A crossover study of short daily haemodialysis
Background. The benefits of daily haemodialysis (DHD) compared to conventional three times per week haemodialysis (CHD) have been described in a number of observational studies. Most of these previous studies however have not been performed with rigorous controls. Methods. We performed a crossover s...
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Published in | Nephrology, dialysis, transplantation Vol. 21; no. 1; pp. 166 - 175 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
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Oxford
Oxford University Press
01.01.2006
Oxford Publishing Limited (England) |
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Abstract | Background. The benefits of daily haemodialysis (DHD) compared to conventional three times per week haemodialysis (CHD) have been described in a number of observational studies. Most of these previous studies however have not been performed with rigorous controls. Methods. We performed a crossover study following an A-B-A design: phase A was 4 weeks of thrice weekly dialysis, 3–4 h per treatment (CHD); phase B was 8 weeks of six times/week dialysis, each session being one-half of the usual time (DHD) and phase A with 4 weeks of thrice weekly dialysis (CHD) was repeated. Patients characteristics: n = 12, six males; age 52±18 years, six diabetics. Results. Weekly single-pool Kt/V, equilibrated Kt/V and standard Kt/V of urea, and β-2-microglobulin clearance values were greater during DHD. Eight of 12 patients who completed the study reported symptomatic benefits from DHD that partially or completely disappeared during the second period of CHD. Quality of life of patients improved during DHD. Three patients had problems with arteriovenous access during DHD. Average blood pressure was lower during DHD (systolic 139.5±22.7 mmHg) compared to the initial (147.7±21.4 mmHg, P<0.001) and last (146.4±20.0 mmHg, P<0.005) CHD periods. No significant changes in predialysis haemoglobin and the serum concentration of albumin, phosphate, β-2-microglobulin or B-type natriuretic peptides (BNP) were observed, although BNP trended downward during DHD and returned to baseline level during the second period of CHD. The dose of erythropoietin did not change significantly. Patient compliance with the dialysis schedule was lower during DHD. Dialysis staff perceived an increased workload but felt that the patients benefited medically from DHD. Conclusions. The results of this cross-over study suggest symptomatic benefits and decrease in blood pressure, but there are potential problems with compliance and vascular access during DHD. |
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AbstractList | The benefits of daily haemodialysis (DHD) compared to conventional three times per week haemodialysis (CHD) have been described in a number of observational studies. Most of these previous studies however have not been performed with rigorous controls.
We performed a crossover study following an A-B-A design: phase A was 4 weeks of thrice weekly dialysis, 3-4 h per treatment (CHD); phase B was 8 weeks of six times/week dialysis, each session being one-half of the usual time (DHD) and phase A with 4 weeks of thrice weekly dialysis (CHD) was repeated. Patients characteristics: n=12, six males; age 52+/-18 years, six diabetics.
Weekly single-pool Kt/V, equilibrated Kt/V and standard Kt/V of urea, and beta-2-microglobulin clearance values were greater during DHD. Eight of 12 patients who completed the study reported symptomatic benefits from DHD that partially or completely disappeared during the second period of CHD. Quality of life of patients improved during DHD. Three patients had problems with arteriovenous access during DHD. Average blood pressure was lower during DHD (systolic 139.5+/-22.7 mmHg) compared to the initial (147.7+/-21.4 mmHg, P<0.001) and last (146.4+/-20.0 mmHg, P<0.005) CHD periods. No significant changes in predialysis haemoglobin and the serum concentration of albumin, phosphate, beta-2-microglobulin or B-type natriuretic peptides (BNP) were observed, although BNP trended downward during DHD and returned to baseline level during the second period of CHD. The dose of erythropoietin did not change significantly. Patient compliance with the dialysis schedule was lower during DHD. Dialysis staff perceived an increased workload but felt that the patients benefited medically from DHD.
The results of this cross-over study suggest symptomatic benefits and decrease in blood pressure, but there are potential problems with compliance and vascular access during DHD. Background. The benefits of daily haemodialysis (DHD) compared to conventional three times per week haemodialysis (CHD) have been described in a number of observational studies. Most of these previous studies however have not been performed with rigorous controls. Methods. We performed a crossover study following an A-B-A design: phase A was 4 weeks of thrice weekly dialysis, 3–4 h per treatment (CHD); phase B was 8 weeks of six times/week dialysis, each session being one-half of the usual time (DHD) and phase A with 4 weeks of thrice weekly dialysis (CHD) was repeated. Patients characteristics: n = 12, six males; age 52±18 years, six diabetics. Results. Weekly single-pool Kt/V, equilibrated Kt/V and standard Kt/V of urea, and β-2-microglobulin clearance values were greater during DHD. Eight of 12 patients who completed the study reported symptomatic benefits from DHD that partially or completely disappeared during the second period of CHD. Quality of life of patients improved during DHD. Three patients had problems with arteriovenous access during DHD. Average blood pressure was lower during DHD (systolic 139.5±22.7 mmHg) compared to the initial (147.7±21.4 mmHg, P<0.001) and last (146.4±20.0 mmHg, P<0.005) CHD periods. No significant changes in predialysis haemoglobin and the serum concentration of albumin, phosphate, β-2-microglobulin or B-type natriuretic peptides (BNP) were observed, although BNP trended downward during DHD and returned to baseline level during the second period of CHD. The dose of erythropoietin did not change significantly. Patient compliance with the dialysis schedule was lower during DHD. Dialysis staff perceived an increased workload but felt that the patients benefited medically from DHD. Conclusions. The results of this cross-over study suggest symptomatic benefits and decrease in blood pressure, but there are potential problems with compliance and vascular access during DHD. BACKGROUNDThe benefits of daily haemodialysis (DHD) compared to conventional three times per week haemodialysis (CHD) have been described in a number of observational studies. Most of these previous studies however have not been performed with rigorous controls.METHODSWe performed a crossover study following an A-B-A design: phase A was 4 weeks of thrice weekly dialysis, 3-4 h per treatment (CHD); phase B was 8 weeks of six times/week dialysis, each session being one-half of the usual time (DHD) and phase A with 4 weeks of thrice weekly dialysis (CHD) was repeated. Patients characteristics: n=12, six males; age 52+/-18 years, six diabetics.RESULTSWeekly single-pool Kt/V, equilibrated Kt/V and standard Kt/V of urea, and beta-2-microglobulin clearance values were greater during DHD. Eight of 12 patients who completed the study reported symptomatic benefits from DHD that partially or completely disappeared during the second period of CHD. Quality of life of patients improved during DHD. Three patients had problems with arteriovenous access during DHD. Average blood pressure was lower during DHD (systolic 139.5+/-22.7 mmHg) compared to the initial (147.7+/-21.4 mmHg, P<0.001) and last (146.4+/-20.0 mmHg, P<0.005) CHD periods. No significant changes in predialysis haemoglobin and the serum concentration of albumin, phosphate, beta-2-microglobulin or B-type natriuretic peptides (BNP) were observed, although BNP trended downward during DHD and returned to baseline level during the second period of CHD. The dose of erythropoietin did not change significantly. Patient compliance with the dialysis schedule was lower during DHD. Dialysis staff perceived an increased workload but felt that the patients benefited medically from DHD.CONCLUSIONSThe results of this cross-over study suggest symptomatic benefits and decrease in blood pressure, but there are potential problems with compliance and vascular access during DHD. |
Author | Kutner, Nancy G. Cheung, Alfred K. Goldfarb-Rumyantzev, Alexander S. Leypoldt, John K. Nelson, Natalia |
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Cites_doi | 10.1097/00002480-199711000-00011 10.1159/000057427 10.1159/000065280 10.1056/NEJMoa010877 10.1053/j.ajkd.2003.09.017 10.1007/BF00451725 10.1016/S0272-6386(03)00537-7 10.1046/j.1523-1755.1999.00493.x 10.1681/ASN.V451205 10.1016/S0272-6386(03)00535-3 10.1053/ajkd.2001.20758 10.1016/S0272-6386(03)00531-6 10.1111/j.0894-0959.2004.17203.x 10.1111/j.0894-0959.2004.17212.x 10.1111/hdi.1999.3.1.41 10.1159/000073015 10.1016/S0272-6386(03)00533-X 10.1016/S0272-6386(03)00532-8 10.1016/S0272-6386(03)00534-1 10.1097/00002480-200201000-00012 |
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Keywords | Kidney disease urea kinetics Urinary system disease Prognosis Hemodialysis Quality of life Extrarenal dialysis Urea quotidian haemodialysis Renal failure daily haemodialysis Arterial pressure Blood pressure outcome |
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Notes | local:gfi116 Correspondence and offprint requests to: Alexander S. Goldfarb-Rumyantzev, Division of Nephrology and Hypertension, University of Utah Health Sciences Center, 85 North Medical Drive, East Rm 201, Salt Lake City, UT 84112, USA. Email: alex.goldfarb@hsc.utah.edu istex:5E165FD3F3BA0F7DAF6C11062007C906348D382B ark:/67375/HXZ-V9KZRK3H-1 ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 |
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Snippet | Background. The benefits of daily haemodialysis (DHD) compared to conventional three times per week haemodialysis (CHD) have been described in a number of... The benefits of daily haemodialysis (DHD) compared to conventional three times per week haemodialysis (CHD) have been described in a number of observational... BACKGROUNDThe benefits of daily haemodialysis (DHD) compared to conventional three times per week haemodialysis (CHD) have been described in a number of... |
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SubjectTerms | Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences blood pressure Blood Pressure Determination Cross-Over Studies daily haemodialysis Emergency and intensive care: renal failure. Dialysis management Female Humans Intensive care medicine Kidney Failure, Chronic - diagnosis Kidney Failure, Chronic - therapy Kidney Function Tests Male Medical sciences Middle Aged Nephrology. Urinary tract diseases Nephropathies. Renovascular diseases. Renal failure outcome Patient Compliance Probability Prognosis Quality of Life quotidian haemodialysis Renal Dialysis - methods Renal failure Risk Assessment Severity of Illness Index Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system Time Factors Treatment Outcome Urea - blood urea kinetics |
Title | A crossover study of short daily haemodialysis |
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