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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.

  NEWS & LATEST ARTICLES
NxStage System One: Saying Goodbye to Headaches - Blog entry by Peter Laird, MD and dialysis patient, from Dialysis from the Sharp End of the Needle. - February 17, 2010
First Quincy Medical Group Patient Finds Success Using Nocturnal Home Dialysis - Article from the Herald-Whig (MA). - February 16, 2010
"Schmidt has done every kind of dialysis, and she's on a list awaiting for a kidney transplant. But after a month on nocturnal home hemodialysis, Schmidt's lab results confirmed what she already felt -- that the machine works for her almost as well as a normal kidney."
Nurse-Patient Communication While Perfroming Home Dialysis: The Patients' Perceptions - Abstract from Journal of Renal Care. - February 15, 2010
Taking NxStage System One to the Max - Blog entry by Peter Laird, MD and dialysis patient, from Dialysis from the Sharp End of the Needle. - February 12, 2010
Quality of Life and Alternate Nightly Nocturnal Home Hemodialysis - Abstract from Hemodialysis International. - February 11, 2010
NxStage® Signs Distribution Agreement for Sweden, Denmark and Finland - Article from CNN Money. - February 3, 2010
Illinois Dialysis Patient Advocates for Home Treatment - Article on Rich Berkowitz from the Skokie Review. - February 1, 2010
Solute Kinetics with Short-Daily Home Hemodialysis Using Slow Dialysate Flow Rate - Abstract from Hemodialysis International. - January 2010
Arranging Your Life When Dialysis Comes Home - Article from Home Dialysis Central. - January 20, 2010
NIOSH Hazard Review: Occupational Hazards in Home Healthcare - January 2010
DaVita Appoints Dr. John Moran as Vice President, Clinical Affairs - Home Therapies - Press release. - January 19, 2010
Daily Online Hemodiafiltration: The Perfect ‘Stimulus Package’ To Induce Growth? (in children) - Free, full-text, Advance Access editorial commentary from NDT. - January 18, 2010

PPS Comments to Medicare show the way forward: higher dialysis doses for better health - Blog entry from DSEN. - January 14, 2010
READ THESE PATIENT COMMENTS!! Summary provided by Bill Peckham from Dialysis from the Sharp End of the Needle.
Bill's comments:
"Story, after story of being cured of the symptoms of too little dialysis. All of the symptoms that people mistakenly attribute to dialysis, are reported cured. And not one of these commentators talk of urea."
"There are over 90 times as many people on conventional incenter dialysis as are on frequent home hemo, yet I can think of very few who, by any stretch, wrote to endorse their care. Only those at home, dialyzing more frequently, were moved to do so. They know the truth, their stories tell of a better way."

NxStage Wonkery on the Freedom Cruise - Blog entry by Bill Peckham from Dialysis from the Sharp End of the Needle. - January 13, 2010
NxStage Freedom Cruise Day 5: Belize - Blog entry from DSEN. - January 7, 2010
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  WEB RESOURCES
Latest Scientific Journal Articles on Home and Daily Dialysis - list compiled by RenalWEB's Journal Watch
Home Dialysis Central web site
Nocturnal Home Haemodialysis web site
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 from the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)
Home Dialysis DVD (pdf) from Home Dialysis Central web site
Home Dialysis Assessment Tool (pdf) from the Home Dialysis Central web site
One Hour Video on Home Hemodialysis by Dr. John Agar of Australia - presentation from August 2007. The presentation required Flash Player and a high speed Internet connection.
Book: Daily and Nocturnal Hemodialysis by Lindsay, Buoncristiani, Lockridge, Pierratos, and Ting © 2004
Fluid and solute removal: how and why—part one from the Home Dialysis Central web site
Fluid and solute removal: how and why—part two from the Home Dialysis Central web site
Medicare 101 for people on home dialysis from Home Dialysis Central web site
Method to Assess Treatment Choices for Home Dialysis (MATCH-D) (pdf) from Home Dialysis Central
A workshop of the Task Force on Daily Hemodialysis was held April 11-12 at the National Institute of Health in Bethesda, MD.
Nocturnal Home Hemodialysis - A First Person Account, Part I and Part II by Michael Williams
The National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) is expected to announce soon that they are accepting Requests for Applications (RFAs) for a Clinical Trial of Daily Dialysis. - July 4, 2001

The proposed RFA will solicit applications to support the implementation of a carefully designed randomized trial of frequent dialysis. The overall goal is to assess the impact of more frequent dialysis on patient morbidity and mortality. It is envisioned that a planning group will be established in 2002, with the expectation that the trial will move into full implementation by 2003.

The listing is meant to provide the earliest possible alert to potential applicants in order to maximize application preparation time. While the NIDDK plans to proceed with this initiative, the publication and timing is not certain and depends on sufficient funds being available. Click here for more information on RPAs from the NIDDK web site.
A primer for the prescription of short-daily and nocturnal hemodialysis - full-text article from Hemodialysis International
Water treatment for home hemodialysis from the Home Dialysis Central web site
At Home With Dialysis - patient web site about her experiences on home dialysis.
American Nephrology Nurses Association (ANNA web site) position on daily home hemodialysis
Search result for Nocturnal dialysis by Google Continually Updated!
Home Dialysis web sites by Yahoo! Continually Updated!
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  HOME AND NOCTURNAL DIALYSIS PROGRAMS
Find a home dialysis center in your area from the Home Dialysis Central web site
How to Find a Home Dialysis Center 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
• DCI
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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 2006 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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  DISCUSSION FORUM
Daily, Home, Nocturnal Hemodialysis Discussion Forum - RenalWEB Discussion Forum
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  RELATED TOPICS
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)
Hemodialysis Advisory Information from the American Association of Kidney Patients (AAKP) web site
Statistical Analyses on dialysis patient hospitalization rates, morbidity, mortality, and more from Chronic Disease Research Group (CDRG)
United States Renal Data System (USRDS) 
National Surveillance of Dialysis-Associated Diseases in the U.S., 2002 - 10 page report from the CDC. (pdf format requires Adobe Acrobat reader.)
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  UPCOMING EVENTS
 
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  INPUT / SUGGESTIONS
E-mail to RenalWEB on the Hemodialysis Adequacy Topic
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