Browsing through the ASN's online Renal Week abstracts can be a daunting task. Over the next few weeks, NephrOnline will be highlighting abstracts we think are particularly relevant to our audience.
The Renal Week abstracts provide analyses of different dialysis modalities. Following is a summary of just a few of these studies:
1. A nocturnal in-center hemodialysis pilot program: logistic issues and improved clinical outcomes
Sheila Doss, Brigitte Schiller, Donna Lemus Satellite Healthcare, Mountain View, CA
Modality: Nocturnal in-center hemodialysis
This small study sought to evaluate the patient outcomes and clinic operational issues of offering a pilot program of extended nocturnal hours at a hemodialysis clinic.
Methods: Thrice weekly 8 hour overnight hemodialysis was offered to clinic patients who were already on conventional hemodialysis Twenty-one patients enrolled in the study.
Results:
• Clinical outcome measures improved during twelve months of nocturnal hemodialysis, with 97% albumin greater than 3.5 g/dL compared to 86% in the previous 12 months.
• 62% of phosphate values less than 5.5 mg/dL were reached on nocturnal compared to 46% prior on conventional HD.
• Mean std Kt/V during the 12 months prior to starting nocturnal was 2.5 and increased to 2.8 on nocturnal HD.
• While maintaining Hgb levels ESA use decreased over time and reached 62% lower Epogen dose per treatment by month 12.
• Patients on in-center nocturnal hemodialysis reported significant improvement in quality of life.
• The major operational issue was recruiting and retaining the RN staff for nocturnal schedule.
Conclusion: The study authors said challenges in implementation of nocturnal programs as part of routine ESRD care are outweighed by improved outcomes including decreased drug utilization.
2. A single centre study comparing vascular access related infection rates in nocturnal versus conventional home hemodialysis patients using rope ladder needling technique
Amy A. Crosthwaite, Rosemary Masterson Department of Nephrology, Royal Melbourne Hospital, Melbourne Health, Melbourne, Victoria, Australia
Modalities: Nocturnal home hemodialysis and conventional home hemodialysis.
This study compared septic access event rates between cohorts of conventional and nocturnal home hemodialysis patients to determine whether nocturnal home hemodialysis was associated with increased infection risk.
Methods: A retrospective observational single center cohort study comparing rates of infection and associated complications between nocturnal home hemodialysis and conventional home hemodialysis patients between 2005 and 2010. Rope ladder needling technique was universally used. All patients were followed for at least 12 months after starting home dialysis.
The average patient age was 47 and 80% were male.
Results:
• 19.5% of all patients experienced at least 1 septic access event.
• 67% events occurred in the nocturnal home hemodialysis patient cohort and 9 patients had one or more event.
• There was no significant difference in the rate of events between the two cohorts . Similar proportions of each group developed infections (NHD 27%, CHD 28%).
• The event rates in AVF and AVG were 0.08 and 0.03/patient year respectively.
• MSSA was the most common pathogen identified.
• Complications of infected access included blood stream (NHD 66%, CHD 54.5%) and metastatic infection (NHD 19%, CHD 18%). There was no infection related deaths.
• Five patients discontinued home dialysis due to septic access events.
Conclusions:
• The authors said the data confirms the significant morbidity associated with septic access events in the home dialysis population.
• The increased risk of infection was not associated with longer dialysis hours.
• Compared with other observational data, rope ladder needling technique appears to be associated with a lower rate of access infection.
3. A longitudinal follow-up of quality of life amongst patients on nocturnal hemodialysis
David T. Lau, John W. M. Agar Renal Medicine, Geelong Hospital, Barwon Health, Geelong, Victoria, Australia
Modality: Nocturnal hemodialysis
This study reports the quality of life outcomes for nocturnal hemodialysis patients over an eight year period.
Methods: Using the KDQOL-36, quality of life data was collected annually from 2001 to 2009; medical records were analyzed for factors confounding quality of life.
Results:
• The two quality of life domains reflecting the 'prevalence of symptoms' and the 'individual restrictions placed on lifestyle by dialysis treatment' both scored similarly and were sustained at a consistently high level throughout the 8 year study.
• The nocturnal hemodialysis patients did still feel that the total burden of their kidney disease and its treatment requirements remained significant, as was reflected by their lower though also stable scores for the 'burden of kidney disease'.
• Physical and mental health composite scores compared favorably with the normal population.
Conclusion: The authors said that the data suggests that despite the lack of major lifestyle limitations, and despite physical and mental stability, NHD patients are still dialysis-dependent, an unalterable, permanent, additional encumbrance in their daily lives.
4. Quality of Life in the oldest dialysis patients, important differences between hemodialysis and peritoneal dialysis
Inger Laegreid, Knut Aasarod, Marit Jordhoy Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Nephrology, St. Olavs University Hospital, Trondheim, Norway; Regional Center of Excellence in Palliative Care, Oslo University Hospital, Oslo, Norway.
Modalities: Hemodialysis and peritoneal dialysis
This study sought to describe and compare the quality of life of the older Norwegian hemodialysis and peritoneal dialysis population, and to explore whether the starting point of peritoneal dialysis and hemodialysis differ (early vs late start).
Methods: All patients older than 75 years who were on dialysis were asked to participate and mailed the quality of life questionnaire.
A total of 230 patients (72%) responded, 152(66%) men and 78 (34%) women,
189 patients (82%) were on hemodialysis, 41 patients (18%) on peritoneal dialysis. Mean age HD: 80.5 years, PD: 80.0 years.
Results:
• At start of dialysis, there was no significant difference in the distribution of comorbidities, estimated glomerular filtration rate or the proportion of early start.
• Preplanned start was more frequent among peritoneal dialysis patients (86% vs73%) and duration of treatment was shorter.
• Peritoneal dialysis patients had lower blood pressure
• Albumin and BMI were comparable.
• Overall, the quality of life scores were low, and there was no statistical or clinically significant difference between the two groups.
Conclusion: The authors said there are little differences between hemodialysis and peritoneal dialysis patients in terms of quality of life scores and basic characteristic.