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Last Updated 05/10/15

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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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Temporal Changes in Mortality Risk by Dialysis Modality in the Australian and New Zealand Dialysis Population - Article in Press abstract from American Journal of Kidney Diseases. - May 6, 2015
"Our study indicates that outcomes on dialysis therapy are improving with time and that this improvement is most marked with home dialysis modalities, especially home HD."

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Follow-On Study Finds Increased Mortality With Frequent Nocturnal Dialysis - (Registration required, but free.) Reuters article via Medscape. - May 4, 2015
Editor's note: Must-read commentary by Dr. John Agar.

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NxStage Establishes New Scientific Advisory Board to Build Clinical Evidence and Drive Adoption of Home Hemodialysis Therapy - Press release. - May 4, 2015

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Intensive Home Hemodialysis: an Eye at the Past Looking for the Hemodialysis of the Future - Early View abstract from Artificial Organs. - April 29, 2015

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An Education Initiative Modifies Opinions of Hemodialysis Nurses Towards Home Dialysis - Abstract and full-text article (8-page pdf) from Canadian Journal of Kidney Health and Disease. - April 28, 2015

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Special Issue: An Open-Source Practical Manual for Home Hemodialysis - 12 free, full-text articles from Hemodialysis International. - April 2015

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A Sad Direction in Home Dialysis Research: The FHN 2 Nocturnal Survival Analysis - Blog posting by Dr. John Agar from Home Dialysis Central. - April 23, 2015
Editor's note: When the AJKD Article in Press abstract appeared on April 9th, I immediately e-mailed lead author Dr. Michael Rocco and requested the full-text article. I wanted to read the entire document before commenting. At the same time I specifically asked him why the "elite" of U.S. nephrology would reach such a conclusion from such an underpowered study and then publish it in a top journal. When he did not reply, I repeated the request. I have still not heard from him.

I fear this awful paper will be used to justify the denial of patient requests for home and nocturnal hemodialysis.

In my opinion, this paper serves primarily to protect U.S. nephrologists' legal positions and business interests.

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Absurd! EPOCH-RRT Study "Decision Aid" Won't Include Home Hemodialysis - Posting by Dr. John Agar from Home Dialysis Central. - April 16, 2015
Editor's note: It is time to recognize that, as a group, U.S. dialysis-care nephrologists are the worst physicians in the U.S. Their field of medicine has lagged far behind all others. They have greatly increased the unemployment rate among working-age patients over the course of the last 40 years. They are heavily invested in brick-and-mortar clinics that continually harm patients with inadequate and inappropriate care, which they would never accept for themselves. They are holding patients hostage in their clinics, demanding more money from CMS for home dialysis training.

Forty years ago, U.S. nephrologists make a huge mistake when they agreed that time on dialysis did not matter, only small molecule clearances did. They then built an industry based on that theory which provides fast, cheap, in-center dialysis to nearly all. Unfortunately, no nephrologist today would say that time on dialysis does not matter, but few changes have been made.

U.S. nephrologists were wrong and dialysis patients have been being harmed and dying prematurely in the U.S. unnecessarily for decades. This care has also made employment and rehabilitation nearly impossible. When will they finally find leadership that will admit all this and address these problems?

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In-Center Nocturnal Hemodialysis: the Experience of a Center - (6-page pdf) Article from the Portuguese Journal of Nephrology & Hypertension. - January-March 2015

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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 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

Clinical Practice Guidelines and Clinical Practice Recommendations 2006 Updates
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)
United States Renal Data System (USRDS) 
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E-mail to RenalWEB on the Hemodialysis Adequacy Topic
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