1
|
Kang M, Chen J, Liu L, Xue C, Tang X, Lv J, Fu L, Mei C, Mao Z, Liu Y, Dai B. In-center Nocturnal Hemodialysis Reduced the Circulating FGF23, Left Ventricular Hypertrophy, and All-Cause Mortality: A Retrospective Cohort Study. Front Med (Lausanne) 2022; 9:912764. [PMID: 35801203 PMCID: PMC9253468 DOI: 10.3389/fmed.2022.912764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
Fibroblast growth factor 23(FGF23) is the most important biomarker and pathogenic factor in Chronic Kidney Disease–Mineral and Bone Disorder (CKD–MBD). In the moderate and severe stages of chronic renal failure, abnormally elevated circulating FGF23 can lead to some complications, including myocardial hypertrophy, which is positively correlated with all-cause mortality. However, the circulating FGF23 level of different hemodialysis modalities, the underlying essential regulatory factors, and potential clinical benefits remain to be elucidated. In this retrospective cohort study, 90 in-center nocturnal hemodialysis (INHD) and 90 matched conventional hemodialysis (CHD) patients were enrolled. The complete blood count, intact FGF23(iFGF23), calcium, phosphorus, PTH, and other biochemical and echocardiographic parameters of INHD and CHD patients were collected and analyzed at 1-year follow-up. The all-cause mortality was recorded during the 7-year follow-up. Furthermore, the regulatory factors of iFGF23 and its association with echocardiographic parameters and mortality were investigated by multivariate regression. The levels of iFGF23 and serum phosphate in patients undergoing INHD were significantly lower than those in patients undergoing CHD. The left ventricular volume index (LVMI) in patients with INHD was significantly attenuated and positively correlated with the drop of serum iFGF23. The INHD group had reduced all-cause mortality compared to the CHD group. Multivariate analysis showed that iFGF23 was positively correlated with serum calcium, serum phosphorus, and calcium-phosphate product. The calcium-phosphate product is an independent determining factor of serum iFGF23. Compared with the CHD group, the INHD group presented with a significantly reduced circulating iFGF23 level, which was closely associated with attenuation of left ventricular hypertrophy, but INHD reduced all-cause mortality in an FGF23 independent manner.
Collapse
Affiliation(s)
- Meizi Kang
- Division of Nephrology, The Second Affiliated Hospital of Nantong University, Nantong, China
- Division of Nephrology, Kidney Institute of People's Liberation Army of China, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jing Chen
- Division of Nephrology, Kidney Institute of People's Liberation Army of China, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Lingling Liu
- Division of Nephrology, Kidney Institute of People's Liberation Army of China, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Cheng Xue
- Division of Nephrology, Kidney Institute of People's Liberation Army of China, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xiaojing Tang
- Division of Nephrology, Kidney Institute of People's Liberation Army of China, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jiayi Lv
- Division of Nephrology, Kidney Institute of People's Liberation Army of China, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Lili Fu
- Division of Nephrology, Kidney Institute of People's Liberation Army of China, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Changlin Mei
- Division of Nephrology, Kidney Institute of People's Liberation Army of China, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhiguo Mao
- Division of Nephrology, Kidney Institute of People's Liberation Army of China, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yawei Liu
- Division of Nephrology, Kidney Institute of People's Liberation Army of China, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Department of Internal Medicine, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Bing Dai
| | - Bing Dai
- Division of Nephrology, Kidney Institute of People's Liberation Army of China, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Yawei Liu
| |
Collapse
|
2
|
Laruelle É, Corlu L, Pladys A, Dolley Hitze T, Couchoud C, Vigneau C. [Prolonged hemodialysis: Rationale, practical organization, results]. Nephrol Ther 2021; 17S:S71-S77. [PMID: 33910702 DOI: 10.1016/j.nephro.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/07/2020] [Indexed: 11/15/2022]
Abstract
In France, long nocturnal dialyses, eight hours three-times a week, are sparsely proposed. However, numerous studies reported that this specific type of dialysis is associated to better blood pressure control, better cardiac remodeling, better mineral and nutritional balance as well as better life quality and survival rate. MATERIAL AND METHODS: In this study, we aimed at quantifying the benefits, risks and obstacles of developing night dialysis and at describing the results of a program that took place in Rennes from 2002 to 2019. Data were collected between 2008 and 2014 for eighteen case-patients and were compared to thirty-six controls that underwent conventional dialysis. Patients were paired according sex, age and year of dialysis start. RESULTS: The median age for dialysis start was 47.5 years [27-60] with a male prevalence (5/1). After six months, a significant difference was reported for postdialytic, systolic and diastolic pressure (respectively 126±15 vs 139±21 [P=0.04] and 72±9 vs 81±14 [P=0.02]) despite an antihypertensive reduction ranging from 2.4±1.4 to 1.3±0.9 per day at six months and 0.7±0.9 at one year (P=0.02). An increase of nPCR was evidenced at 6 and 9 months (P=0.02). At the end of the study, the phosphate level was maintained for both cohorts at the expense of an increased consumption of phosphate binder for the long nocturnal dialysis group (P=0.025). As a whole, 61% of the patients that pursued long night dialysis maintained a professional activity compared to only 30% for the controls (P=0.04). This highlights the advantages of night dialysis for maintaining employment but also the bias that represents the employment status in observational study on this specific topic.
Collapse
Affiliation(s)
- Éric Laruelle
- AUB Santé, 28, rue Henri-Le-Guilloux, 35033 Rennes, France.
| | - Léa Corlu
- Service de néphrologie, groupe hospitalier Bretagne-Sud, Lorient, France
| | | | | | | | - Cécile Vigneau
- EHESP, 35033 Rennes, France; Inserm, EHESP, IRSET (institut de recherche en santé, environnement et travail)-UMR S1805, université de Rennes, CHU de Rennes, 35000 Rennes, France
| |
Collapse
|
3
|
Sun M, Cao X, Guo Y, Tan X, Dong L, Pan C, Shu X. Long-term impacts of hemodialysis on the right ventricle: Assessment via 3-dimensional speckle-tracking echocardiography. Clin Cardiol 2018; 41:87-95. [PMID: 29363796 DOI: 10.1002/clc.22857] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/06/2017] [Accepted: 11/21/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Right ventricular (RV) dysfunction is a major cause of death in patients undergoing maintenance hemodialysis (MHD). We used 3-dimensional speckle-tracking echocardiography (3DSTE) to evaluate long-term impacts of MHD on RV function. HYPOTHESIS In this study, RV dysfunction in MHD patients will be revealed and studied in depth by 3DSTE. METHODS Echocardiography was performed on 110 consecutively enrolled individuals: 30 controls and 80 patients with MHD. Conventional echocardiographic parameters and 3DSTE parameters were obtained and compared between groups. Univariate and multivariate logistic regression analysis identified independent predictors of intradialytic hypotension (IDH). RESULTS Compared with the control group, RV end-diastolic volume (RVEDV) was markedly enlarged (46.1 ± 11.8 mL/m2 vs 42.3 ± 8.6 mL/m2 ; P = 0.047), whereas RV ejection fraction (RVEF) was significantly lower in the MHD group (50.6% ± 5.8% vs 55.2% ± 3.7%; P < 0.001). RV global, septal, and lateral wall longitudinal strains were also decreased in the MHD group (-18.2 ± 3.6 vs -22.6 ± 4.3%; -13.1 ± 3.8 vs -17.5 ± 5.5%; and -23.4 ± 4.7 vs -27.7 ± 4.0%, respectively; all P < 0.001). RVEF (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.51 to 1.01, P = 0.038) and history of diabetes (OR: 11.14, 95% CI: 1.16 to 106.71, P = 0.036) were 2 independent predictors of IDH. Ultrafiltration rate was an independent factor associated with RVEF (β = -0.01, 95% CI: -0.019 to 0.001, P = 0.039). CONCLUSIONS RVEF by 3DSTE could be an important predictor of IDH in MHD patients, and lower ultrafiltration rate was protective for RVEF. 3DSTE may have potential in RV evaluation and risk stratification in MHD patients.
Collapse
Affiliation(s)
- Minmin Sun
- Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Xuesen Cao
- Department of Nephrology, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Yao Guo
- Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Xiao Tan
- Department of Nephrology, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Lili Dong
- Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Cuizhen Pan
- Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
| |
Collapse
|
4
|
Graham-Brown MPM, Churchward DR, Hull KL, Preston R, Pickering WP, Eborall HC, McCann GP, Burton JO. Cardiac Remodelling in Patients Undergoing in-Centre Nocturnal Haemodialysis: Results from the MIDNIGHT Study, a Non-Randomized Controlled Trial. Blood Purif 2017; 44:301-310. [PMID: 29084397 DOI: 10.1159/000481248] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 09/04/2017] [Indexed: 01/01/2023]
Abstract
Evidence suggests extended-hours haemodialysis (HD) may improve cardiovascular, medical and quality-of-life outcomes. In-centre nocturnal haemodialysis (INHD) is an established but underutilized method of providing extended-hours treatment. This 6-month, non-randomized controlled trial (ISRCTN16672784) recruited 13 INHD patients and 12 control patients on conventional HD. The effects of treatment on left ventricular (LV) structure, function and myocardial fibrosis were assessed using cardiac magnetic resonance imaging and native T1 mapping. Quality-of-life and clinical measures were also collected. INHD led to significant reductions in LV mass (-14.75 vs. +6.54 g; p = 0.02), global T1 (-30.62 vs. 0.4 ms; p = 0.05) and non-septal native T1 values (-30.93 vs. 8.96 ms; p = 0.02) over time. There were also significant improvements in serum phosphate (-0.39 vs. +0.02 mmol/L; p = 0.03) and reductions in ultrafiltration rates (-2.32 vs. +0.70 mL/h/kg p = 0.05) between INHD and controls. Six-months of INHD was associated with favourable LV remodelling and reduced myocardial fibrosis compared to patients on conventional haemodialysis.
Collapse
|
5
|
Wong B, Collister D, Muneer M, Storie D, Courtney M, Lloyd A, Campbell S, Pauly RP. In-Center Nocturnal Hemodialysis Versus Conventional Hemodialysis: A Systematic Review of the Evidence. Am J Kidney Dis 2017; 70:218-234. [PMID: 28359656 DOI: 10.1053/j.ajkd.2017.01.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 01/03/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Owing to its longer treatment duration-up to 8 hours per dialysis treatment-in-center thrice-weekly nocturnal hemodialysis (HD) is receiving greater attention. To better understand the evidence for in-center nocturnal HD, we sought to systematically review the literature to determine the effects of in-center nocturnal HD versus conventional HD on clinically relevant outcomes. STUDY DESIGN We searched MEDLINE, Embase, Evidence-Based Medicine Reviews (EBMR), Web of Science, and Scopus from the earliest date in the database to November 2016. SETTING & POPULATION Adults receiving in-center nocturnal HD compared with those receiving conventional HD. SELECTION CRITERIA FOR STUDIES All quasi-experimental and observational studies were considered; randomized trials were sought but not found. PREDICTOR Nocturnal vs conventional in-center HD. OUTCOMES Indexes of blood pressure and left ventricular hypertrophy, markers of anemia, measures of bone mineral metabolism, nutrition, quality of life, sleep quality, episodes of intradialytic hypotension, hospitalization, and mortality. RESULTS Of 2,086 identified citations, 21 met the inclusion criteria, comprising a total of 1,165 in-center nocturnal HD patients and 15,865 conventional HD patients. Although there was substantial heterogeneity in reporting of outcomes, we pooled data for measures of blood pressure, anemia, and mineral metabolism. Though heterogeneity was generally high, in-center nocturnal HD was associated with improved systolic blood pressure (-3.18 [95% CI, -5.58 to -0.78) mm Hg, increased hemoglobin levels (0.53 [95% CI, 0.11-0.94] g/dL), and lower serum phosphate levels (-0.97 [95% CI, -1.48 to -0.46] mg/dL). LIMITATIONS No randomized trials have been conducted to address the clinical effects of in-center nocturnal HD. The quality of the observational literature contributing to the results of this review was generally poor to moderate. Confounded outcomes are a significant concern. Publication bias and outcome reporting bias remain possibilities. CONCLUSIONS Relative to conventional HD, in-center nocturnal HD was associated with improvements in several clinically relevant outcomes. Other benefits may not have been detected due to small sample sizes of included studies; no prespecified outcome was worse with in-center nocturnal HD.
Collapse
Affiliation(s)
- Ben Wong
- Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, AB, Canada; Headwaters Health Care Centre, Orangeville, ON, Canada.
| | | | - Maliha Muneer
- Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, AB, Canada
| | - Dale Storie
- University of Alberta Libraries, Edmonton, AB, Canada
| | - Mark Courtney
- Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, AB, Canada
| | - Anita Lloyd
- Alberta Kidney Disease Network, Edmonton, AB, Canada
| | | | - Robert P Pauly
- Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
6
|
Liu F, Sun Y, Xu T, Sun L, Liu L, Sun W, Feng X, Ma J, Wang L, Yao L. Effect of Nocturnal Hemodialysis versus Conventional Hemodialysis on End-Stage Renal Disease: A Meta-Analysis and Systematic Review. PLoS One 2017; 12:e0169203. [PMID: 28107451 PMCID: PMC5249197 DOI: 10.1371/journal.pone.0169203] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 12/12/2016] [Indexed: 12/20/2022] Open
Abstract
Objectives The purpose of this study is to assess the efficacy and safety of nocturnal hemodialysis on end-stage renal disease (ESRD) patients. Methods We searched Medline, EmBase, and the Cochrance Central Register of Controlled Trials for studies up to January 2016. Analysis was done to compare variant outcomes of different hemodialysis schedules, including mortality, cardiovascular-associated variables, uremia-associated variables, quality of life (QOL), side-effects, and drug usage. Results We collected and analyzed the results of 28 studies involving 22,508 patients in our meta-analysis. The mortality results in this meta-analysis indicated that the nocturnal hemodialysis (NHD) group was not significantly different from conventional hemodialysis (CHD) group (Mortality: OR: 0.75; 95% confidence intervals (CIs): 0.52 to 1.10; p = 0.145), but the CHD group had significantly fewer number of hospitalizations than the NHD group (OR: 1.54; 95%CI: 1.32 to 1.79; p<0.001). NHD was superior to CHD for cardiovascular-associated (left ventricular hypertrophy [LVH]: SMD: -0.39; 95%CI: -0.68 to -0.10; p = 0.009, left ventricular hypertrophy index [LVHI]: SMD: -0.64; 95%CI: -0.83 to -0.46; p<0.001) and uremia-associated intervention results (Serum albumin: SMD: 0.89; 95%CI: 0.41 to 1.36; p<0.001). For the assessment of quality of life, NHD treatment significantly improved the patients’ QOL only for SF36-Physical Components Summary (SMD: 0.43; 95%CI: 0.26 to 0.60; p<0.001). NHD intervention was relatively better than CHD for anti-hypertensive drug usage (SMD: -0.48; 95%CI: -0.91 to -0.05; p = 0.005), and there was no difference between groups in our side-effects assessment. Conclusion NHD and CHD performed similarly in terms of ESRD patients’ mortality and side-effects. NHD was superior to CHD for cardiovascular-associated and uremia-associated results, QOL, and drug usage; for number of hospitalizations, CHD was relatively better than NHD.
Collapse
Affiliation(s)
- Fangjie Liu
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yiting Sun
- Department of Clinical Medicine, China Medical University, Shenyang, Liaoning, China
| | - Tianhua Xu
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Li Sun
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Linlin Liu
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wei Sun
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xin Feng
- Blood Purification Center, Liaoning Electric Power Center Hospital, Shenyang, Liaoning, China
| | - Jianfei Ma
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Lining Wang
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Li Yao
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, Liaoning, China
- * E-mail:
| |
Collapse
|
7
|
Nie Y, Zhang Z, Zou J, Liang Y, Cao X, Liu Z, Shen B, Chen X, Ding X. Hemodialysis-induced regional left ventricular systolic dysfunction. Hemodial Int 2016; 20:564-572. [PMID: 27312507 DOI: 10.1111/hdi.12434] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction Hemodialysis (HD) patients are under observably elevated cardiovascular mortality. Cardiac dysfunction is closely related to death caused by cardiovascular diseases (CVD). In the general population, repetitive myocardial ischemia induced left ventricular (LV) dysfunction may progress to irreversible loss of contraction step by step, and finally lead to cardiac death. In HD patients, to remove water and solute accumulated from 48 or 72 hours of interdialysis period in a 4-hour HD session will induce myocardial ischemia. In this study, we evaluated the prevalence and potential risk factors associated with HD-induced LV systolic dysfunction and provide some evidences for clinical strategies. Methods We recruited 31 standard HD patients for this study from Fudan University Zhongshan hospital. Echocardiography was performed predialysis, at peak stress during HD (15 minutes prior to the end of dialysis), and 30 minutes after HD. Auto functional imaging (AFI) was used to assess the incidence and persistence of HD-induced regional wall motion abnormalities (RWMAs). Blood samples were drawn to measure biochemical variables. Findings Among totally 527 segments of 31 patients, 93.54% (29/31) patients and 51.40% (276/527) segments were diagnosed as RWMAs. Higher cTnT (0.060 ± 0.030 vs. 0.048 ± 0.015 ng/mL, P = 0.023), phosphate (2.07 ± 0.50 vs. 1.49 ± 0.96 mmol/L, P = 0.001), UFR (11.00 ± 3.89 vs. 8.30 ± 2.66 mL/Kg/h, P = 0.039) and lower albumin (37.83 ± 4.48 vs. 38.38 ± 2.53 g/L, P = 0.050) were found in patients with severe RWMAs (RWMAs in more than 50% segments). After univariate and multivariate analysis, interdialytic weight gain (IDWG) was found as independent risk factor of severe RWMAs (OR = 1.047, 95%CI 1.155-4.732, P = 0.038). Discussion LV systolic dysfunction induced by HD is prevalent in conventional HD patients and should be paid attention to. Patients would benefit from better weight control during interdialytic period to reduce ultrafiltration rate.
Collapse
Affiliation(s)
- Yuxin Nie
- Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China
| | - Zhen Zhang
- Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China
| | - Jianzhou Zou
- Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China.,Key Laboratory of Kidney and Blood Purification of Shanghai, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Yixiu Liang
- Division of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Xuesen Cao
- Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China
| | - Zhonghua Liu
- Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China
| | - Bo Shen
- Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China
| | - Xiaohong Chen
- Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China
| | - Xiaoqiang Ding
- Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China. .,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China. .,Key Laboratory of Kidney and Blood Purification of Shanghai, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.
| |
Collapse
|
8
|
El-Nahid MS, El-Ashmaoui AM. Functional and structural abnormalities of the skin microcirculation in hemodialysis patients. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2014. [DOI: 10.4103/1110-7782.145307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
|
9
|
Wong B, Courtney M, Pauly RP, Jindal K, Klarenbach S. Cost analysis of in-centre nocturnal compared with conventional hemodialysis. Can J Kidney Health Dis 2014; 1:14. [PMID: 25780609 PMCID: PMC4349597 DOI: 10.1186/2054-3581-1-14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 06/05/2014] [Indexed: 11/30/2022] Open
Abstract
Background Provision of in-centre nocturnal hemodialysis (ICNHD; 6–8 hours thrice weekly) is associated with health benefits, but the economic implications of providing this treatment are unclear. Objective We conducted a health care costing study comparing ICNHD to in-centre thrice-weekly conventional hemodialysis (CvHD). Design Micro-costing of both ICNHD and CvHD as practiced at our centre. Setting Hemodialysis unit at a tertiary-care hospital in Edmonton. Participants An informal survey of 2 other Canadian ICNHD programs was conducted to inform practices that may deviate from ours to guide sensitivity analysis. Measurements Resources consumed for each strategy were determined, and the cost of each unit (CAN $2012) was used to calculate incremental costs of ICNHD and CvHD. Methods We focused on resources that differ between strategies (staffing, dialysis materials, and utilities). The reference case considered 1:3 staff to patient ratio; alternate scenarios explored nursing pay grade and ratio, full care vs. self-care dialysis (including training costs), and medication costs. Results In the reference case, ICNHD was $61 more costly per dialysis treatment compared with CvHD ($9,538 per patient per year). Incremental annual costs for staffing, dialysis materials, and utilities were $8,201, $1,193, and $144, respectively. If ICNHD reduces medication use (anti-hypertensives, bone mineral metabolism medications), the incremental cost of ICNHD decreases to $8,620 per patient per year. In a scenario of self-care ICNHD utilizing a staff-to-patient ratio of 1:10, ICNHD is more costly in year 1 ($15,196), but results in cost savings of $2,625 in subsequent years compared with CvHD. Limitations The findings of this cost analysis may not be generalizable to other health care systems, including other parts of Canada. Conclusions Compared to CvHD, provision of ICNHD is more expensive, largely driven by increased staffing costs as patients dialyze longer. Alternate staffing models, including self-care ICNHD with minimal staff, may lead to net cost savings. The incremental cost of treatment should be considered in the context of impact on patient health outcomes, staffing model, and pragmatic factors, such as current capacity for daytime CvHD and the capital costs of new dialysis stations. Electronic supplementary material The online version of this article (doi:10.1186/2054-3581-1-14) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ben Wong
- Department of Medicine, University of Alberta, Edmonton, Alberta Canada ; Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
| | - Mark Courtney
- Department of Medicine, University of Alberta, Edmonton, Alberta Canada
| | - Robert P Pauly
- Department of Medicine, University of Alberta, Edmonton, Alberta Canada
| | - Kailash Jindal
- Department of Medicine, University of Alberta, Edmonton, Alberta Canada
| | - Scott Klarenbach
- Department of Medicine, University of Alberta, Edmonton, Alberta Canada ; Institute of Health Economics, Edmonton, Alberta Canada ; Alberta Kidney Disease Network, Edmonton, Alberta Canada
| |
Collapse
|
10
|
McIntyre CW. Cardiovascular benefits of daily haemodialysis: peeling the onion. Nephrol Dial Transplant 2013; 29:1-4. [DOI: 10.1093/ndt/gft315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
|