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Last Updated 6/22/14

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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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Home Dialyzors United Adds Board Member and Makes Committee Appointments - June 19, 2014

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Don's Story: When People Feel Better, They Live Better - Video from NxStage. - June 2014

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Optimized Dosing of Cefazolin in Patients Treated With Nocturnal Home Hemodialysis - Articles in Press Abstract from American Journal Of Kidney Diseases - June 11, 2014

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Home Dialyzors United Responds to the 21st Century Cures Initiative - Letter to the House Committee on Energy and Commerce. - June 9, 2014
Editor's note: Be sure to read the patients' comments at the end of the letter.

"Dialysis machines have evolved extremely slowly for about 50 years. I usually say that if the evolution in consumer electronics had followed that of dialysis machines, my laptop would be the size of Manhattan."

"Unlike other diseases, like some forms of cancer, where huge gains have been made in the last forty years, dialysis is still back in the 1970s."

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Cardiovascular Remodeling during Long-Term Nocturnal Home Hemodialysis - Free, full-text, Online First article from Clinical and Experimental Nephrology. - June 4, 2014
Conclusions: Long-term nocturnal hemodialysis leads to favorable cardiovascular remodeling with a reduction in cavity dimensions, regression of left ventricular hypertrophy, and an improvement in diastolic function, as assessed by both transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR).
Editor's note: This industry is still causing myocardial stunning in most patients.

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Baxter Presents Efficacy and Safety Data on VIVIA Haemodialysis System at ERA-EDTA Congress - Press release. Their approach will utilize the VIVIA machine, which has received the CE Mark for use in Europe. Also see Baxter's High Dose Haemodialysis web site. - June 3, 2014
"Moreover, while conventional haemodialysis sustains life, it rarely restores health."

Editor's note: Finally, the therapy option that most dialysis professionals would choose for themselves is identified by a major industry player.

Will Fresenius and DaVita embrace this or will the need for profits drive them in another direction?

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How Do Hospitalization Patterns of Home Hemodialysis Patients Compare with a Reasonably Well Dialysis Patient Cohort? - Abstract from International Journal of Nephrology and Renovascular Disease. - May 2014

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Home Hemodialysis: Beliefs, Attitudes, and Practice Patterns - Early View abstract from Hemodialysis International. - May 11, 2014

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Home Dialysis: More Than Just a Convenience? - (Registration required, but free.) Article from MedPage Today. - May 9, 2014

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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)
Home At Last Newsletter from the NxStage 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 (pdf format requires Adobe Acrobat reader) 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
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
American Nephrology Nurses Association (ANNA web site) position on daily home hemodialysis

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
Rubin Diaylsis Center
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 Table of Contents

Clinical Practice Guidelines and Clinical Practice Recommendations 2008 Updates

I. Measurement of Hemodialysis Adequacy (Guidelines 1-3)

II. Hemodialysis Dose (Guidelines 4-6)

III. Blood Urea Nitrogen (BUN) Sampling (Guidelines 7-9)

V. Hemodialysis Dose Troubleshooting (Guideline 14)

VI. Maximizing Patient Compliance to the Hemodialysis Prescription (Guidelines 15-16)
K/DOQI Home Page from the National Kidney Foundation web site
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Daily, Home, Nocturnal Hemodialysis Discussion Forum - RenalWEB Discussion Forum
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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)
Statistical Analyses on dialysis patient hospitalization rates, morbidity, mortality, and more from Chronic Disease Research Group (CDRG)
United States Renal Data System (USRDS) 
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E-mail to RenalWEB on the Hemodialysis Adequacy Topic
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