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Thrice-Weekly Nocturnal In-Centre Haemodiafiltration: A 2-Year Experience.

Dey V, Hair M, So B, Spalding EM - Nephron Extra (2015)

Bottom Line: The use of quotidian nocturnal dialysis is effective but not practical in the in-centre setting.The pre-dialysis phosphate level fell from a mean of 1.52 ± 0.4 to 1.06 ± 0.1 mmol/l (p < 0.05).The average binder intake of 3.26 ± 2.6 tablets was eliminated.

View Article: PubMed Central - PubMed

Affiliation: John Stevenson Lynch Renal Unit, Crosshouse Hospital, Kilmarnock, UK.

ABSTRACT

Background: Adequate control of plasma phosphate without phosphate binders is difficult to achieve on a thrice-weekly haemodialysis schedule. The use of quotidian nocturnal dialysis is effective but not practical in the in-centre setting. This quality improvement project was set up as an exercise allowing the evaluation of small-solute clearance by combining convection with extended-hour dialysis in a thrice-weekly hospital setting.

Methods: A single-centred, prospective analysis of patients' electronic records was performed from August 2012 to July 2014. The duration of haemodiafiltration was increased from a median of 4.5 to 8 h. Dialysis adequacy, biochemical parameters and medications were reviewed on a monthly basis. A reduction in plasma phosphate was anticipated, so all phosphate binders were stopped.

Results: Since inception, 14 patients have participated with over 2,000 sessions of dialysis. The pre-dialysis phosphate level fell from a mean of 1.52 ± 0.4 to 1.06 ± 0.1 mmol/l (p < 0.05). The average binder intake of 3.26 ± 2.6 tablets was eliminated. A normal plasma phosphate range has been maintained with increased dietary phosphate intake and no requirement for intradialytic phosphate supplementation.

Conclusion: Phosphate control can be achieved without the need for binders or supplementation on a thrice-weekly in-centre haemodiafiltration program.

No MeSH data available.


Significant reduction in the use of phosphate binders (p < 0.05 at 3, 6, 9 and 24 months) and phosphate levels (p < 0.05 at 24 months) on conversion from standard 4-hour HDF to nocturnal 8-hour HDF. Means ± standard deviations are given. * n = 9, † n = 5, where n is the number of patients.
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Figure 1: Significant reduction in the use of phosphate binders (p < 0.05 at 3, 6, 9 and 24 months) and phosphate levels (p < 0.05 at 24 months) on conversion from standard 4-hour HDF to nocturnal 8-hour HDF. Means ± standard deviations are given. * n = 9, † n = 5, where n is the number of patients.

Mentions: The pre-dialysis phosphate level fell from a mean of 1.52 ± 0.41 to 1.21 ± 0.2, 1.26 ± 0.45, 1.28 ± 0.32 and 1.06 ± 0.13 mmol/l at 3, 6, 9 and 24 months, respectively (p < 0.05 at 24 months; table 1; fig. 1). The use of binders dropped from an average of 3.26 ± 2.63 tablets to zero (p < 0.05; table 1; fig. 1). None of the patients have required recommencement of a phosphate binder or supplementation during dialysis due to low phosphate levels.


Thrice-Weekly Nocturnal In-Centre Haemodiafiltration: A 2-Year Experience.

Dey V, Hair M, So B, Spalding EM - Nephron Extra (2015)

Significant reduction in the use of phosphate binders (p < 0.05 at 3, 6, 9 and 24 months) and phosphate levels (p < 0.05 at 24 months) on conversion from standard 4-hour HDF to nocturnal 8-hour HDF. Means ± standard deviations are given. * n = 9, † n = 5, where n is the number of patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4592506&req=5

Figure 1: Significant reduction in the use of phosphate binders (p < 0.05 at 3, 6, 9 and 24 months) and phosphate levels (p < 0.05 at 24 months) on conversion from standard 4-hour HDF to nocturnal 8-hour HDF. Means ± standard deviations are given. * n = 9, † n = 5, where n is the number of patients.
Mentions: The pre-dialysis phosphate level fell from a mean of 1.52 ± 0.41 to 1.21 ± 0.2, 1.26 ± 0.45, 1.28 ± 0.32 and 1.06 ± 0.13 mmol/l at 3, 6, 9 and 24 months, respectively (p < 0.05 at 24 months; table 1; fig. 1). The use of binders dropped from an average of 3.26 ± 2.63 tablets to zero (p < 0.05; table 1; fig. 1). None of the patients have required recommencement of a phosphate binder or supplementation during dialysis due to low phosphate levels.

Bottom Line: The use of quotidian nocturnal dialysis is effective but not practical in the in-centre setting.The pre-dialysis phosphate level fell from a mean of 1.52 ± 0.4 to 1.06 ± 0.1 mmol/l (p < 0.05).The average binder intake of 3.26 ± 2.6 tablets was eliminated.

View Article: PubMed Central - PubMed

Affiliation: John Stevenson Lynch Renal Unit, Crosshouse Hospital, Kilmarnock, UK.

ABSTRACT

Background: Adequate control of plasma phosphate without phosphate binders is difficult to achieve on a thrice-weekly haemodialysis schedule. The use of quotidian nocturnal dialysis is effective but not practical in the in-centre setting. This quality improvement project was set up as an exercise allowing the evaluation of small-solute clearance by combining convection with extended-hour dialysis in a thrice-weekly hospital setting.

Methods: A single-centred, prospective analysis of patients' electronic records was performed from August 2012 to July 2014. The duration of haemodiafiltration was increased from a median of 4.5 to 8 h. Dialysis adequacy, biochemical parameters and medications were reviewed on a monthly basis. A reduction in plasma phosphate was anticipated, so all phosphate binders were stopped.

Results: Since inception, 14 patients have participated with over 2,000 sessions of dialysis. The pre-dialysis phosphate level fell from a mean of 1.52 ± 0.4 to 1.06 ± 0.1 mmol/l (p < 0.05). The average binder intake of 3.26 ± 2.6 tablets was eliminated. A normal plasma phosphate range has been maintained with increased dietary phosphate intake and no requirement for intradialytic phosphate supplementation.

Conclusion: Phosphate control can be achieved without the need for binders or supplementation on a thrice-weekly in-centre haemodiafiltration program.

No MeSH data available.