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Clinical, patient-related, and economic outcomes of home-based high-dose hemodialysis versus conventional in-center hemodialysis.

Mitsides N, Mitra S, Cornelis T - Int J Nephrol Renovasc Dis (2016)

Bottom Line: In the last 20 years, the focus of development in the field of hemodialysis (HD) has centered around adequate removal of urea and other associated toxins.However, the uptake of this modality is low, and the risk associated with the therapy is not fully understood.Recent studies have highlighted the evidence base and improved our understanding of this technique of dialysis.

View Article: PubMed Central - PubMed

Affiliation: Department of Renal Medicine, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Center, Manchester; National Institute for Healthcare Research Devices for Dignity Healthcare Co-operative, Sheffield, UK.

ABSTRACT
Despite technological advances in renal replacement therapy, the preservation of health and quality of life for individuals on dialysis still remains a challenge. The high morbidity and mortality in dialysis warrant further research and insight into the clinical domains of the technique and practice of this therapy. In the last 20 years, the focus of development in the field of hemodialysis (HD) has centered around adequate removal of urea and other associated toxins. High-dose HD offers an opportunity to improve mortality, morbidity, and quality of life of patients with end-stage kidney disease. However, the uptake of this modality is low, and the risk associated with the therapy is not fully understood. Recent studies have highlighted the evidence base and improved our understanding of this technique of dialysis. This article provides a review of high-dose and home HD, its clinical impact on patient outcome, and the controversies that exist.

No MeSH data available.


Related in: MedlinePlus

Target populations for high-dose home HD.Abbreviations: HD, hemodialysis; HTN, hypertension; LVH, left ventricular hypertrophy; ECF, extracellular fluid; CV, cardiovascular; ESRD, end-stage renal disease; NRSOT, nonrenal solid organ transplantation; QoL, quality of life; PD, peritoneal dialysis; OSA, obstructive sleep apnea.
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f1-ijnrd-9-151: Target populations for high-dose home HD.Abbreviations: HD, hemodialysis; HTN, hypertension; LVH, left ventricular hypertrophy; ECF, extracellular fluid; CV, cardiovascular; ESRD, end-stage renal disease; NRSOT, nonrenal solid organ transplantation; QoL, quality of life; PD, peritoneal dialysis; OSA, obstructive sleep apnea.

Mentions: All patients going through predialysis education clinic who are capable and willing could be offered the choice of home HD as a form of a home-based therapy (Figure 1). Some of these patients and those established on a dialysis modality could be targeted for consideration of high-dose home HD.79 Patients with ESRD with persistent extracellular fluid overload, severe hypertension and/or LVH, hemodynamic instability, resistant hyperphosphatemia as well as pregnant women or women on dialysis who wish to conceive are established target populations for consideration of high-dose home HD. Sleep apnea, reduced QoL, uremic symptoms, and persistent inflammation/oxidative stress are other factors that should also trigger the consideration of high-dose home HD in a dialysis patient (suggested target population). In addition to these target populations, there are emerging patient groups for whom high-dose home HD may also be considered. These range from caregiver-dependent patients (both patients and caregivers generally prefer a home-based dialysis therapy), crash starters, employed patients, patients with failing transplants, patients with failing PD, and morbid obese and elderly patients with ESRD.80 Although the list of target populations for home high-dose HD is extensive, it is by no means exclusive. High-dose HD may be considered for management of rare and challenging conditions such as severe hyperoxaluria where significant benefits of frequent NHD have been reported.81


Clinical, patient-related, and economic outcomes of home-based high-dose hemodialysis versus conventional in-center hemodialysis.

Mitsides N, Mitra S, Cornelis T - Int J Nephrol Renovasc Dis (2016)

Target populations for high-dose home HD.Abbreviations: HD, hemodialysis; HTN, hypertension; LVH, left ventricular hypertrophy; ECF, extracellular fluid; CV, cardiovascular; ESRD, end-stage renal disease; NRSOT, nonrenal solid organ transplantation; QoL, quality of life; PD, peritoneal dialysis; OSA, obstructive sleep apnea.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940011&req=5

f1-ijnrd-9-151: Target populations for high-dose home HD.Abbreviations: HD, hemodialysis; HTN, hypertension; LVH, left ventricular hypertrophy; ECF, extracellular fluid; CV, cardiovascular; ESRD, end-stage renal disease; NRSOT, nonrenal solid organ transplantation; QoL, quality of life; PD, peritoneal dialysis; OSA, obstructive sleep apnea.
Mentions: All patients going through predialysis education clinic who are capable and willing could be offered the choice of home HD as a form of a home-based therapy (Figure 1). Some of these patients and those established on a dialysis modality could be targeted for consideration of high-dose home HD.79 Patients with ESRD with persistent extracellular fluid overload, severe hypertension and/or LVH, hemodynamic instability, resistant hyperphosphatemia as well as pregnant women or women on dialysis who wish to conceive are established target populations for consideration of high-dose home HD. Sleep apnea, reduced QoL, uremic symptoms, and persistent inflammation/oxidative stress are other factors that should also trigger the consideration of high-dose home HD in a dialysis patient (suggested target population). In addition to these target populations, there are emerging patient groups for whom high-dose home HD may also be considered. These range from caregiver-dependent patients (both patients and caregivers generally prefer a home-based dialysis therapy), crash starters, employed patients, patients with failing transplants, patients with failing PD, and morbid obese and elderly patients with ESRD.80 Although the list of target populations for home high-dose HD is extensive, it is by no means exclusive. High-dose HD may be considered for management of rare and challenging conditions such as severe hyperoxaluria where significant benefits of frequent NHD have been reported.81

Bottom Line: In the last 20 years, the focus of development in the field of hemodialysis (HD) has centered around adequate removal of urea and other associated toxins.However, the uptake of this modality is low, and the risk associated with the therapy is not fully understood.Recent studies have highlighted the evidence base and improved our understanding of this technique of dialysis.

View Article: PubMed Central - PubMed

Affiliation: Department of Renal Medicine, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Center, Manchester; National Institute for Healthcare Research Devices for Dignity Healthcare Co-operative, Sheffield, UK.

ABSTRACT
Despite technological advances in renal replacement therapy, the preservation of health and quality of life for individuals on dialysis still remains a challenge. The high morbidity and mortality in dialysis warrant further research and insight into the clinical domains of the technique and practice of this therapy. In the last 20 years, the focus of development in the field of hemodialysis (HD) has centered around adequate removal of urea and other associated toxins. High-dose HD offers an opportunity to improve mortality, morbidity, and quality of life of patients with end-stage kidney disease. However, the uptake of this modality is low, and the risk associated with the therapy is not fully understood. Recent studies have highlighted the evidence base and improved our understanding of this technique of dialysis. This article provides a review of high-dose and home HD, its clinical impact on patient outcome, and the controversies that exist.

No MeSH data available.


Related in: MedlinePlus