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Two Years' Experience of Intensive Home Hemodialysis with the Physidia S 3 System: Results from the RECAP Study. J Clin Med 2023; 12:jcm12041357. [PMID: 36835894 PMCID: PMC9958970 DOI: 10.3390/jcm12041357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/20/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
The RECAP study reports results and outcomes (clinical performances, patient acceptance, cardiac outcomes, and technical survival) achieved with the S3 system used as an intensive home hemodialysis (HHD) platform over a three-year French multicenter study. Ninety-four dialysis patients issued from ten dialysis centers and treated more than 6 months (mean follow-up: 24 months) with S3 were included. A two-hour treatment time was maintained in 2/3 of patients to deliver 25 L of dialysis fluid, while 1/3 required up to 3 h to achieve 30 L. The additional convection volume produced by means of the SeCoHD tool (internal filtration backfiltration) was 3 L/session, and the net ultrafiltration produced to achieve dry weight was 1.4 L/session. On a weekly basis, an average 156 L of dialysate corresponding to 94 L of urea clearance when considering 85% dialysate saturation under low flow conditions was delivered. Such urea clearance was equivalent to 9.2 [8.0-13.0] mL/min weekly urea clearance and a standardized Kt/V of 2.5 [1.1-4.5]. The predialysis concentration of selected uremic markers remained remarkably stable over time. Fluid volume status and blood pressure were adequately controlled by means of a relatively low ultrafiltration rate (7.9 mL/h/kg). Technical survival on S3 was 72% and 58% at 1 and 2 years, respectively. The S3 system was easily handled and kept by patients at home, as indicated by technical survival. Patient perception was improved, while treatment burden was reduced. Cardiac features (assessed in a subset of patients) tended to improve over time. Intensive hemodialysis relying on the S3 system offers a very appealing option for home treatment with quite satisfactory results, as shown in the RECAP study throughout a two-year follow-up time, and offers the best bridging solution to kidney transplantation.
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Ong JP, Wald R, Goldstein MB, Leipsic J, Kiaii M, Deva DP, Kirpalani A, Jimenez‐Juan L, Bello O, Azizi PM, Wald RM, Wright GA, Harel Z, Connelly KA, Yan AT. Left ventricular strain analysis using cardiac magnetic resonance imaging in patients undergoing in‐centre nocturnal haemodialysis. Nephrology (Carlton) 2019; 24:557-563. [DOI: 10.1111/nep.13404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Jann P Ong
- Division of CardiologySt. Michael’s Hospital Toronto Ontario Canada
- University of Toronto Toronto Ontario Canada
| | - Ron Wald
- University of Toronto Toronto Ontario Canada
- Division of NephrologySt Michael’s Hospital, and Li Ka Shing Knowledge Institute of St. Michael’s Hospital Toronto Ontario Canada
| | - Marc B Goldstein
- University of Toronto Toronto Ontario Canada
- Division of NephrologySt Michael’s Hospital, and Li Ka Shing Knowledge Institute of St. Michael’s Hospital Toronto Ontario Canada
| | - Jonathon Leipsic
- Department of Radiology and Division of CardiologySt. Paul’s Hospital, University of British Columbia Vancouver British Columbia Canada
| | - Mercedeh Kiaii
- Division of NephrologySt. Paul’s Hospital, University of British Columbia Vancouver British Columbia Canada
| | - Djeven P Deva
- University of Toronto Toronto Ontario Canada
- Department of Medical ImagingSt. Michael’s Hospital, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital Toronto Ontario Canada
| | - Anish Kirpalani
- University of Toronto Toronto Ontario Canada
- Department of Medical ImagingSt. Michael’s Hospital, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital Toronto Ontario Canada
| | - Laura Jimenez‐Juan
- University of Toronto Toronto Ontario Canada
- Department of Medical ImagingSunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Olugbenga Bello
- Division of CardiologySt. Michael’s Hospital Toronto Ontario Canada
| | | | - Rachel M Wald
- University of Toronto Toronto Ontario Canada
- Division of CardiologyToronto General Hospital Toronto Ontario Canada
| | - Graham A Wright
- University of Toronto Toronto Ontario Canada
- Schulich Heart Program and the Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Ziv Harel
- University of Toronto Toronto Ontario Canada
- Division of NephrologySt Michael’s Hospital, and Li Ka Shing Knowledge Institute of St. Michael’s Hospital Toronto Ontario Canada
| | - Kim A Connelly
- Division of CardiologySt. Michael’s Hospital Toronto Ontario Canada
- University of Toronto Toronto Ontario Canada
| | - Andrew T Yan
- Division of CardiologySt. Michael’s Hospital Toronto Ontario Canada
- University of Toronto Toronto Ontario Canada
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Perl J, Dember LM, Bargman JM, Browne T, Charytan DM, Flythe JE, Hickson LJ, Hung AM, Jadoul M, Lee TC, Meyer KB, Moradi H, Shafi T, Teitelbaum I, Wong LP, Chan CT. The Use of a Multidimensional Measure of Dialysis Adequacy-Moving beyond Small Solute Kinetics. Clin J Am Soc Nephrol 2017; 12:839-847. [PMID: 28314806 PMCID: PMC5477210 DOI: 10.2215/cjn.08460816] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Urea removal has become a key measure of the intensity of dialysis treatment for kidney failure. Small solute removal, exemplified by Kt/Vurea, has been broadly applied as a means to quantify the dose of thrice weekly hemodialysis. Yet, the reliance on small solute clearances alone as a measure of dialysis adequacy fails fully to quantify the intended clinical effects of dialysis therapy. This review aims to (1) understand the strengths and limitations of small solute kinetics as a surrogate marker of dialysis dose, and (2) present the prospect of a more comprehensive construct for dialysis dose, one that considers more broadly the goals of ESRD care to maximize both quality of life and survival. On behalf of the American Society of Nephrology Dialysis Advisory Group, we propose the need to ascertain the validity and utility of a multidimensional measure that moves beyond small solute kinetics alone to quantify optimal dialysis derived from both patient-reported and comprehensive clinical and dialysis-related measures.
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Affiliation(s)
- Jeffrey Perl
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Noori N, Yan AT, Kiaii M, Rathe A, Goldstein MB, Bello O, Wald R. Nutritional status after conversion from conventional to in-centre nocturnal hemodialysis. Int Urol Nephrol 2017; 49:1453-1461. [PMID: 28456922 DOI: 10.1007/s11255-017-1595-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/11/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Recipients of conventional hemodialysis (CHD; 3-4 h/session, 3 times/week) experience volume expansion and nutritional impairment which may contribute to high mortality. Prolongation of sessions with in-centre nocturnal hemodialysis (INHD; 7-8 h/session, 3 times/week) may improve clinical outcomes by enhancement of ultrafiltration and uremic toxin removal. MATERIALS AND METHODS In this prospective cohort study, 56 adult patients who were receiving maintenance CHD for at least 90 days were assigned to CHD (patients who remained in CHD) and INHD (patients who switched to INHD) groups. Both groups were followed for 1 year divided into four 13-week quarters; post-dialysis weight and interdialytic weight gain (IDWG) were captured in each quarter. Repeated measures analysis of variance was used to calculate group main effect, time main effect or time-group interaction effect. RESULTS Conversion to INHD was associated with a mean (95% confidence interval) change in IDWG of 0.5 (0.08, 1.2) kg as compared to -0.3 (-0.9, 0.1) kg in the CHD group (p < 0.01). In the INHD group, post-dialysis weight (% of baseline pre-dialysis weight) decreased after conversion, reaching a nadir during the first 3 months (0.7%) and subsequently it gradually increased and returned to its baseline at the end of follow-up. A similar temporal trend was seen for serum creatinine but not serum N-terminal pro-brain natriuretic peptide (NT-proBNP) which is a marker of extracellular volume. The changes in serum albumin, prealbumin and hs-CRP were not different between the two groups. CONCLUSIONS Conversion to INHD was associated with greater IDWG and relatively stable body mass. We speculate that this gain in weight reflects an increase in lean body mass following the change in dialysis modality, which can be concluded from the parallel increase in serum creatinine and the lack of increase in NT-proBNP.
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Affiliation(s)
- Nazanin Noori
- Division of Nephrology, St. Michael's Hospital, 140-61 Queen Street East, Toronto, ON, M5C 2T2, Canada
| | - Andrew T Yan
- Division of Cardiology, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, ST. Michael's Hospital, Toronto, ON, Canada
| | - Mercedeh Kiaii
- Division of Nephrology, St. Paul's Hospital, Vancouver, BC, Canada
| | - Andrea Rathe
- Division of Nephrology, St. Michael's Hospital, 140-61 Queen Street East, Toronto, ON, M5C 2T2, Canada
| | - Marc B Goldstein
- Division of Nephrology, St. Michael's Hospital, 140-61 Queen Street East, Toronto, ON, M5C 2T2, Canada.,Li Ka Shing Knowledge Institute, ST. Michael's Hospital, Toronto, ON, Canada
| | - Olugbenga Bello
- Division of Cardiology, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Ron Wald
- Division of Nephrology, St. Michael's Hospital, 140-61 Queen Street East, Toronto, ON, M5C 2T2, Canada. .,Li Ka Shing Knowledge Institute, ST. Michael's Hospital, Toronto, ON, Canada.
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Mitsides N, Keane DF, Lindley E, Mitra S. Technology innovation for patients with kidney disease. J Med Eng Technol 2016; 39:424-33. [PMID: 26453039 DOI: 10.3109/03091902.2015.1088089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The loss of kidney function is a life-changing event leading to life-long dependence on healthcare. Around 5000 people are diagnosed with kidney failure every year. Historically, technology in renal medicine has been employed for replacement therapies. Recently, a lot of emphasis has been placed on technologies that aid early identification and prevent progression of kidney disease, while at the same time empowering affected individuals to gain control over their chronic illness. There is a shift in diversity of technology development, driven by collaborative innovation initiatives such the National Institute's for Health Research Healthcare Technology Co-operative for Devices for Dignity. This has seen the emergence of the patient as a key figure in designing technologies that are fit for purpose, while business involvement has ensured uptake and sustainability of these developments. An embodiment of this approach is the first successful Small Business Research Initiative in the field of renal medicine in the UK.
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Affiliation(s)
- Nicos Mitsides
- a NIHR D4D Healthcare Technology Co-operative, Department of Renal Medicine, Central Manchester University Hospital NHS Foundation Trust , Second Floor, Manchester Royal Infirmary, Oxford Road , Manchester M13 9WL , UK .,b NIHR Devices For Dignity Healthcare Technology Co-operative , Sheffield , UK .,c School of Cardiovascular Sciences, The University of Manchester , Manchester , UK , and
| | - David F Keane
- b NIHR Devices For Dignity Healthcare Technology Co-operative , Sheffield , UK .,d Department of Renal Medicine and Medical Physics , Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - Elizabeth Lindley
- b NIHR Devices For Dignity Healthcare Technology Co-operative , Sheffield , UK .,d Department of Renal Medicine and Medical Physics , Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - Sandip Mitra
- a NIHR D4D Healthcare Technology Co-operative, Department of Renal Medicine, Central Manchester University Hospital NHS Foundation Trust , Second Floor, Manchester Royal Infirmary, Oxford Road , Manchester M13 9WL , UK .,b NIHR Devices For Dignity Healthcare Technology Co-operative , Sheffield , UK .,c School of Cardiovascular Sciences, The University of Manchester , Manchester , UK , and
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Wald R, Goldstein MB, Perl J, Kiaii M, Yuen D, Wald RM, Harel Z, Weinstein JJ, Jakubovic B, Leong-Poi H, Kirpalani A, Leipsic J, Dacouris N, Wolf M, Yan AT. The Association Between Conversion to In-centre Nocturnal Hemodialysis and Left Ventricular Mass Regression in Patients With End-Stage Renal Disease. Can J Cardiol 2015; 32:369-77. [PMID: 26386732 DOI: 10.1016/j.cjca.2015.07.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 06/26/2015] [Accepted: 07/05/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND In-centre nocturnal hemodialysis (INHD, 7-8 hours/session, 3 times/week) is an increasingly utilized form of dialysis intensification, though data on the cardiovascular benefits of this modality are limited. METHODS In this prospective cohort study, we enrolled 67 prevalent conventional hemodialysis (CHD, 4 hours/session, 3 times/week) recipients at 2 medical centres in Canada, of whom 37 converted to INHD and 30 remained on CHD. The primary outcome was the change in left ventricular mass (LVM) after 1 year as assessed by cardiac magnetic resonance imaging. Secondary outcomes included changes in serum phosphate concentration, phosphate binder burden, haemoglobin, erythropoiesis stimulating agent usage, and blood pressure. RESULTS Conversion to INHD was associated with a 14.2 (95% confidence interval [CI] 1.2-27.2) g reduction in LVM as compared with continuation on CHD. This result was maintained after adjustment for baseline imbalances between the groups and in ancillary analyses. There was a trend toward a larger drop in systolic blood pressure (9.8 [95% CI, -1.4-20.9] mm Hg) among INHD recipients with a significant reduction in the number of prescribed antihypertensive agents (0.7 [95% CI, 0.3-1.1] agents). Serum phosphate declined by 0.40 (95% CI, 0.16-0.63) mmol/L among INHD recipients without any difference in calcium-based phosphate binder requirements, as compared with those who remained on CHD. CONCLUSIONS Compared with continuation of CHD, conversion to INHD was associated with significant LVM regression and reduction in serum phosphate concentration at 1 year.
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Affiliation(s)
- Ron Wald
- Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada.
| | - Marc B Goldstein
- Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Jeffrey Perl
- Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Mercedeh Kiaii
- Division of Nephrology, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Darren Yuen
- Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Rachel M Wald
- Divisions of Cardiology and Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Ziv Harel
- Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Jordan J Weinstein
- Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Baruch Jakubovic
- Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Howard Leong-Poi
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Division of Cardiology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Anish Kirpalani
- Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada
| | - Jonathon Leipsic
- Department of Radiology and Division of Cardiology, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Niki Dacouris
- Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Myles Wolf
- Division of Nephrology and Center for Translational Metabolism and Health - Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew T Yan
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Division of Cardiology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
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Dialysis frequency versus dialysis time, that is the question. Kidney Int 2013; 85:1024-9. [PMID: 24336033 DOI: 10.1038/ki.2013.474] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 08/05/2013] [Accepted: 08/15/2013] [Indexed: 11/09/2022]
Abstract
We reviewed a number of prospective randomized and multiple retrospective cohort studies of different dialysis prescriptions: longer dialysis time, at a frequency of at least three times a week, or a frequency of daily hemodialysis with a shorter dialysis time. Interestingly, the retrospective analyses have generally found significant survival benefits in the intensive dialysis groups, whereas more modest effects were observed in the prospective randomized controlled trials. The reason for this discrepancy may be related to the retrospective nature of the studies and possible selection bias; for example, the patients who were prescribed more frequent dialysis may have had more difficulties with volume control or high blood pressure. In contrast, the randomized controlled trials of increased dialysis frequency, which have shown indirect and modest benefits in complex coprimary end points, have small sample sizes and are plagued with difficulties in recruitment and compliance with the randomly allocated more frequent dialysis. This review, which attempts to balance the potential benefits of more frequent dialysis with the burden on the patient's lifestyle, an increased risk of access malfunction, as well as societal costs of such intensive dialysis prescriptions, concludes in favor of the conventional three times per week dialysis (at a minimum) but at longer dialysis times than is currently prescribed based on the Kt/Vurea metric alone.
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