Improved Biochemical Variables, Nutrient Intake, and Hormonal Factors in Slow Nocturnal Hemodialysis: A Pilot Study
Section snippets
Study Subjects
Five adult patients with end-stage renal disease maintained on conventional (three times per week) hemodialysis were recruited into the study. All patients had documented end-stage renal disease (creatinine clearances less than or equal to 1.5 mL/min per 1.73 m2). Patients were excluded from the study if they had diabetes mellitus, documented cancer, dementia, angina during a 2-week period before the study, or active infections.
Protocol
On entrance into the study, the patients underwent a physical
RESULTS
Five patients (three men and two women) were enrolled in the study (Table 1). Three patients completed 8 weeks of SNHD before returning to conventional hemodialysis. One female patient (patient E) was removed from the study on day 7 because of an internal jugular catheter-related bacteremia believed to be due to unauthorized self-manipulation of the catheter—a self-induced complication related to her preexisting psychiatric illness. One man (patient B) had catheter-related sepsis and internal
DISCUSSION
The United States Renal Data System 1996 Annual Data Report revealed survival rates at 1, 2, and 5 years on conventional hemodialysis modalities to be 77.7%, 61.4%, and 29.4%, respectively.6 Just as alarming are the data reported by Held and associates,7, 8, 9, 10 which showed the US end-stage renal disease 5-year mortality rate to be 15% higher than for the countries of the European Dialysis and Transplant Association and 30% higher than in Japan. Critical review of the data showed that the
CONCLUSION
SNHD with use of high-flux dialyzers, large surface areas, a dialysate flow rate of 300 mL/min, and a blood flow rate of 250 mL/min can be safely performed without fear of accidental disconnections or intradialytic patient instability. This modality achieves higher solute clearances than conventional hemodialysis and thus results in improvement of many biochemical variables. Further long-term studies are necessary to explore changes in individual biochemical and endocrine factors seen in this
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2013, American Journal of Kidney DiseasesCitation Excerpt :Despite the lack of information about the critical and many important outcome measures, there is consistent reporting of a reduction in serum phosphate levels and the discontinuation of phosphate binders with more intensive hemodialysis despite an increase in dietary phosphate.8,61-63 The observed decrease in serum phosphate levels on long-frequent hemodialysis was 0.36 mmol/L (2 randomized controlled trials)4,64 to 0.5 mmol/L (6 observational studies)8,52,53,60,61,63 compared to 0.45 mmol/L on long hemodialysis (6 observational studies).2,58,65-68 In the observational studies of long hemodialysis, ∼40% of patients still require phosphate binders.2,56,58,67
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2013, American Journal of Kidney DiseasesCitation Excerpt :A total of 6 studies reported the effects of long-frequent HD on serum PTH values (Fig 3). PTH levels decreased by a mean of 13.58 (95% CI, −24.05 to −3.10) pmol/L with long-frequent compared to conventional HD.6,23-26,28 This was not associated with a change in predialysis serum calcium (5 studies; Fig 4)6,23,24,26,28 or alkaline phosphatase levels (2 studies; Fig 5).6,24
Anorexia and Appetite Stimulants in Chronic Kidney Disease
2013, Nutritional Management of Renal Disease
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