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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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Pstras L, Stachowska-Pietka J, Debowska M, Pietribiasi M, Poleszczuk J, Waniewski J. Dialysis therapies: Investigation of transport and regulatory processes using mathematical modelling. Biocybern Biomed Eng 2022. [DOI: 10.1016/j.bbe.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Gautier N, Sampol J, Zagdoun E, Duquennoy S, Dione DJP, Edet S, Lobbedez T, Ficheux M. What Total Body Water Measurement Should Be Used for Prescribing the Dialysis Dose in Low-Flow Home Daily Dialysis? Blood Purif 2021; 51:540-547. [PMID: 34404044 DOI: 10.1159/000517815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/13/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In low-flow home daily dialysis (HDD), the dialysis dose is evaluated from the total body water (TBW). TBW can be estimated by anthropometric methods or bioimpedance spectroscopy. METHODS A multicentric cross-sectional study of patients in HDD for >3 months was conducted to assess the correlation and the difference between the anthropometric estimate of TBW (Watson-TBW) and the bioimpedance estimate (BIS-TBW) and to analyse the impact on the dialysate volume prescribed. RESULTS Forty patients from 10 centres were included. The median BIS-TBW and Watson-TBW were 35.1 (29.1-41.4 L) and 36.9 (32-42.4 L), respectively. The 2 methods had a good correlation (r = 0.87, p < 0.05). However, Bland-Altman analysis showed an overestimation of TBW with Watson's formula, with a bias of 2.77 L. For 4, 5, or 6 sessions per week, the use of Watson-TBW increases the dialysate prescription per week by 100 L, 45 L, or 10 L, respectively, over our entire cohort. There is no increase in the volume of dialysate prescribed with the 7 sessions per week schedule. CONCLUSION BIS-TBW and Watson-TBW estimation have a good correlation; however, Watson's equation overestimates TBW. This overestimation is negligible for a prescription frequency of >5 sessions per week.
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Affiliation(s)
- Nicolas Gautier
- Néphrologie, CHU de Caen Normandie, Caen, France.,ANIDER, Caen, France
| | - Jerome Sampol
- Phocean Nephrology Institute, Clinique Bouchard, Elsan, Marseille, France.,Association pour le Traitement des Urémiques en Provence, Marseille, France
| | | | | | | | | | - Thierry Lobbedez
- Néphrologie, CHU de Caen Normandie, Caen, France.,U1086 INSERM - ANTICIPE, Centre Régional de Lutte contre le Cancer François Baclesse, Caen, France.,Université Caen Normandie - UFR de médecine (Medical School), Caen, France
| | - Maxence Ficheux
- Néphrologie, CHU de Caen Normandie, Caen, France.,ANIDER, Caen, France
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Kohn OF, Plascencia M, Taylor Y, Koyner JL. Novel Use of Premixed Dialysate Bags during Water Supply Interruption in Acute Hospital Setting. KIDNEY360 2021; 2:339-343. [PMID: 35373022 PMCID: PMC8740998 DOI: 10.34067/kid.0004762020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/08/2020] [Indexed: 06/14/2023]
Abstract
Patients on dialysis are exposed to large amounts of water during conventional intermittent hemodialysis; hence, there are strict regulations regarding the quality of water used to prepare dialysate. Occasionally, water systems fail due to natural disasters or structural supply issues, such as water-main breaks or unplanned changes in municipal or facility water quality. It is critical to regularly monitor and immediately recognize such a failure and take steps to avoid exposing the patients to contaminants. In addition to the recognition of the problem, the ability to pivot and continue to provide safe treatment to inpatients who are dependent on dialysis is essential, both from an ultrafiltration and a clearance standpoint. At our hospital, an unforeseen water disruption occurred and we were able to continue to provide KRT with premade, bagged dialysate to mitigate the effect on our patients on dialysis. This is a novel method using available machines and dialysate, which we normally stock for continuous KRT, for short dialysis sessions. The methodology is similar to that which has been widely used for short daily home hemodialysis with low dialysate flow rate. Because this situation occurred in the midst of the SARS-CoV-2 pandemic, we had to be mindful of dialysate volumes and staffing time. Here, we present our investigation into the cause of the water-system failure and how we quickly implemented the alternative dialysis method. Short dialysis with low-flow dialysate will not deliver the same Kt/V per session as standard dialysis; however, this method was successfully implemented and tailored with adjustments for patients requiring higher clearance for specific indications, such as severe hyperkalemia.
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Affiliation(s)
- Orly F Kohn
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois
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Colussi G, Brunati CCM, Gervasi F, Montoli A, Vergani D, Curci F, Minetti E. A simple method for the calculation of dialysis Kt factor as a quantitative measure of removal efficiency of uremic retention solutes: Applicability to high-dialysate vs low-dialysate volume technologies. PLoS One 2020; 15:e0233331. [PMID: 32469929 PMCID: PMC7259768 DOI: 10.1371/journal.pone.0233331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/02/2020] [Indexed: 12/03/2022] Open
Abstract
Dialysis urea removal metrics may not translate into proportional removal efficiency of non-urea solutes. We show that the Kt factor (plasma volume totally cleared of any solutes) differentiates removal efficiency of non-urea solutes in different technologies, and can easily be calculated by instant blood-dialysate collections. We performed mass balances of urea, creatinine, phosphorus and beta2-microglobulin by whole dialysate collection in 4 low-flux and 3 high-flux hemodialysis, 2 high-volume post-hemodiafiltration and 7 short-daily dialysis with the NxStage-One system. Instant dialysate/blood determinations were also performed at different times, and Kt was calculated as the product of the D/P ratio by volume of delivered dialysate plus UF. There were significant differences in single session and weekly Kt (whole dialysate and instant calculations) between methodologies, most notably for creatinine, phosphorus and beta2-microglobulin. Urea Kt messured in balance studies was almost equal to that derived from the usual plasma kinetic model-based Daugirdas’ equation (eKt/V) and independent V calculation, indicating full correspondence. Non-urea solute Kt as a fraction of urea Kt (i.e. fractional removal relative to urea) showed significant differences between technologies, indicating non-proportional removal of non-urea solutes and urea. Instant Kt was higher than that in full balances, accounting for concentration disequilibrium between arterial and systemic blood, but measured and calculated quantitative solute removal were equal, as were qualitative Kt comparisons between technologies. Thus, we show that urea metrics may not reliably express removal efficiency of non-urea solutes, as indicated by Kt. Kt can easily be measured without whole dialysate collection, allowing to expand the metrics of dialytic efficiency to almost any non-urea solute removed by dialysis.
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Affiliation(s)
- Giacomo Colussi
- Division of Nephrology, Dialysis and Renal Transplantation, ASST GOM Niguarda, Milan, Italy
- Ambrosiana Clinic-Sacra Famiglia Foundation, Milan, Italy
- * E-mail: ,
| | | | - Francesca Gervasi
- Division of Nephrology, Dialysis and Renal Transplantation, ASST GOM Niguarda, Milan, Italy
- Nephrology School, Milano-Bicocca University, Milan, Italy
| | - Alberto Montoli
- Division of Nephrology, Dialysis and Renal Transplantation, ASST GOM Niguarda, Milan, Italy
| | - Denise Vergani
- Division of Nephrology, Dialysis and Renal Transplantation, ASST GOM Niguarda, Milan, Italy
| | - Federica Curci
- Division of Nephrology, Dialysis and Renal Transplantation, ASST GOM Niguarda, Milan, Italy
| | - Enrico Minetti
- Division of Nephrology, Dialysis and Renal Transplantation, ASST GOM Niguarda, Milan, Italy
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Sangala N, Ficheux M, Fessi H, Borman N, Collins A. Using more frequent haemodialysis to manage volume overload in dialysis patients with heart failure, obesity or pregnancy. Nephrol Dial Transplant 2020; 35:ii11-ii17. [PMID: 32162662 PMCID: PMC7066540 DOI: 10.1093/ndt/gfaa020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Indexed: 11/14/2022] Open
Abstract
Managing dialysis in patients with heart failure, pregnancy or obesity is complex. More frequent haemodialysis 5–6 days/week in randomized clinical trials has shown benefits for controlling volume overload, blood pressure and phosphorus, reducing left ventricular hypertrophy (LVH), and improving patient tolerance to therapy. Therapy prescriptions were guided by volume of urea cleared, time-integrated fluid loading control and increased phosphate–β2 microglobulin removal, with greater treatment frequency to address clinical efficacy targets. Case studies in all three categories show that treatment with more frequent haemodialysis in low-dialysate flow systems (Qd <200 mL/min, dialysate of 25–30 L/session, 5–7 days/week for 2.5–3.0 h/session) improves control of heart failure. In pregnancy, treatment 7 days/week with 30 L and 3 h/session of dialysis enabled successful delivery of infants at 32–34 weeks, with all doing well 2–5 years after birth. Obese patients with a body mass index (BMI) >35 achieved control of volume, blood pressure and uraemic symptoms compared to their prior 3 times/week in-centre haemodialysis. Greater application of more frequent haemodialysis should be considered, particularly in high-risk populations, to improve clinical care.
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Affiliation(s)
| | | | - Hafedh Fessi
- Department of Nephrology, Hospital Tenon, Paris, France
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