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Dialysate calcium concentration and mineral metabolism in long and long-frequent hemodialysis: a systematic review and meta-analysis for a Canadian Society of Nephrology clinical practice guideline.

https://arctichealth.org/en/permalink/ahliterature114688
Source
Am J Kidney Dis. 2013 Jul;62(1):97-111
Publication Type
Article
Date
Jul-2013
Author
Deborah L Zimmerman
Gihad E Nesrallah
Christopher T Chan
Michael Copland
Paul Komenda
Philip A McFarlane
Azim Gangji
Robert Lindsay
Jennifer MacRae
Robert P Pauly
David N Perkins
Andreas Pierratos
Jean-Philippe Rioux
Andrew Steele
Rita S Suri
Reem A Mustafa
Author Affiliation
Division of Nephrology, Kidney Research Centre of the Ottawa Hospital Research Institute, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada. dzimmerman@ottawahospital.on.ca
Source
Am J Kidney Dis. 2013 Jul;62(1):97-111
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Calcium - chemistry - metabolism
Canada
Hemodialysis Solutions - chemistry - metabolism - standards
Humans
Minerals - metabolism
Nephrology - methods - standards
Practice Guidelines as Topic - standards
Randomized Controlled Trials as Topic - methods - standards
Renal Dialysis - methods - standards
Societies, Medical - standards
Time Factors
Abstract
Patients treated with conventional hemodialysis (HD) develop disorders of mineral metabolism that are associated with increased morbidity and mortality. More frequent and longer HD has been associated with improvement in hyperphosphatemia that may improve outcomes.
Systematic review and meta-analysis to inform the clinical practice guideline on intensive dialysis for the Canadian Society of Nephrology.
Adult patients receiving outpatient long (=5.5 hours/session; 3-4 times per week) or long-frequent (=5.5 hours/session, =5 sessions per week) HD.
We included clinical trials, cohort studies, case series, case reports, and systematic reviews.
Dialysate calcium concentration =1.5 mmol/L and/or phosphate additive.
Fragility fracture, peripheral arterial and coronary artery disease, calcific uremic arteriolopathy, mortality, intradialytic hypotension, parathyroidectomy, extraosseous calcification, markers of mineral metabolism, diet liberalization, phosphate-binder use, and muscle mass.
21 studies were identified: 2 randomized controlled trials, 2 reanalyses of data from the randomized controlled trials, and 17 observational studies. Dialysate calcium concentration =1.5 mmol/L for patients treated with long and long-frequent HD prevents an increase in parathyroid hormone levels and a decline in bone mineral density without causing harm. Both long and long-frequent HD were associated with a reduction in serum phosphate level of 0.42-0.45 mmol/L and a reduction in phosphate-binder use. There was no direct evidence to support the use of a dialysate phosphate additive.
Almost all the available information is related to changes in laboratory values and surrogate outcomes.
Dialysate calcium concentration =1.5 mmol/L for most patients treated with long and long-frequent dialysis prevents an increase in parathyroid hormone levels and decline in bone mineral density without increased risk of calcification. It seems prudent to add phosphate to the dialysate for patients with a low predialysis phosphate level or very low postdialysis phosphate level until more evidence becomes available.
Notes
Comment In: Am J Kidney Dis. 2013 Nov;62(5):1018-924157274
Comment In: Am J Kidney Dis. 2013 Nov;62(5):1019-2024157276
PubMed ID
23591289 View in PubMed
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Patient and technique survival among a Canadian multicenter nocturnal home hemodialysis cohort.

https://arctichealth.org/en/permalink/ahliterature141826
Source
Clin J Am Soc Nephrol. 2010 Oct;5(10):1815-20
Publication Type
Article
Date
Oct-2010
Author
Robert P Pauly
Katerina Maximova
Jennifer Coppens
Reem A Asad
Andreas Pierratos
Paul Komenda
Michael Copland
Gihad E Nesrallah
Adeera Levin
Anne Chery
Christopher T Chan
Author Affiliation
Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. robert.pauly@ualberta.ca
Source
Clin J Am Soc Nephrol. 2010 Oct;5(10):1815-20
Date
Oct-2010
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Canada
Catheterization, Central Venous - adverse effects
Cohort Studies
Diabetes Mellitus - mortality
Disease-Free Survival
Female
Hemodialysis, Home - adverse effects - mortality
Humans
Kaplan-Meier Estimate
Kidney Failure, Chronic - mortality - therapy
Male
Middle Aged
Outcome and Process Assessment (Health Care) - statistics & numerical data
Program Evaluation
Proportional Hazards Models
Registries
Risk assessment
Risk factors
Time Factors
Treatment Failure
Abstract
As a result of improved clinical and quality-of-life outcomes compared with conventional hemodialysis, interest in nocturnal home hemodialysis (NHD) has steadily increased in the past decade; however, little is known about the flow of patients through NHD programs or about patient-specific predictors of mortality or technique failure associated with this modality. This study addressed this gap in knowledge.
This study included 247 NHD patients of the Canadian Slow Long nightly ExtEnded dialysis Programs (CAN-SLEEP) cohort from 1994 through 2006 inclusive. The association between program- and patient-specific variables and risk for adverse outcomes was determined using uni- and multivariable Cox regression.
A total of 14.6% of the cohort experienced death or technique failure. Unadjusted 1- and 5-year adverse event-free survival was 95.2 and 80.1%, respectively. Significant predictors of a composite of mortality and technique failure included advanced age (P
Notes
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PubMed ID
20671218 View in PubMed
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Rationale for a home dialysis virtual ward: design and implementation.

https://arctichealth.org/en/permalink/ahliterature104973
Source
BMC Nephrol. 2014;15:33
Publication Type
Article
Date
2014
Author
Michael E Schachter
Joanne M Bargman
Michael Copland
Michelle Hladunewich
Karthik K Tennankore
Adeera Levin
Matthew Oliver
Robert P Pauly
Jeffrey Perl
Deborah Zimmerman
Christopher T Chan
Author Affiliation
Department of Medicine, Division of Nephrology, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada. christopher.chan@uhn.ca.
Source
BMC Nephrol. 2014;15:33
Date
2014
Language
English
Publication Type
Article
Keywords
Canada
Delivery of Health Care - methods - organization & administration
Hemodialysis, Home - methods
Humans
Patient Education as Topic - methods - organization & administration
Renal Insufficiency, Chronic - diagnosis - therapy
Software
Software Design
Telemedicine - methods - organization & administration
User-Computer Interface
Abstract
Home-based renal replacement therapy (RRT) [peritoneal dialysis (PD) and home hemodialysis (HHD)] offers independent quality of life and clinical advantages compared to conventional in-center hemodialysis. However, follow-up may be less complete for home dialysis patients following a change in care settings such as post hospitalization. We aim to implement a Home Dialysis Virtual Ward (HDVW) strategy, which is targeted to minimize gaps of care.
The HDVW Pilot Study will enroll consecutive PD and HHD patients who fulfilled any one of our inclusion criteria: 1. following discharge from hospital, 2. after interventional procedure(s), 3. prescription of anti-microbial agents, or 4. following completion of home dialysis training. Clinician-led telephone interviews are performed weekly for 2 weeks until VW discharge. Case-mix (modified Charlson Comorbidity Index), symptoms (the modified Edmonton Symptom Assessment Scale) and patient satisfaction are assessed serially. The number of VW interventions relating to eight pre-specified domains will be measured. Adverse events such as re-hospitalization and health-services utilization will be ascertained through telephone follow-up after discharge from the VW at 2, 4, 12 weeks. The VW re-hospitalization rate will be compared with a contemporary cohort (matched for age, gender, renal replacement therapy and co-morbidities). Our protocol has been approved by research ethics board (UHN: 12-5397-AE). Written informed consent for participation in the study will be obtained from participants.
This report serves as a blueprint for the design and implementation of a novel health service delivery model for home dialysis patients. The major goal of the HDVW initiative is to provide appropriate and effective supports to medically complex patients in a targeted window of vulnerability.
(NCT01912001).
Notes
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PubMed ID
24528505 View in PubMed
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Survival among nocturnal home haemodialysis patients compared to kidney transplant recipients.

https://arctichealth.org/en/permalink/ahliterature149830
Source
Nephrol Dial Transplant. 2009 Sep;24(9):2915-9
Publication Type
Article
Date
Sep-2009
Author
Robert P Pauly
John S Gill
Caren L Rose
Reem A Asad
Anne Chery
Andreas Pierratos
Christopher T Chan
Author Affiliation
Department of Medicine, University of Alberta Hospital, University of Alberta, Edmonton, AB, Canada. robert.pauly@ualberta.ca
Source
Nephrol Dial Transplant. 2009 Sep;24(9):2915-9
Date
Sep-2009
Language
English
Publication Type
Article
Keywords
Adult
Cohort Studies
Female
Hemodialysis, Home - mortality
Humans
Kidney Failure, Chronic - mortality - surgery - therapy
Kidney Transplantation - mortality
Living Donors
Male
Middle Aged
Ontario - epidemiology
Proportional Hazards Models
Survival Analysis
Tissue Donors
Abstract
Kidney transplantation is the gold standard renal replacement therapy. Nocturnal haemodialysis (NHD) is an intensive dialysis modality (6-8 h/session, 3-7 sessions/week) associated with a significant improvement of clinical and biochemical parameters compared to conventional dialysis. To date, no studies have compared survival in patients treated with NHD and kidney transplantation.
Using data from two regional NHD programmes and the USRDS from 1994 to 2006, we performed a matched cohort study comparing survival between NHD and deceased and living donor kidney transplantation (DTX and LTX) by randomly matching NHD patients to transplant recipients in a 1:3:3 ratio. The independent association of treatment modality with survival was determined using Cox multivariate regression.
The total study population consisted of 177 NHD patients matched to 1062 DTX and LTX recipients (total 1239 patients) followed for a maximum of 12.4 years. During the follow-up period, the proportion of deaths among NHD, DTX and LTX patients was 14.7%, 14.3% and 8.5%, respectively (P = 0.006). We found no difference in the adjusted survival between NHD and DTX (HR 0.87, 95% CI 0.50-1.51; NHD reference group), while LTX survival was better (HR 0.51, 95% CI 0.28-0.91).
These results indicate that NHD and DTX survival is comparable, and suggest that this intensive dialysis modality may be a bridge to transplantation or even a suitable alternative in the absence of LTX in the current era of growing transplant waiting lists and organ shortage.
PubMed ID
19584107 View in PubMed
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Vascular access for intensive maintenance hemodialysis: a systematic review for a Canadian Society of Nephrology clinical practice guideline.

https://arctichealth.org/en/permalink/ahliterature113003
Source
Am J Kidney Dis. 2013 Jul;62(1):112-31
Publication Type
Article
Date
Jul-2013
Author
Reem A Mustafa
Deborah Zimmerman
Jean-Philippe Rioux
Rita S Suri
Azim Gangji
Andrew Steele
Jennifer MacRae
Robert P Pauly
David N Perkins
Christopher T Chan
Michael Copland
Paul Komenda
Philip A McFarlane
Robert Lindsay
Andreas Pierratos
Gihad E Nesrallah
Author Affiliation
Department of Clinical Epidemiology and Biostastistics, McMaster University, Hamilton, Ontario, Canada. ramustafa@gmail.com
Source
Am J Kidney Dis. 2013 Jul;62(1):112-31
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Canada
Catheters, Indwelling - standards
Humans
Nephrology - standards
Practice Guidelines as Topic - standards
Randomized Controlled Trials as Topic - methods - standards
Renal Dialysis - methods - standards
Abstract
Practices in vascular access management with intensive hemodialysis may differ from those used in conventional hemodialysis.
We conducted a systematic review to inform clinical practice guidelines for the provision of intensive hemodialysis.
Adult patients receiving maintenance (>3 months) intensive hemodialysis (frequent [=5 hemodialysis treatments per week] and/or long [>5.5 hours per hemodialysis treatment]).
We searched EMBASE and MEDLINE (1990-2011) for randomized and observational studies. We also searched conference proceedings (2007-2011).
(1) Central venous catheter (CVC) versus arteriovenous (AV) access, (2) buttonhole versus rope-ladder cannulation, (3) topical antimicrobial cream versus none in buttonhole cannulation, and (4) closed connector devices among CVC users.
Access-related infection, survival, hospitalization, patency, access survival, intervention rates, and quality of life.
We included 23, 7, and 5 reports describing effectiveness by access type, buttonhole cannulation, and closed connector device, respectively. No study directly compared CVC with AV access. On average, bacteremia and local infection rates were higher with CVC compared with AV access. Access intervention rates were higher with more frequent hemodialysis, but access survival did not differ. Buttonhole cannulation was associated with bacteremia rates similar to those seen with CVCs in some series. Topical mupirocin seemed to attenuate this effect. No direct comparisons of closed connector devices versus standard luer-locking devices were found. Low rates of actual or averted (near misses) air embolism and bleeding were reported with closed connector devices.
Overall, evidence quality was very low. Limited direct comparisons addressing main review questions, small sample sizes, selective outcome reporting, publication bias, and residual confounding were major factors.
This review highlights several differences in the management of vascular access in conventional and intensive hemodialysis populations. We identify a need for standardization of vascular access outcome reporting and a number of priorities for future research.
PubMed ID
23773840 View in PubMed
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