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Last Updated 06/19/16

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The benefits of daily hemodialysis treatments seem obvious. Daily treatments more closely resemble normal kidney function than three-times-a-week treatments. It also means fewer dietary and fluid restrictions as well as fewer medications. Patient testimonials about the benefits of daily treatments are abundant.

Medicare payment policy, also known as the composite rate, is based on three-times-a-week dialysis. This is, at first glance, less expensive for the government than daily treatments. Evidence is building, however, that daily treatments may result in overall lower healthcare costs for end-stage renal disease patients by reducing hospitalizations and lowering overall drug costs.

The most expensive cost component of a hemodialysis treatment is the patient-care (nursing) labor. This can be greatly reduced by performing hemodialysis treatments in the home. A new generation of home hemodialysis machines is currently under development that greatly simplifies their operation and reduces the burden on a home partner. The Internet also makes remote monitoring of the dialysis machines by trained professional staff affordable and convenient.

Warning:  Changes should never be made in a patient's treatment or care based solely on the information found here.  Every patient has unique healthcare concerns and considerations and all these factors must all be taken into account before any changes can be safely made.  All medical and therapeutic decisions must come from a qualified health care provider.  Read RenalWEB's Legal Disclaimer before proceeding.

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Effects of Physician Payment Reform on Provision of Home Dialysis - Full-text article from American Journal of Managed Care. - June 16, 2016
"Our findings indicate that economic incentives have had a substantial effect on physicians’ decisions regarding dialysis modality, and that payment reform had the unintended consequence of leading fewer patients to home dialysis. Since the choice of dialysis modality is central to patients’ quality of life, independence, and healthcare costs, a reduction in the use of home dialysis can be seen as a failure of the policy."

Editor's note: More evidence that financial incentives influence nephrologists' decisions in U.S. dialysis care more than scientific data. U.S. nephrology is in near complete denial about the pervasive negative effects of its greed.

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Phosphate Removal During Long Nocturnal Hemodialysis/Hemodiafiltration: A Study With Total Dialysate Collection - Abstract from Therapeutic Apheresis and Dialysis - June 16, 2016

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Study Protocol — The WISHED Trial: Implementation of an Interactive Health Communication Application for Patients with Chronic Kidney Disease - Free, full-text, Open Access article from Canadian Journal of Kidney Health and Disease. - June 15, 2016

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Social Workers Are a Valuable Resource to Help Home Dialyzors Cope with Dialysis - Posting from the KidneyViews blog. - June 2, 2016
"Too-high caseloads and inappropriate task assignment, barriers that can prevent social workers from performing these functions, need to be eliminated."

Editor's note: This is another huge disconnect between what is needed in dialysis care and what the financial incentives in dialysis care actually force upon professionals and patients.

Education alone will not change the behaviors of the large for-profit corporations. Until the financial incentives are changed, the many disconnects of U.S. dialysis care — short dialysis times, unmet psychosocial needs, low employment, nonexistent rehabilitation, underutilization of home therapies, no well-patient model — will remain ignored and unaddressed by the most powerful players in the industry.

These corporations found out long ago that they can eliminate professional criticisms by financially partnering with nephrologists and by donating money to patient advocacy groups that attempt to fill the gaps in well-patient dialysis care by providing education and support programs of their own.

Profit incentives in medicine can drive incredible breakthroughs. However, when profit incentives are not properly aligned with patients' best interests, it can also result in a system of self-defeating medical care that no professional would choose for themselves.

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Patient Experiences of Training and Transition to Home Hemodialysis: a Mixed Methods Study - Accepted Articles Abstract from Nephrology - June 2, 2016

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Conventional Hemodialysis Is Associated with Greater Bone Loss Than Nocturnal Hemodialysis: a Retrospective Observational Study of a Convenience Cohort - Free, full-text, Open Access article from Canadian Journal of Kidney Health and Disease. - June 1, 2016

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GUIDE, a Structured Predialysis Program That Increases the Use of Home Dialysis - Free, full-text, Advance Access article from Clinical Kidney Journal. - May 30, 2016

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blue ball Latest Scientific Journal Articles on Home and Daily Dialysis Continually Updated!
Home Dialysis Central web site
Nocturnal Home Haemodialysis web site
Home Dialyzors United web site
Current Issues of Home Dialysis Central Newsletter
Current Issue of At Home with AAKP an electronic newsletter produced and distributed by the American Association of Kidney Patients (AAKP)
Alliance for Home Dialysis web site
Home Hemodialysis Fact Sheet (pdf format requires Adobe Acrobat reader.) from the American Nephrology Nurses’ Association
PD and Home Hemo Coverage Maps from the Home Dialysis Central web site
Home Hemodialysis from the National Kidney Foundation (NKF) web site
Home Hemodialysis: Helping Patients Lead a Healthier Life online seminar from the American Association of Kidney Patients (AAKP)
Home Hemodialysis from the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)
Home Dialysis DVD from Home Dialysis Central web site
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new GUIDE, a Structured Predialysis Program That Increases the Use of Home Dialysis from Clinical Kidney Journal. - May 30, 2016

Home Dialysis Assessment Tool (pdf) from the Home Dialysis Central web site

Live healthier, better, longer with more frequent home hemodialysis an educational booklet that outlines the documented benefits and risks of home and more frequent home hemodialysis therapy from the NxStage web site

Book: Daily and Nocturnal Hemodialysis by Lindsay, Buoncristiani, Lockridge, Pierratos, and Ting © 2004

Book: Help, I Need Dialysis! How to have a good future with kidney disease by Dori Schatell, MS and Dr. John Agar © 2012

Nocturnal Home Hemodialysis - A First Person Account, Part I and Part II by Michael Williams

Self-Cannulation - Video via Renal Fellow Network web site

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A Home Dialysis Slide Show—And Sign Up For A Meeting! from the NxStage web site

blue ball Search result for Nocturnal dialysis by Google Continually Updated!
Home Dialysis web sites by Yahoo! Continually Updated!
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Find a home dialysis center in your area from the Home Dialysis Central web site
The following Frequently Asked Questions (FAQs) were prepared by the staff of the Nocturnal Home Hemodialysis (NHHD) program at the Humber River Regional Hospital in Toronto.
Lynchburg Nephrology (Virginia) has their Nightly Home Hemodialysis (NHHD) Program.
Rogosin Kidney Center of The Rogosin Institute is the first center in the New York City metropolitan area to offer patients nocturnal hemodialysis. This type of self care home dialysis offers patients independence and freedom for day time activities.

Four, well known, not-for-profit dialysis providers:

Northwest Kidney Centers
Satellite Healthcare

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  PUBMED SEARCHES (National Library of Medicine's MEDLINE Database)
daily dialysis AND hemodialysis Continually Updated!
home hemodialysis Continually Updated!
nocturnal AND dialysis Continually Updated!
MEDLINE / Pubmed Information from the National Library of Medicine
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  K/DOQI™ -  Kidney Disease Outcomes Quality Initiative
NKF-K/DOQI Clinical Practice Guidelines


Clinical Practice Guidelines and Clinical Practice Recommendations 2006 Updates
K/DOQI Home Page from the National Kidney Foundation web site
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Care-Partners for Home Dialysis discussion page
Daily, Home, Nocturnal Hemodialysis Discussion Forum - RenalWEB Discussion Forum
Home Dialysis Central Face Book discussion page
Home Dialyzors United Face Book discussion page
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Adequate Hemodialysis Therapy - topic page from RenalWEB
Hemodialysis Dose and Adequacy from NIDDK
Clinical Practice Guideline on Adequacy of Hemodialysis - a book available from the Renal Physicians Association web site
Consensus Statement: Mortality and Morbidity of Dialysis from the NIH Consensus Development Program (written in 1993 with 1998 update)
United States Renal Data System (USRDS) 
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E-mail to RenalWEB on the Hemodialysis Adequacy Topic
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