are doing well on their dialysis treatment,” said Tennankore. “This study also tells us that patients who are receiving this type of dialysis still have very good health outcomes."

“The gap in clinical outcomes between all forms of kidney transplantation and the putative best forms of dialysis is large," said Thomas Golper, MD, and Rachel Fissell, MD, from Vanderbilt University Medical Center, in an accompanying editorial. "This gap is made even more evident in the report by Tennankore et al,” they wrote.

The article, entitled “Survival and Hospitalization for Intensive Home Hemodialysis Compared with Kidney Transplantation,” and the editorial, entitled “Mind the Gap,” appear online at http://jasn.asnjournals.org/.

[Bill Peckham]

I think the word you're looking for is evidence, not proof.

[PrimeTimer]

Tennankore KK1, Kim SJ2, Baer HJ3, Chan CT4.

"Canadian patients receiving intensive home hemodialysis (IHHD; ≥16 hours per week) have survival comparable to that of deceased donor kidney transplant recipients in the United States"

The above line is from an article on "intensive" home dialysis vs. kidney transplant.  They consider 16 hours per week to be the level of intensive dialysis.
Guess what folks---At this level it is comparable to transplant!!!!!    YES.!!!

Now for those who read my posts you will see that I have been repeating over and over the same concept of TIME on machine. I use Dr. Agars writings of 10% of time on machine , which interesting enough comes out to 16.8 hours per week. That is almost exactly what this study found. IT WORKS!!
(I have my wife on 17.5 hours).   So those that can get to this level whether it is at home or nocturnal can get the benefits of survival equal to a transplant.
For those on Nxstage remeber that I have been hounding all of you to get to 17 hours per week.  Now WE HAVE PROOF!!!

ITS ALL ABOUT TIME!!

We do 17.50 hours a week, too and so far, so great. My husband is still able to work a semi-physical full time job, his labs are looking great and his BP is finally starting to come down (so hopefully the doc will lower his BP meds). Slower and more frequency seems to be having a healthy impact! (for both of us). Thanks for bringing all this to light for us, Dr. O!  Maybe someday we will be brave enough to do nocturnal like Peckham but we're still new to all this and too chicken to trust sleeping with needles in and having the carepartner (me) off snoring at the same time.

[obsidianom]

"Canadian patients receiving intensive home hemodialysis (IHHD; ≥16 hours per week) have survival comparable to that of deceased donor kidney transplant recipients in the United States"

Now you all missed the first line. The sudy started witha KNOWN given that in FACT Canadian patients doing home extended hemo have a COMPARABLE survival to US deceased donor kidney transplant recipients. That was the beginning premise.-- That may be due to the US not doing as well in the deceased donor transplants compared with what they eventually found in Canada during the study. Yes when they compared Canadian intensive dialysis to transplants in the study thay found slightly better survival in the transplants.  ----BUT the original premise they had FROM PREVIOUS STUDIES is the Canadian dialyzers did as well as American deceased donor transplants.
What this indicates is 2 things . 1.  Extended dialysis does give excellant survival comparable to US deceased donor survival  2. That the Canadians have better survival of deceased donor transplants than the US. (there are probably several reasons for this that i wont go into here).
Bottom line---if you are in the US , extended dialysis is comparable to deceased donor transplant.  ( If you want better survival --go to Canada )

[noahvale]

^



 

[komomai]

Aloha Dr. Obsidianom, I just start home hemodialysis, here on Okinawa, Japan.  Going on my 3rd week, my routine is 3 hours/day 6 days a week.  I feel great, my BP is lower, my blood test numbers have dropped, I'm trying to keep my weight down below 80 kilos more like 77.  I'm still working full time at my job, so it's great to hear that the more hours I use my machine the better it is for me.  Mahalo.

[justagirl2325]

Canadian here.  Currently my husband does home hemo in the evenings.  4 hours a session, every second day.  That works out to an average of 14 hours a week.  He is in the process of switching to noctural at home (he's just building a bedroom for himself and the machine).  At that point his "dialysis prescription" from his Nephrologist is 6 hours a session, 6 nights a week.  My husband still has the catheter which is quite stable and we're both comfortable with.  Not sure how it will be with the needles (fistula not even a month old yet).

[Simon Dog]

I do 17.5 hours/week.  One great benefit is that my P and K lab values are in the normal range for a person not on dialysis - not in the "extended range" that the clinic staff say is acceptable for a dialysis patient.  And I still have an occasional potato.

[PrimeTimer]

I do 17.5 hours/week.  One great benefit is that my P and K lab values are in the normal range for a person not on dialysis - not in the "extended range" that the clinic staff say is acceptable for a dialysis patient.  And I still have an occasional potato.

That's fantastical! We watch my husband's labs closely every month, always within range but we are starting to tweak things as such by going how he feels and not just his labs.so...longer slower treatments some days, shorter on others and how much work and sweating he has done outdoors. We are trying to keep him hydrated and feeling more perked up rather than dehydrated and feeling lousy. So long as he doesn't need more than 2.0 kilos over his dry weight removed, he does good. Usually only needs about 1 kilo removed. The closer he sticks to his dry weight, the better he feels providing that he gets to intake some fluid during the day when thirsty. When he's hydrated, he feels better when working and during treatment; dehydrated and he slows down and aches.

[obsidianom]

Aloha Dr. Obsidianom, I just start home hemodialysis, here on Okinawa, Japan.  Going on my 3rd week, my routine is 3 hours/day 6 days a week.  I feel great, my BP is lower, my blood test numbers have dropped, I'm trying to keep my weight down below 80 kilos more like 77.  I'm still working full time at my job, so it's great to hear that the more hours I use my machine the better it is for me.  Mahalo.

Good job. 18 Hours per week is what we do. It really works well . Keep up the good work.

[del]

We are in Canada and my husband does 7 hours a night /5 nights a week. He gets 35 hours a week and his labs are awesome!!

[obsidianom]

We are in Canada and my husband does 7 hours a night /5 nights a week. He gets 35 hours a week and his labs are awesome!!

That is some AWSOME dialysis. Good job.!

[Simon Dog]

so long as he doesn't need more than 2.0 kilos over his dry weight removed, he does good

The RN at my clinic told me to never take off more than 2K, and that if I need more, get it the next day.   I often hit 2K after a long gap (with NxStage that means one day off), usually right around 1000 other days  (was 1200 today).    Have not had a cramp since starting this protocol with NxStage.