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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

Effects of Thrice Weekly Nocturnal Hemodialysis on Arterial Stiffness - Abstract from Atherosclerosis - February 2012

An Economic Assessment Model for in Center, Conventional Home, and More Frequent Home Hemodialysis - Free full-text article from Kidney International. - February 2012

AAKP Conference Call on Jan. 25: Home Hemodialysis: Helping Patients Lead a Healthier Life! - Registration information from the American Association of Kidney Patients.

Regression of Left Ventricular Mass Following Conversion from Conventional Hemodialysis to Thrice Weekly in-Center Nocturnal Hemodialysis - Provisional abstract and full-text article (25-page PDF) from BMC Nephrology. - January 19, 2012

The Drum Beats of a New Dialysis Randomized Trial are Growing - Posting by Dr. Peter Laird from HemoDoc. - January 18, 2012
Editor's note: Until psycho-social factors are considered, any new RCT is likely to suffer from many of the same unacknowledged design flaws and confounding variables as previous studies.
Many patients are reluctant to agree to more dialysis time because it means spending more time away from their normal activities of daily living, as well as spending more time in an environment where they have little control — which is also often unpleasant, noisy, boring, and sometimes hostile ("life-sucking" says one).
If we had time to do all the studies, we would likely find that the best renal replacement therapy is a wholistic approach: individualized daily hemodialysis, for at least six hours, is portable and convenient, can be combined with restorative sleep, minimizes recovery time, minimizes disruptions in patients' lives, maintains the patients' careers and lifestyles, and includes substantial psycho-social support programs and structures. With accompanying technological developments that provides this kind of treatment (which we should have seen!), the overall societal costs of CKD5 would be lower and the benefits would be far greater than those seen today. We can do so much better — starting right now.

Was the FHN a Waste of Research Effort and Expense? - Posting by Dr. Peter Laird from HemoDoc. - January 10, 2012
Editor's note: Dr. Laird points out a recent article from Current Opinion in Nephrology & Hypertension whose summary could be adopted by the LDOs as the next big "advance" in patient care. (Instead of more dialysis, more diet and fluid restrictions... and their pharmaceuticals?)

NxStage, Bringing Dialysis Home - Thank You - Posting by Peter Laird, MD from HemoDoc. - January 4, 2012
"The testimony of so many patients is that NxStage gave them their life back. I second that testimony and only wish to say, thank you."

Has Anybody Here, Seen My Old Friend Allient? Can You Tell Me Where He's Gone? - Posting by Peter Laird, MD from HemoDoc.- January 1, 2012
Editor's note: The dialysis industry is NOT producing the technology that will improve patients' HRQOL. They are producing machines that are most profitable for the corporate operations of the large dialysis providers.
Forty years after the start of the federal dialysis program, dialysis machines should be much smaller and far easier to use than the large machines being produced for today's in-center dialysis facilities. We simply have the wrong goals for patients and the wrong financial incentives for corporations.

Medicare to Tackle Chronic Illnesses with Home Care - Article from Healthcare IT News. - December 30, 2011

In UK, Mobile Dialysis Patient Monitoring Trialled - Article from Healthcare Today. - December 20, 2011

New Affordable Care Act Demonstration To Provide Care at Home for Medicare - December 20, 2011

At Home or on the Go, Dialysis Is an Option for Jim Smith - December 16, 2011

Patient Advocacy Group, Home Dialyzors United, Sends Comments to the Ways & Means Social Security Subcommittee on Disability Insurance - Posting from NxStageUsers Group blog. - December 15, 2011

Will Home Hemodialysis Ever Prosper in the United States? - Blog posting from eAJDK. - December 15, 2011

UK Dialysis Patient Gives Birth to Healthy Baby Girl after Daily Dialysis - Article from Liverpool Echo. - December 10, 2011

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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 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 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
Book: Daily and Nocturnal Hemodialysis by Lindsay, Buoncristiani, Lockridge, Pierratos, and Ting © 2004
Nocturnal Home Hemodialysis - A First Person Account, Part I and Part II by Michael Williams
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
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) 
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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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