Daily Hemodialysis Research Articles

Effect of dialysate potassium and lactate on serum potassium and bicarbonate concentrations during daily hemodialysis at low dialysate flow rates

BackgroundObservational studies of hemodialysis patients treated thrice weekly have shown that serum and dialysate potassium and bicarbonate concentrations are associated with patient outcomes. The effect of more frequent hemodialysis on serum potassium and bicarbonate concentrations has rarely been studied, especially for treatments at low dialysate flow rate.MethodsThese post-hoc analyses evaluated data from patients who transferred from in-center hemodialysis (HD) to daily HD at low dialysate flow rates during the FREEDOM Study. The primary outcomes were the change in predialysis serum potassium and bicarbonate concentrations after transfer from in-center HD (mean during the last 3 months) to daily HD (mean during the first 3 months).ResultsAfter transfer from in-center HD to daily HD (data from 345 patients, 51 ± 15 years of age, mean ± standard deviation), predialysis serum potassium decreased (P < 0.001) by approximately 0.4 mEq/L when dialysate potassium concentration during daily HD was 1 mEq/L; no change occurred when dialysate potassium concentration during daily HD was 2 mEq/L. After transfer from in-center HD to daily HD (data from 284 patients, 51 ± 15 years of age), predialysis serum bicarbonate concentration decreased (P = 0.0022) by 1.0 ± 3.3 mEq/L when dialysate lactate concentration was 40 mEq/L but increased (P < 0.001) by 2.5 ± 3.5 mEq/L when dialysate lactate concentration was 45 mEq/L. These relationships were dependent on serum potassium and bicarbonate concentrations during in-center HD.ConclusionsControl of serum potassium and bicarbonate concentrations during daily HD at low dialysate flow rates is readily achievable; the choice of dialysate potassium and lactate concentration can be informed when transfer is from in-center HD to daily HD.

SAT-024 EFFECT OF HAEMODIALYSIS SESSION FREQUENCY AND DURATION ON SURVIVAL IN AUSTRALIAN END-STAGE KIDNEY DISEASE PATIENTS: A COHORT STUDY

End-stage kidney disease (ESKD) patients have substantially increased mortality compared to the general population. Intensive haemodialysis (HD) of more frequent and or longer duration treatment has been proposed to improve survival in this population. However, it is not clear whether the improved survival observed in studies is attributed to increased frequency, increased duration, or both. We aimed to examine the independent effects of session frequency and session duration on mortality in incident ESKD patients initiating HD. A retrospective cohort study of HD patients was performed using data from Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). The cohort included all patients aged ≥18 years who initiated HD of ≥3 sessions/week in Australia from 2001 to 2015. Indigenous patients and patient who received <90 days of HD were excluded. Initial dialysis prescription was categorised as 3 sessions/week compared to >3 sessions/week, and session durations ≤5 hours/session compared to >5 hours/session. The outcome of interest was patient mortality. Survival analysis was performed using Cox regression analysis, with multivariable analysis controlling for available covariates. In total, 16,944 patients were included in survival analyses with a combined follow up time of 54478.2 person-years. Both frequent and extended duration HD was associated with improved survival in univariate analysis with >3 sessions having a 44% reduced risk of mortality (HR = 0.56; 95% CI 0.48-0.64) and >5 hours session duration having a 68% reduced mortality risk (HR = 0.32; 95% CI 0.26-0.39). After controlling for frequency and other covariates, patients initiated on HD sessions >5 hours had a significantly reduced risk of mortality compared with patients with HD session ≤5 hours (adjusted HR = 0.57; 95% CI 0.44-0.74). In contrast, patients initiated on >3 sessions of HD per week had a similar risk of death when compared with patients on 3 sessions of HD per week (adjusted HR = 0.97; 95% CI 0.84-1.13), independent of session duration. Longer duration HD rather than increased frequency of treatment appears to reduce mortality in HD patients receiving at least 3 sessions per week. This has significant potential implications for management and requires further study.

Resource utilisation and description of patients perceived as receiving inappropriate critical care

ObjectiveMedical interventions that do not offer the patient meaningful benefit due to inconsistency with prognoses are often considered “inappropriate” by clinicians. We described the clinical details and resource utilisation of patients who were assessed as receiving inappropriate treatment. DesignChart abstraction was performed on 123 patients who were assessed by their critical care physician as having received inappropriate treatment to document clinical characteristics, diagnostic testing, life-sustaining treatments and nursing assessments of daily pain and level of consciousness. ResultsThe mean age was 67 and on admission, 41% had cancer and 25% had advanced pulmonary disease. At least one of the following three conditions was noted in 57% of the patients: severe neurological injury, overwhelming sepsis or irreversible respiratory failure. Patients were less likely to be alert (OR 0.39, CI 0.16–0.91, p = 0.03) on days they were assessed as receiving inappropriate critical care. After they were assessed as receiving inappropriate critical care, they received 172 imaging studies, 151 procedures, 522 days of mechanical ventilation (excludes one patient who received 1020 days of mechanical ventilation), 254 days of vasopressors, 226 days of hemodialysis and 10 attempts at cardiopulmonary resuscitation. ConclusionsPatients assessed as receiving inappropriate critical care receive resource-intensive medical care, largely while non-alert.

FP749The effect of short daily home hemodialysis with low-flow, lactate-buffered dialysate on nutritional status and body composition

FP749The effect of short daily home hemodialysis with low-flow, lactate-buffered dialysate on nutritional status and body composition

Evaluation of Daily Hemodialysis With Low Dialysate Flux in Unscheduled Patients With Kidney Injury Admitted to Hemodialysis

Evaluation of Daily Hemodialysis With Low Dialysate Flux in Unscheduled Patients With Kidney Injury Admitted to Hemodialysis

Daily hemodialysis practices in Australia/New Zealand and in France: a comparative cohort study

BackgroundAs patients on daily hemodialysis (DHD) have heterogeneous profiles, DHD benefit in terms of survival is still debated. The aim of this study was to compare DHD practices in France and in Australia and New Zealand.MethodsThis study was based on data from the French Renal Epidemiology and Information Network (REIN) and the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). All incident patients from both registries who underwent DHD (i.e., 5–6 sessions/week, including short daily hemodialysis and long nocturnal hemodialysis) at least once during their trajectories were included, and their characteristics and care trajectories were compared. For survival analyses, one French patient was matched to one Australian or New Zealand patient, based on age, sex and year of dialysis start. Survival was assessed using the Cox proportional hazards model, and access to renal transplantation was evaluated using the Fine & Gray model to take into account death as competing risk.ResultsBetween 2003 and 2012, 523 patients from the AZNDATA and 753 from the REIN registry started DHD. ANZDATA patients were younger (54.8 vs 64.0 years, p < 0.001) and had comorbidities more frequently than French patients. In both registries, one third of patients were on early DHD (i.e., DHD started less than one year after dialysis initiation). Long nocturnal hemodialysis was more frequent in the ANZDATA than in the REIN cohort (20.8 and 3%, respectively). Comparison of the matched subgroups showed comparable survival rates between French and Australian/New Zealand patients (HRadjusted = 1.08; 95%CI: 0.78–1.50). Access to renal transplantation also was similar between matched groups (SHRadjusted = 1.30, 95%CI: 0.86–1.97).ConclusionsOur study shows that, despite differences in terms of patients’ characteristics and DHD regimens, the mortality risk and access to renal transplantation are similar in France and Australia and New Zealand.

Synthetic 2018 data report of the French Language Peritoneal Dialysis and Home Hemodialysis Registry (RDPLF)

The RDPLF was created in 1986 and collects the main data of peritoneal dialysis of French patients and of various French-speaking countries. The database is structured in several modules: a compulsory core module including a follow-up of comorbidities, assistance, infections, survival, transplantation, and optional modules following more specific aspects: nursing, catheter, anemia, nutrition, heart failure. In addition, since 2012 patients treated at home in hemodialysis are also followed. This article presents a summary of the main characteristics of patients in the RDPLF in 2018. It highlights important differences in practices and patient profiles between francophone countries. Daily low dialysate flow rate hemodialysis is predominant in the new centers and sometimes begins to appear as a transitional mode that allows home maintenance for patients who cannot continue on peritoneal dialysis.

TCTAP C-191 A New Insight of In-stent Occlusion Following Subclavian Vein Stenting in Hemodialysis Patients: Intravascular Ultrasound and Angioscopy Findings

### Patient Initials or Identifier Number NH ### Relevant Clinical History and Physical Exam A 60-year-old male, treating on daily hemodialysis through the arteriovenous (AV) fistula in the left arm, presented with left arm swelling and ulcer with congestive dermatitis. He had a history of

The effect of increased frequency of hemodialysis on serum cystatin C and β2-microglobulin concentrations: A secondary analysis of the frequent hemodialysis network (FHN) trial.

Small molecular weight toxin clearance is the main method of assessment of hemodialysis efficiency. Middle molecules including cystatin C (CysC) and Beta-2 microglobulin (β2-M) are understudied. We hypothesized that lowering of predialysis CysC and β2-M serum concentrations would be affected by switching to more frequent hemodialysis. Predialysis CysC and β2-M serum concentrations were measured from serum samples of the Frequent Hemodialysis Network (FHN) Daily and Nocturnal Trials. The differences between predialysis concentrations at baseline (while on conventional thrice weekly dialysis) and those after 12-months of study (on more frequent dialysis) were compared separately by trial (Nocturnal, Daily). We tested the associations between predialysis serum CysC and β2-M concentrations and outcomes. Forty-nine percent and 52% of the patients from the FHN Daily and Nocturnal Trials respectively were included in this ancillary study. Predialysis serum CysC concentrations remained unchanged after intensifying hemodialysis dose by either modality. There was significant lowering of the serum β2-M concentrations in the frequent Daily Trial hemodialysis group at 12 months in all patients and in patients without residual renal function at baseline (-3.8 ± 12.62 μg/mL, P = 0.004; -5.9 ± 12.99 μg/mL, P = 0.02, respectively). There were no significant differences between the baseline and the 12-months predialysis β2-M serum concentrations in the two control groups (Daily 3× and Nocturnal 3× groups). No association between the changes in the two biomarkers between baseline and 12-months and in changes in left ventricular mass, physical-health composite scores, hospitalization rate, and death were found. The numbers of hospitalizations and deaths were small. β2-M may be a better biomarker of dialysis dose than CysC. Reduction in the concentration of potentially toxic long-lived proteins of the size of β-2M is one potential long-term benefit of more intensive dialysis that may be explored.

PERBEDAAN ASUPAN ZAT GIZI PASIEN HEMODIALISA DI RSUD dr. DORIS SYLVANUS PALANGKA RAYA

ABSTRACT&#x0D; Background: Hemodialysis is a catabolic process (breakdown of complex compounds into simpler compounds) in which amino acid removal and protein synthesis depletion occurred.&#x0D; Objective: To investigate differences in nutritional intake of hemodialysis patients at RSUD dr. Doris Sylvanus Palangka Raya.&#x0D; Research Methodology: This research is an observational research with Pre-post design. Purposive sampling technique was employed on 13 PGK patients who undertake weekly hemodialysis at RSUD dr. Doris Sylvanus Palangka Raya. Data of protein, sodium, potassium and oral intakes were obtained by interview and 24-hour food recall for 2 consecutive days of pre and post hemodialysis. BM photo book was used during interview and food recall. Data were analyzed using paired t-test.&#x0D; Result of the study: Most of samples were female (92%), ranged at 46-67 years old, graduated from elementary school and not working. Bivariate test showed p value of protein, sodium, potassium and fluid intakes were 0.022, 0.382, 0.075 and 0.836, respectively. Hemodialysis aims to restrain uremia, excessive fluid and electrolyte imbalance that occur in end-stage renal failure patients. Hemodialysis may increase survival rate of patients as it is effectively removing fluids, electrolytes and metabolites.&#x0D; Conclusion: There was a significant difference in protein intake and insignificant differences in sodium, potassium and fluid intakes of pre and post hemodialysis patients at RSUD dr. Doris Sylvanus Palangka Raya.&#x0D;

The association between longer haemodialysis treatment times and hospitalization and mortality after the two-day break in individuals receiving three times a week haemodialysis.

BackgroundOn the first haemodialysis (HD) day after the 2-day break in three times a week (3×W) in-centre HD, mortality and hospitalization are higher. If longer HD sessions prescribed 3×W is associated with a reduction in these events is unknown. MethodsHD session length in 19 557 prevalent European in-centre 3×W HD patients participating in the Dialysis Outcomes and Practice Patterns Study (1998–2011) were categorized into <200, 200–225, 226–250 or >250 min. Standardized event rates on the first (HD1) versus the second (HD2) HD day after the 2-day break, with supporting Cox proportional hazards models adjusted for patient and dialysis characteristics, were generated for all-cause mortality, all-cause hospitalization, out-of-hospital death and fluid overload hospitalization.ResultsBy comparing HD1 with HD2, increased rates of all endpoints were observed (all P < 0.002). As HD session lengthened across the four groups, all-cause mortality per 100 patient-years on the HD1 (23.0, 20.4, 16.4 and 14.6) and HD2 (26.1, 13.3, 13.4 and 12.1) reduced. Similar improvements were observed for out-of-hospital death but were less marked for hospitalization endpoints. However, even patients dialysing >250 min were at significantly greater risk on HD1 when compared with their HD2 for out-of-hospital death [hazard ratio (HR) = 2.1, 95% CI 1.0–4.3], all-cause hospitalization (HR = 1.3, 95% CI 1.2–1.4) and fluid overload hospitalization (HR = 3.2, 95% CI 1.8–6.0).ConclusionsDespite the association between reduced mortality across all dialysis days in patients performing longer sessions, elevated risk on the first dialysis day relative to the second persists even in patients dialysing 4.5 h 3×W.

Association Between Renal Function Pattern and Mortality in Patients With Cirrhosis

Renal dysfunction increases risk of death for patients with cirrhosis. We investigated whether mortality differs significantly among patients with acute kidney injury (AKI), chronic kidney disease (CKD), and both. We performed a retrospective analysis of all non-status 1 adults on the waitlist for liver transplantation for at least 90 days, collected from the Organ Procurement and Transplantation Network registry from July 1, 2007 through July 1, 2014. We assigned patients to groups of AKI (an increase of ≥0.3 mg/dL or ≥50% in serum creatinine in the last 7 days or fewer than 72 days of hemodialysis), CKD (an estimated glomerular filtration rate <60 ml/min/1.73 m2 for 90 days with a final rate ≥30 ml/min/1.73 m2 or ≥72 days of hemodialysis), AKI and CKD (meet both definitions), or normal (meet neither definition). We performed competing risk analyses to associate patterns of renal dysfunction with waitlist mortality, accounting for liver transplantation, with renal pattern as a time-dependent covariate. Logistic regression for 6-month mortality determined the added benefit of including renal function pattern in the assessment. There were 22,680 patients in the cohort; they spent a median 1.6 years (range, 0.7-3.1 years) on the waitlist and a median 5 years (range, 2-9 years) undergoing assessments of renal function. In competing risk analysis, even after adjusting for confounders including final model for end-stage liver disease sodium (MELD-Na) scores, the pattern of renal function was significantly associated with waitlist mortality: AKI and CKD (subhazard ratio [SHR], 2.86; 95% CI, 2.65-3.10), AKI (SHR, 2.42; 95% CI 2.22-2.64), CKD (SHR, 1.56; 95% CI, 1.45-1.67) compared with normal. The area under the curve values, based on MELD-Na score at time of placement on the waitlist, were 0.80 with renal function pattern and 0.71 without (P < .001). In competing risk analysis, even after adjusting for confounders including final MELD-Na score, we found the pattern of renal dysfunction to associate with mortality in patients with cirrhosis. Including information on type of renal dysfunction could improve risk analysis.

Antibiotic Dosing in Chronic Kidney Disease and End-Stage Renal Disease: A Focus on Contemporary Challenges.

Infections are an important cause of morbidity and mortality among patients with chronic kidney disease. Therefore, appropriate antibiotic dosing is imperative to achieve positive patient outcomes while minimizing antibiotic dose-related toxicity. Accurately assessing renal function and determining the influence of renal replacement therapy on antibiotic clearance makes drug dosing in this patient population challenging. Furthermore, as technological advances in hemodialysis and peritoneal dialysis occur, research incorporating newer dialysis parameters to guide drug dosing may not be readily available. Currently, there are limited data to guide drug dosing in the setting of automated peritoneal dialysis, short daily hemodialysis, and nocturnal hemodialysis. Antibiotic-dosing recommendations should be carefully evaluated considering the accuracy of the renal function assessment, the similarity of the operating characteristics of the renal replacement therapy studied compared with those being used, and whether the dosing strategy takes advantage of the pharmacodynamic profile of the antibiotic under consideration. After implementing the antibiotic-dosing regimen, therapeutic drug monitoring should occur when possible along with careful monitoring for antibiotic efficacy and safety.

Survival Comparisons of Home Dialysis Versus In-Center Hemodialysis: A Narrative Review.

Purpose of review:Many observational studies have demonstrated a survival benefit with home dialysis compared with in-center dialysis; however, results have been conflicting. The purpose of this review was to identify pitfalls and limitations in existing literature and examine the challenges of studying home and in-center dialysis populations.Sources of information:Original research articles were identified from MEDLINE using search terms “in-center hemodialysis,” “home hemodialysis,” “conventional hemodialysis,” “nocturnal hemodialysis,” and “short daily hemodialysis.”Methods:A focused review and critical appraisal of existing home versus in-center hemodialysis survival literature was conducted to identify potential causes for variability in the observed survival outcomes.Key findings:The controversy in existing literature stems from the challenges of randomizing patients to home versus in-center hemodialysis modalities, and therefore a reliance on observational comparisons for study. In many cases, these observational analyses have been limited by selection bias (variabilities in populations included, inclusion of both incident and prevalent cohorts, and variabilities in dialysis intensity), as well as residual confounding. Furthermore, the studies that do exist lack generalizability in many cases.Limitations:There are few randomized controlled trials examining the survival benefit of home versus in-center hemodialysis and existing observational studies are often limited by bias and reduced generalizability. These limitations comprise the body of this review.Implications:This review examines challenges surrounding survival comparisons with home versus in-center hemodialysis and identify important directions for future study.

Birth, Rise, Decline and Revival of Home Hemodialysis – French experience

The first publication in 1960 on maintenance hemodialysis was followed in 1963 by some reports on dialysis in the home. The introduction of proportioning pumps and concentrated electrolyte solutions led to developing single-patient machines and safety devices that made home hemodialysis possible. It was demonstrated in 1964 that home hemodialysis can be done overnight, unattended. This led to a steady rise in the number of patients treated at home. The percentage in France was ≈20% by the end of the seventies, out of a total of ≈ 6 000. The decline began when Public Health authorities authorized a program of ‘’limited – care’’ units. A loophole in the regulations led to a massive transfer of patients to these units and a rapid decline of home HD. The revival can be dated to 2012 with the development of disposable dialysate bags that make low flow daily home HD feasible. Efficacy and tolerability are such that the total number of patients treated at home rose from 307 in 2014 to 374 in 2016, owing to those on daily hemodialysis - an increase from 55 in 2014 to 374 in 2016 and 448 by the end of 2018. Currently, ≈46 000 patients are hemodialyzed in France. The % of those treated at home is very low but the trend is to a steady increase.

Calciphylaxie dans un contexte de maladie de Basedow : à propos d’un cas

BackgroundCalciphylaxis or calcific uremic arteriolopathy (CUA) is a cutaneous disease with ulcerations secondary to calcification of cutaneous and subcutaneous small arteries and arterioles. It is a rare but severe disease with significant morbidity and mortality affecting 1 to 4% of dialysis patients. The circumstances of occurrence are multiple. CaseWe report the case of a severe bilateral lower limb calciphylaxis in a 69-year-old, obese, hemodialysis patient with a recent diagnosis of Graves’ disease complicated with hypercalcemia and cardiac arrhythmia requiring the use of vitamin K antagonist. Complex and multidisciplinary therapeutic management (daily hemodialysis, sodium thiosulfate therapy, treatment of hypercalcemia by denosumab, hyperbaric oxygen therapy, meshed skin autograft) allowed complete healing of the lesions. ConclusionThis is the first description of AUC secondary to hyperthyroidism in a dialysis patient. Multidisciplinary care is essential to achieve clinical improvement in those critical situations.

Oral and maxillofacial surgery in patients undergoing dialysis for advanced renal disease: report of five cases

BackgroundPerioperativemanagement of hemodialysis patients involves many difficulties. High mortality rate and circulatory or respiratory complications in these patients were reported. However, in such reports, there is no concrete information of perioperative management in hemodialysis patients to prevent surgical complications and successful outcomes.Case presentationWe retrospectively reviewed the cases of 5 hemodialysis patients who underwent oral surgery under general anesthesia between January 2005 and December 2017.Primary disease was oral squamous cell carcinoma (SCC) in 4 patients and mandibular ameloblastoma in 1 patient. Partial resection was performed in 2 cases, neck dissection in 1 case. Two cases underwent surgery including vascularized reconstruction. The patients were dialyzed the day before and after surgery for the control of fluid and electrolyte status. Patients received intraoperative and postoperative intravenous infusion of potassium-free solution at 20–40 mL/h. Erythropoiesis-stimulating agents (ESAs) were used on the day of hemodialysis during hospitalization. Nafamostat mesilate as an anticoagulant during hemodialysis were used from postoperative day (POD)1 to 7. From POD 1 to 10, cephalosporin as prophylactic antibiotics is adjusted to quarter from half the initial dose. The resuming time of oral intake was similar to that of other oral surgery patients without kidney disease. The daily intake limits of protein, salt and liquid were managed during hospitalization and no cases suffered from malnutrition. No cardiorespiratory complications occurred during the perioperative period. In a case of vascularized osteocutaneous scapular flap reconstruction, grafted scapular bone survived and scapular cutaneous flap necrotized. Necrotic tissue was debrided and split thickness skin was successfully used to cover the grafted scapular bone.ConclusionsPostoperative better result could be achieved if adequate perioperative management specific to hemodialysis patients is carried out. Vascularized flap reconstruction at oral and maxillofacial region in hemodialysis patients is beneficial treatment. Even if the first flap has wound complication secondary flap reconstruction is success and aesthetically better results could be achieved by the strict wound management and debridement.

Effect of hemodialysis on respiratory mechanics in acute kidney injury patients.

Hemodialysis (HD) is one treatment for acute kidney injury (AKI) patients. Studies have shown that this dialysis modality may lead to changes in pulmonary function with an impact on prognosis. The aim of our study was to evaluate changes in respiratory mechanics and oxygenation of AKI patients admitted to an intensive care unit who were undergoing intermittent mechanical ventilation (IMV) and daily HD. This prospective cohort study evaluated 94 AKI patients and 234 HD sessions. Pulmonary static compliance (Pcs), resistance (Rsr), and arterial partial pressure of oxygen and the fraction of inspired oxygen (PaO2 /FiO2 ) ratio were assessed during the initial three-day period of daily HD therapy. Psc increased progressively during HD sessions, from 39.4 ± 21.4 mL/cm H2 O prior to the initial dialysis to 55.5 ± 25.2 at the end of the last dialysis during the study period (P = 0.04). Similarly, Rsr and PaO2 /FiO2 ratio also improved, from 11.1 ± 6.3 cm H2 O/L/s prior to the initial dialysis to 8.8 ± 4.2 at the end of the last dialysis (P =0.0027) and from 228 ± 85 prior to the initial dialysis to 312.1 ± 111.5, P < 0.001, to the end of the last dialysis, respectively. This study showed that AKI patients undergoing IMV and daily HD improve their respiratory mechanics and oxygenation.

Attitudes of nephrologists towards intensified hemodialysis .

Intensified hemodialysis (HD) programs have been developed to overcome the shortcomings of conventional HD. However, there are no data on the implementation of intensified HD programs into routine care. Therefore, we investigated the attitude of nephrologists towards intensified HD, its penetrance into clinical practice, and barriers to implementation. We performed an online survey within the German Society of Nephrology on the beliefs and attitudes towards intensified HD. 44% of the respondents believe that there is sufficient evidence in favor of intensified HD independent of whether the respondent offers intensified HD or not. Before expanding intensified HD, adequate funding (81%) and more staff (60%) are needed. 44% of the respondents offer intensified HD to their patients. The offer of intensified HD is made to the patients mainly if the patient is not adequately treated with conventional HD (50%); only 19% offer it routinely to all patients with CKD stage 4, in preparation for renal replacement therapy. 33% of the respondents offer short daily HD, 70% nocturnal intermittent, and 4% daily nocturnal. In 30% of the respondent centers, intensified dialysis is performed at home. Nearly one-half of the respondents already offer intensified HD. Inappropriate funding of intensified HD programs represents the most important barrier for further implementation. .

Home hemodialysis : is there still room for high dialysis solution flow rate ?

Abstract&#x0D; The availability in France, for the last decade, of low dialysate flow rate hemodialysis monitors, specifically adapted for daily hemodialysis (5 to 6 sessions per week), is contemporary with a real renewal of home hemodialysis. The clinical benefits of daily hemodialysis with high dialysate flow and of thrice-weekly long nocturnal hemodialysis, which are two intensive hemodialysis modalities, have been demonstrated ; however they are less well demonstrated with low dialysate flow hemodialysis. Thus, some patients may still wish to use conventional hemodialysis monitors in order to limit the number of sessions (and therefore the number of vascular punctures) to 3 per week (or every other day) or wish to benefit from a modality of intensive hemodialysis.