hemodialysis thread

To the class,

Who would benefit the most for hemodialysis treatment? Please site a literature to support your response.

Deadline: July 16, 2009 - 12noon.

Prof. Bondad

Answer: Young, non-diabetic ESRD patients benefit the most for hemodialysis treatment. They have better survival rate.

Title: Different Impact of Biomarkers as Mortality Predictors among Diabetic and Nondiabetic Patients Undergoing Hemodialysis

Berthold Hocher, Reinhard Ziebig, Claudia Altermann, Rolfdieter Krause, Gernot Asmus, Claus-Michael Richter, Torsten Slowinski, Pranav Sinha and Hans-H. Neumayer

Hocher, B., Zeibig, R. et al. conducted a prospective cohort study that aimed to analyze and compare the risk factors for diabetic and nondiabetic patients that undergoing hemodialysis. A total of 245 patients undergoing hemodialysis participated in the study.There were 84 patients with diabetes mellitus and 161 without diabetes mellitus. Exclusion citeria include: (1) patients with malignancies; (2)chronic infections (such as osteomyelitis); and (3)conditions that might affect the tested serum parameters. Included in the initial documentation were age, gender, underlying renal disease, residual renal function and urinary output, presence of diabetes mellitus, hypertension, smoking, heart disease, and coronary status. Beginning with the day of blood sampling which is taken in March 2000, patients were monitored for exactly 775 days.

Risk factors that have direct effects on mortality rate were: (1) Age P = 0.0078; (2) diabetes mellitus P < 0.0001; (3) oliguria P = 0.0019; (4) coronary artery disease P = 0.0038; (5) CrP levels P = 0.0008; (6) fibrinogen levels P = 0.0169; (7) D-dimer levels P < 0.0001; ( and time on dialysis (P = 0.0438). For diabetic patients, the risk factors predicting mortality rates were Oliguria of <200 ml/d, CrP levels, and HDL levels. For nondiabetic patient, the risk factors determining mortality rates were TnT levels, followed by cholesterol, D-dimer, and albumin levels. Cholesterol and LDL levels are inversely associated with mortality rate. Smoking and gender appeared to be less important risk factors.

Diabetic patients have a higher mortality risk, compared with nondiabetic patients. Diabetes mellitus was an important risk factor predicting all-cause death in the whole study population. Age remained a predominant factor in survival rate. It is important to consider the differences in risk factor profiles between the diabetic and nondiabetic patients with End stage renal disease in designing therapeutic strategies to reduce mortality rate. The findings of this study suggest that it is important to monitor Serum albumin TnT and D-dimer levels, and CrP levels of patients undergoing hemodialysis.

Reference
Hocher, B et al. (2003). Different Impact of Biomarkers as Mortality Predictors among Diabetic and Nondiabetic Patients Undergoing Hemodialysis. J Am Soc Nephrol 14:2329-2337. Retrieved July 15, 2009 from http://jasn.asnjournals.org/cgi/reprint/14/9/2329?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=hemodialysis+survival+rate&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

BY: GIL LEGARDA

ANSWER: Patients with ACUTE RENAL FAILURE are the one who benefited the most from INTERMITTENT HEMODIALYSIS. Patients have a better survival rate under intermittent hemodialysis compared to conventional or alternate-day intermittent hemodialysis because kidneys are not working, reabsorbing of toxins will occur but if patients will undergo daily dialysis treatment therapy it can clean blood most often thus decreasing risk oh having complications.




TITLE: DAILY HEMODIALYSIS AND THE OUTCOME OF ACUTE RENAL FAILURE
By: HELMUT S CHIFFL , M.D., SUSANNE M. L ANG , M.D.,AND RAINALD FISCHER, M.D.


A Prospective study made by Chiffl S.H. et al. about the daily hemodialysis and the outcome of acute renal failure. The purpose of this study was to determine the effect of daily intermittent hemodialysis, as compared with conventional or alternate-day intermittent hemodialysis, on survival among patients with acute renal failure. There were about 172 patients with acute renal failure enrolled in this study but only 160 patients completed the study because the 11 patients were declined to participate and to finish the study and 1 was excluded because of initiation of contrast medium prior to hemodialysis. The Researchers used a Double blinded randomized controlled trial. There were 2 separated medical groups working in an intensive care unit under clinical rotations for a period of 6 years. These said nephrologists as well as the staff nurses and enrolled patients were unaware of the treatment assignments until the first session of HD had been completed. After the first session there were no attempts made to maintain the blinded conditions. The main inclusion criterion was a diagnosis of severe acute tubular necrosis caused by recent ischemic or nephritic injury needed a for at least 1 week intermittent hemodialysis, with a history of a profound hypotension, severe overdose of nephrotoxins and the presence of risk factors for nephrotoxic acute tubular necrosis. The main exclusion criterion was if patients had a functional azotemia, urinary tract obstruction, acute interstitial nephritis, rapidly progressive glomerulonephritis, history of chronic renal insufficiency, and renal transplantation. The study held in the medical and surgical intensive care units at the University Hospitals of Munich, Innenstadt, Germany. The researchers used same machines for all the patients the MTS 2008C, Fresenius, Bad Homburg, Germany also only first-use, high-flux, synthetic dialyzer membranes the polysulfone specifically the F60 manufacturede by Fresenius or dialyzer acrylonitrile AN69, Hospal, Lyons, France were used. Multiple regression analysis was used to identify the effect of the variables such as age, sex, cause of acute tubular necrosis, presence or absence of oliguria, APACHE III score and the assigned treatment on the risk of death during ARF. The primary endpoint of the study was survival of 14 days from the last session of HD and the second outcome was the frequency of treatment-related complications and the duration of ARF.

Hemodialysis session’s mean duration, mean prescribed and delivered doses and average blood flow rate did not differ significantly between the two groups however the delivered dose was significantly lower then the prescribed dose in each group. Small solute level in the prior to treatment and the proportion of patients with volume overload before the initiation of dialysis did not differ significantly between the treatment groups. Daily hemodialysis showed a better control of uremia that alternated-day hemodialysis. The over all mortality was 37% but the 3% died due to Good Pasteurs disease.

This study says that the high mortality rate among critically ill patients with acute renal failure who require renal-replacement therapy is related to both coexisting conditions and uremic damage to other organ systems. This study claims that intensive hemodialysis reduces mortality without increasing hemodynamically induced morbidity. Higher doses of hemodialysis, although beneficial in critically ill patients this ill patients were the one who had end stage renal disease having a lower than 5% of the kidney is functioning unlike other kidney diseases having a better functioning level or rate. But some issues such as financial matter can be cause of problems why patients cant avail to have a daily dialysis therapy.

Reference:
Schiffl H., M.D. et al. (2002). DAILY HEMODIALYSIS AND THE OUTCOME OF ACUTE RENAL FAILURE. The New England Journal of Medicine. Vol. 346 no. 5. pages 305-310. http://content.nejm.org/cgi/reprint/346/5/305.pdf

By guo man man

Answer: This hemodialysis treatment good for the patients with high blood pressure.

home hemodialysis

Authors Christopher R Blagg, MD, FRCP Lionel U Mailloux, MD, FACP

Home hemodialysis began in the early 1960s in Boston, Seattle, and London [1-5]. Studies since then have shown that patients using conventional, three times weekly home hemodialysis have an increased survival [6-13] and better quality of life [14-16] compared to those who use other dialysis modalities. This modality also costs significantly less than conventional in-center hemodialysis [17-21].

These findings led some investigators to believe that home hemodialysis is the best renal replacement therapy other than renal transplantation. Despite these apparent benefits, the proportion of patients with end-stage renal disease (ESRD) treated by home hemodialysis in the United States declined steadily from the start of the Medicare ESRD program in 1973 until 2001; since then, until 2005, it remained relatively stable at approximately 0.6 percent of dialysis patients [22]. Similar changes have occurred in other countries [23-25]. According to currently unpublished data from the Forum of End Stage Renal Disease Networks 2007 Report, the proportion of home hemodialysis patients increased in 2006 to 0.75 percent. This reflects an increasing interest in more frequent home hemodialysis.

A review of issues relating to patient survival and other benefits derived from home hemodialysis, the declining incidence of this modality in the United States, and developments with more frequent daily and nightly hemodialysis (which are generally performed at home at night) are discussed here and elsewhere [26]. How home, short daily, and nocturnal hemodialysis are performed is discussed separately. (See "Organization and elements of a home hemodialysis program" and see "Nocturnal hemodialysis" and see "Short daily hemodialysis").

INCIDENCE AND PREVALENCE — The absolute number and relative percentage of dialysis patients who use home hemodialysis in the United States has declined over the last 33 years and are much lower in some other first-world countries. According to the 2007 United States Renal Data System Report, only 0.40 percent of all incident dialysis patients and 0.62 percent of all prevalent dialysis patients were treated by home hemodialysis in 2005 [22].

Internationally, there is virtually no home hemodialysis except in high income countries with an annual per capita gross national income greater than United States $10,000, and it has been declining in most of these countries [25]. The prevalence of home hemodialysis in 2001 to 2003 varied from zero per million population (pmp) in Portugal to 58.4 pmp in New Zealand, and country to country variation was more than that of any other modality of ESRD treatment. In the United States in 2005, the home hemodialysis rate was 7.1 pmp.

reference

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Response By: Raymond C. Ursal

Answer: Acute kidney failure for better survival rate rather than the Chronic kidney failure and End stage renal failure which are candidate for transplant.

Treatment Options for End Stage Renal Disease
Paul W. Crawford, MD, FACPa,b, Edgar V. Lerma, MD, FACP, FASN, FAHAc,d

The article talks about the different treatment options for End Stage Renal Disease (ESRD) which is mainly hemodialysis and kidney Transplant. Approximately 480,000 United States Citizen are receiving dialysis, 314,000 of which are receiving hemodialysis, more than 25,000 are receiving peritoneal dialysis, and another 143,000 undergo transplant. Significantly 16.8% of the populations have Chronic Kidney Disease (CKD).

According to Helmut, S., Susanne M. L., et al. the indication for hemodialysis were fluid volume overload, electrolyte imbalances, acid base disturbance, Blood urea nitrogen level exceeded from normal which is 7 - 20 mg/dl per 100ml (MedlinePlus, 2009). The hemodialysis is terminated if there was a partial recovery of renal function, defined as the restoration of dieresis, the absence of uremia, and improvement from the acid and base homeostasis.

On the otherhand, According to Paul W. C., Edgar V. L., and et al. the contraindications to hemodialysis includes: hemodynamic instability, hypotension, unstable cardiac rhythm and patient refusal. For patients needing chronic hemodialysis, creation of an arteriovenous (AV) fistula (connecting an artery to a vein using a surgical anastomosis of the native vessels) in an upper extremity is imperative. For early detection the patients in CKD Stage 4 should have vein mapping with ultrasound. After mapping has identified that the patient has adequate size vessels for the creation of a native AV fistula, a surgical referral for creation of an AV fistula should be made.


References:

Helmut, S., Susanne M. L., et al. (2002). Daily Hemodialysis and the Outcome of Acute Renal Failure, Volume 346:305-310 . Retrieved July 16, 2009 from http://content.nejm.org/cgi/content/full/346/5/305

Paul W. C., Edgar V. L., et al. (2008). Treatment Options for End Stage Renal Disease, Crawford PW - Prim Care 35(3): 407-32. July 16, 2009 from http://www.mdconsult.com/das/article/body/149943376-8/jorg=journal&source=MI&sp=20933684&sid=863323423/N/655559/s0095454308000328.pdf?SEQNO=1&issn=0095-4543

Response by Von Deneb H. Vitto

A: multiple myeloma with dialysis-dependent renal failure Patients.

Extended hemodialysis using a high-cutoff dialyzer (HCO-HD) shows improvement of outcomes in patients with multiple myeloma with dialysis-dependent renal failure. Although the study was a small and uncontrolled trial, the data proved that a combination of chemotherapy and HCO-HD has enhanced renal function and overall survival of the population.

Earlier studies have shown that less than 25% of multiple myeloma patients with biopsy-proven cast nephropathy and dialysis-dependent renal failure are able to come off of dialysis. In this study, on the other hand, 74% of the cohort became independent of dialysis, and there is a significant improvement in survival in patients who recovered renal function.

Reference:
Hutchison, C., Bradwell, A., Cook, M., Basnayake, K., Basu, S., Harding, S., Hattersley, J., Evans, N., Chappel, M., Sampson, P., Foggensteiner, L., Adu, D., Cockwell, P. (2009). Treatment of Acute Renal Failure Secondary to Multiple Myeloma with Chemotherapy and Extended High Cut-Off Hemodialysis. Clinical Journal of American Society of Nephrology (2009) 4: 745-754. Retrieved July 16, 2009 from http://cjasn.asnjournals.org/cgi/content/full/4/4/745

According to the American Kidney Organization (2009), the accepted criteria for placing a patient on hemodialysis include the presence of hyperkalemia that is unresponsive to conservative measures. It also includes patients with acidosis refractory to medical therapy, patients with a creatinine clearance of <10cc/min per 1.73 m2. Patients who have large body mass and are with decreased renal functioning are most appropriately placed on hemodialysis. The large surface area of the body means that patient has a large volume of distribution or urea, thus, venous access is required for faster facilitation of toxins removal. The loss of renal functioning means that there is an accumulation of toxic wastes in the body, and thus direct venous access is required for prompt treatment.

Meanwhile, in a study conducted by Hocher, et.al. (2003), patients diagnosed with diabetes and are undergoing hemodialysis demonstrated much worse survival rates compared to nondiabetic patients undergoing the modality of treatment. Their study was a prospective cohort study that aimed at researching and understanding risk predictors, included 245 hemodialysis patients, 84 of which are with DM (for 2 years C-reactive protein, TnT (troponin T), total HDL, LDL, and lipoprotein, cholesterol, apoA2, apoAB, triglyceride, fibrinogen, D-dimer, albumin, and creatinine levels and clinical characteristics). Rates of survival were compared using Kaplan-Meier and Cox regression analyses. Of the participants, 43 DM patients and 30 nondiabetic patients died. Their study highlighted that Dm patients demonstrated higher mortality risk compared with nondiabetic patients. Important to support this includes oliguria, elevated CrP levels, and elevated TnT levels, elevated D-dimer levels, and low cholesterol concentrations. Oliguria was found to be associated with increased mortality risk that are infectious disease-related. Among the study population, high levels of TnT are associated with both cardiovascular and infectious-disease related mortality.

Findings of the above research would therefore suggest that therapeutic strategies should be considered to reduce mortality rates and that due consideration must be taken into account considering the differences in risk factors for DM and nonDM patients with ESRD.



Reference:
National Kidney Foundation (2009). National Kidney Foundation Initiatives in Dialysis. Author. Retrieved July 16, 2009, from http://www.kidney.org/patients/dialysis.cfm.

Hocher, B., Ziebig, R., Altermann, C., Krause, R., Asmus, G., Ritcher, C.M., Slowinski, T., Sinha, P., & Neumayer, H.H. (2003). Different Impact of Biomarkers as Mortality Predictors among Diabetic and Nondiabetic Patients Undergoing Hemodialysis. Journal of American Society of Nephrology. 14:2329-2337. Retrieved July 16, 2009, from http://jasn.asnjournals.org/cgi/reprint/14/9/2329?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=hemodialysis+survival+rate&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT.

Response by Chen Ya (cherry)


A clinical study on hemodiafiltration in elderly patients with uremia

Peng Liren, xu Jihua, Zhao Sumei. Beijing Red Cross Chao Yang Hospital, Beijing 100020

　　Abstract　Objective　To study the tolerance and clinical effect of hemodiafiltration (HDF) in elderly patients.　　Methods　The clinical tolerance, adequate index of dialysis and clearance of β2-microglobulin(β2-MG) and parathyroid hormone (PTH) in 20 cases of elderly uremic patients treated with HDF for 166 times were compared to those when they routinely treated with hemodialysis (HD).　　Results　The clearances of small and middle molecule toxins by HDF were significantly better than that of HD. Before and after the treatment the β2-MG value and PTH value were significantly different (P＜0.001). but before and after the treatment with HD the β2-MG value and PTH vlaue were not significantly different (P＞0.05)。 there were no refractory hypertension, serious low blood pressure, arrhythmia, angina pectoris and heart failure occurred in HDF.　　Conclusions　HDF increases the tolerance to dialysis and significantly improve the effect of dialysis in elderly uremic patients.

ANSWER: Patients with stage 5 CKD can also benefit from hemodialysis treatment, however HD treatment session should be as often as possible or should be increased.

A study recently published in Hemodialysis International found that more frequent hemodialysis treatments (five or more weekly) can significantly increase the survival rate of patients suffering from irreversible kidney failure. Typical treatment in the U.S. generally involves three sessions weekly.

The study examines the mortality rate of 117 U.S. patients. Those receiving five or more treatments per week were shown to have a 61% better chance of survival when compared to patients receiving conventional treatment.

Christopher R. Blagg M.D., lead researcher of the study said that more frequent hemodialysis has been shown to improve patient well-being, reduce symptoms during and between treatments and have beneficial effects on clinical outcomes.

U.S. hemodialysis patients continue to have a high annual mortality rate, despite many improvements in dialysis and overall medical care. Increasing the frequency of dialysis may be an effective means of improving patient survival.

*I also want to add that Obese patients undergoing HD treatment can benefit from treatment.

Despite significant improvements in dialysis treatments, currently over 20% of the 350,000 maintenance hemodialysis (MHD) patients in the United States die each year. A study published in Hemodialysis International finds that this high mortality rate may be attributed to malnutrition.

MHD patients experience what has been termed the “obesity paradox,” wherein obesity is associated with increased chance of survival. “A larger body fat mass as seen in obesity probably represents protective reserves that may mitigate the adverse effects of malnutrition in patients,” according to Kamyar Kalantar-Zadeh M.D., author of the study.

MHD patients tend to have a high degree of protein-energy malnutrition and inflammation. The combination of these two conditions, termed Kidney Disease Wasting (KDW), leads to increased risk of death. Conversely, it has been shown that an increase in protein intake yields the greatest survival in patients.

The study suggests that improved diet as well as appetite-stimulating agents may be a way to improve nutrition and, consequently, outcome in MHD patients. Understanding the factors that lead to KDW will be the key to improving survival in MHD patients, as well as in the 20 to 40 million Americans who exhibit similar risk-factor paradoxes such as those with chronic heart failure, AIDS, rheumatoid arthritis and malignancy.

*Lastly, patients undergoing HD treatment with much longer duration can benefit from this kind of dialysis.

For hemodialysis patients, undergoing dialysis for eight hours overnight, three times weekly, reduces the risk of death by nearly 80 percent, compared to conventional, four-hour dialysis, according to research being presented at the American Society of Nephrology's 41st Annual Meeting and Scientific Exposition in Philadelphia, Pennsylvania.

In a study led by Ercan Ok, MD, of Ege University in Izmir, Turkey, 224 dialysis patients were switched to overnight dialysis. The patients spent three nights a week at the dialysis center where they underwent eight hours of continuous hemodialysis. The patients adjusted well to overnight hemodialysis.

The patients remained on overnight hemodialysis for about one year. Their outcomes were compared with those of a similar group of patients who continued on conventional dialysis: four hours, three days per week.

Overnight dialysis led to improvements in a wide range of outcomes. Dr. Ok commented that the hospitalization rate during follow-up was one-fourth of that observed in patients treated with four-hour conventional hemodialysis. Most importantly, the results confirmed that longer dialysis produces significantly better patient outcomes, with a 78 percent reduction in mortality rate.

Patients receiving overnight hemodialysis had better blood pressure control, leading to a two-thirds reduction in blood pressure medications. They were also at lower risk of blood pressure drops during dialysis, a common problem with conventional hemodialysis. Levels of the mineral phosphate decreased toward normal, despite a 72 percent reduction in medications used to lessen phosphate absorption.

The need for other medications decreased as well. All of these outcomes either did not change or deteriorated in patients on four-hour conventional dialysis.

Most patients in the overnight hemodialysis group mentioned an increase in appetite. They gained weight, and their serum protein (albumin) levels increased. Many patients were able to return to work, reporting improved job performance and better mental (cognitive) functioning.

More frequent and/or longer dialysis regimens are a promising alternative to addressing the "unacceptably high" risk of death among dialysis patients, according to Dr. Ok. Although home dialysis is may be the best approach (aside from kidney transplantation), it is not an option for most patients.

Previous studies of overnight, thrice-weekly hemodialysis have shown impressive results, with ten-year survival rates as high as 75 percent. The new trial is the first prospective, controlled study to compare the results of eight-hour versus four-hour hemodialysis, performed in the dialysis center.

The study has some important limitations, including the fact that patients were not randomly assigned to the two dialysis strategies. With an average age of 45, the patients were younger than the general population of dialysis patients—few older patients were willing to switch to overnight hemodialysis. In addition, the follow-up period was relatively short.

However, given the clear superiority of eight-hour dialysis, the researchers do not think the results would be changed with long-term observation. Dr. Ok adds, "We expect that these data would be convincing to the whole of society—including physicians, patients, health authorities, and social security institutions—for the necessity of longer hemodialysis in order to improve high mortality and morbidity."

The study was supported by a grant from the European Nephrology Dialysis Institution. The study was conducted in Fresenius Medical Care (FMC) Turkey clinics. Ercan Ok, MD and Ali Basci, MD are members of the Scientific Advisory Board of FMC Turkey; Siddig Momin Adam, MD, is a nephrologist in a FMC Turkey Clinic.

Reference:

Blackwell Publishing Ltd. (2006, November 8 ). Increased Hemodialysis May Lead To Greater Survival Rates. ScienceDaily. Retrieved July 16, 2009, from http://www.sciencedaily.com­ /releases/2006/11/061106144733.htm

Blackwell Publishing Ltd. (2006, December 10). Obesity An Advantage In Maintenance Hemodialysis Patients, Study Finds. ScienceDaily. Retrieved July 16, 2009, from http://www.sciencedaily.com­ /releases/2006/11/061114185223.htm

American Society of Nephrology (2008, November 13). Overnight Hemodialysis Dramatically Improves Survival, Study Shows. ScienceDaily. Retrieved July 16, 2009, from http://www.sciencedaily.com­ /releases/2008/11/081108155830.htm

Alexis O. Zano Jr.

Answer: The clients who received A TIMING AND QUALITY OF CARE BEFORE INITIATION OF DIALYSIS WOULD BENEFIT THE MOST FOR THE TREATMENT.

Early referral to the nephrologist and timely initiation of renal replacement therapy: a paradigm shift in the management of patients with chronic renal failure.

Obrador G T; Pereira B J


The high mortality rate among dialysis patients has spawned investigation into potentially correctable factors that are associated with an increased risk of death. Several studies have demonstrated a strong association between an increased risk of death in dialysis patients and suboptimal delivered dose of dialysis, malnutrition, and non-renal comorbidity. In addition, the use of unsubstituted cellulose dialyzers and reprocessed dialyzers also has been associated with an increased risk of death. Increased attention to these factors has resulted in a significant improvement in patient survival. Nonetheless, the mortality of dialysis patients remains unacceptably high and indicates that other factors may be operative. One of the factors that has thus far received scant attention, but could significantly affect morbidity and mortality in dialysis patients, is the timing and quality of care before initiation of dialysis. Optimal pre-end-stage renal disease care involves early interventions aimed at delaying progression of chronic renal failure, judicious management of uremic complications, timely placement of vascular access, timely initiation of renal replacement therapy, and implementation of educational programs targeted at maximum rehabilitation. Given the fact that early referral to the nephrologist is likely to result in optimal pre-dialysis care, the 1993 National Institutes of Health Consensus Statement on Morbidity and Mortality of Dialysis recommended that referral of a patient to a renal team should occur at a serum creatinine of 1.5 mg/dL in women and 2.0 mg/dL in men. Several investigators also have argued that patients with chronic renal failure who begin dialysis at a relatively "high level of residual renal function" (early start) may have lower morbidity and mortality compared with patients who begin dialysis at a more traditional "low level of renal function" (late start). This hypothesis is based on evidence that declining renal function is associated with malnutrition and that malnutrition at the start of dialysis is associated with poor clinical outcomes. Furthermore, patients are started on dialysis at an endogenous solute clearance that is lower than that accepted as optimum for patients on dialysis.

American journal of kidney diseases : the official journal of the National Kidney Foundation, (1998 Mar) Vol. 31, No. 3, pp. 398-417. Ref: 86 Journal code: 8110075. E-ISSN: 1523-6838. .

Nancelle Dumlao

Q:Who would benefit the most for hemodialysis treatment? Please site a literature to support your response.


A:The diabetic ESRD patients aged 45 and above show better survival when they opt for hemodialysis as their treatment modality.

In the past, there were several large-scale studies delving on the mortality rate among ESRD patients who are on renal replacement therapies, such as hemodialysis (HD) and peritoneal dialysis (PD). However, these studies have conflicting results which prompted the authors of this research to further review these previous studies. It is their aim to find out any consistent trends in the outcomes in the use of either HD and PD considering certain subgroups of patients. Summary findings gathered from six large-scale registry researches and three prospective cohort studies in the US, Canada, Denmark and Netherlands were analyzed, together with the previous pertinent data from 398 940 US Medicare patients. All these studies used similar methods of analysis and the outcomes were summarized using relative risk of death for HD and PD. When the differences in the findings from the 9 studies were understood, they were able to come up with more meaningful conclusions about the relationship of mortality rate with the type of dialysis used by ESRD patients.
From the registry studies, the results indicated that among non-diabetic and younger diabetic patients, the use of peritoneal dialysis result to equal or better survival rate as compared to HD in the four countries. On the other hand, for older diabetic patients, HD was associated with better survival for diabetics aged 45 and above only in the USA; while for Canada and Denmark, HD and PD patients has same survival rate. Moreover, all studies show that PD patients have the same or better survival during the first and second year of undergoing dialysis than in HD. Also, there was no consistent findings on the longer-term survival from the different subgroups.
In summary, whether an ESRD patient opts for PD and HD, the treatment modality has no bearing on the survival of these patients. However, for certain select groups of patient, such as those with diabetes and older patients, the use of either PD or HD could have a significant effect of their survival.

Reference:
Vonesh EF, Snyder JJ, Foley RN, Collins AJ. Mortality studies comparing peritoneal dialysis and hemodialysis: what do they tell us? Kidney International Supplementary. 2006 Nov;(103):S3-11
http://www.ncbi.nlm.nih.gov/pubmed/17080109?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.

Based from the article “Thirty-Seven Uninterrupted Years of Hemodialysis: A Case Report” by Stephen I. Rifkin (2008), hemodialysis can best benefit those clients with chronic renal failure. A case report conducted to a patient with glomerulonephritis to study the effect of long term hemodialysis both on the prognosis and reduced mortality. History of this client were collected in order to tract the effects of hemodialysis. Some significant issues to be taken in considerations were incidence of multiple vascular acces problems, cardiac arrhythmias, osteodystrophy, and the possibility of development of hepatitis C. Several literatures regarding the lived experiences of clients on uninterrupted hemodialysis were also reviewed, with the corresponding clinical characteristics and complications thereunto.

Hence, there was no registry record of clients who lived long with uninterrupted hemodialysis. Mostly data were taken from the internet and some medical literatures. Piccoli (2002) had a study of 56 patients having uninterrupted dialysis for 20 years. Another observational study was conducted by Owen and colleagues (1996) to 17 patients who have dialysis for more than 10 years. Another study conducted by Otsubo and colleagues (2007) reported on the characteristics of 16 patients who were on hemodialysis for more than 30 years. In addition to the previous supporting literature was a study conducted from Alwall’s program to 2 patients living more than 35 years with dialysis.

Similar results from the enumerated literatures were taken down. Findings provide details of the effects of hemodialysis to these patients. First is that among the patients, none develop diabetes. Second was the incidence of severe hypertension were low and not a common problem to this group. Third, access to long-term dialysis was beneficial to this group although it is not mandatory. Incidence of hepatitis B and C were common due to several blood transfusion the client received during the dialysis.

References:
Article taken from Medscape J Med. 2008;10(10):231 2008 Medscape

Authors and disclosures:
Stephen I. Rifkin, MD, FACP, FASN, Associate Professor, Division of Nephrology, University of South Florida College of Thirty-Seven Uninterrupted Years of Hemodialysis: A Case Report.

Alwall N. On the organization of treatment with the artificial kidney and clinical nephrology in the 1940s and following decades: a contribution to the history of medicine. IV. The nineteen-sixties, first part. Dial Transplant. 1980;9:669-713.

Piccoli GB, Mezza E, Anania P, et al. Patients on renal replacement therapy for 20 or more years: a clinical profile. Nephrol Dial Transplant. 2002;17:1440-1449.

Owen WF, Madore F, Brenner BM. An observational study of cardiovascular characteristics of long-term end-stage renal disease survivors. Am J Kidney Dis. 1996;28:931-936.

Otsubo S, Otsubo K, Sugimoto H, et al. Characteristics of patients on hemodialysis therapy for more than 30 years. Ther Apher Dial. 2007;11:274-279.

answer:the patients will benifit from hemodialysis are acute renal failure or poisoning, chronic renal failure/ end stage renal disease and rarely inborn errors of metabolism, cardiac failure. included a high plasma level (more than 50 mg/dL for methanol or more than 20 mg/dL for ethylene glycol), the presence of metabolic acidosis, and symptoms (such as visual or mental status changes with methanol). Hemodialysis is continued until the plasma levels fall below the toxic range.

titl: Survival of hemodialysis patients in Lithuania (data from all hemodialysis centers in the 1998-2005 cohort)
Authors: Asta Stankuviene, Inga Arūne Bumblyte, Vytautas Kuzminskis, Edi

There is no any official renal registry in Lithuania, so in order to know the exact demographic statistics of patients on hemodialysis, we started to collect data since 1996. The aim of the study was to estimate the survival rate of hemodialysis patients and its dynamics, to compare survival in different groups of sex, age, primary renal disease, and to compare to survival of dialysis patients in Europe. MATERIAL AND METHODS: We analyzed the data of all patients who started hemodialysis in Lithuania between January 1, 1998, and December 31, 2005. The information was obtained from medical documentation. The total survival rate was estimated using the Kaplan-Maier method. RESULTS: During the study period, 2418 patients started hemodialysis (51.7% of males, 48.3% of females). Their mean age at the beginning of treatment was 56.19+/-16.12 years. Death occurred in 792 patients. The main cause of death was cardiovascular events, accounting for 32.3%. The total survival rate of hemodialysis patients in Lithuania at 1 year was 79.97%; at 2 years, 69.18%; at 5 years, 49.97%; at 7 years, 38.3%. Males lived longer than females (log rank P<0.05), but the mean age of females was greater, and survival rate adjusted for age did not differ between the groups. The highest survival rate was in the youngest group (0-19 years old), the lowest - in patients older than 75 years. Diabetic patients lived shorter than nondiabetic patients (log rank P<0.00001). Although patients who start hemodialysis have become older and their survival has been improving, in the 1998-2002 cohort survival was lower as compared to overall survival of patients on dialysis in European countries participating in ERA-EDTA registry. CONCLUSION: Survival of hemodialysis patients in Lithuania in the 1998-2005 cohort depended on age and primary renal disease and despite aging of population on hemodialysis has been improving.

Prevalence, treatment, and control of hypertension in chronic hemodialysis patients


Rajiv Agarwal MD Allen R. Nissenson MDb, Daniel Batlle MDc, Daniel W. Coyne MD, J. Richard Trout PhDe and David G. Warnock MD

Copyright 2003 Excerpta Medica Inc.

Hypertension is common in chronic hemodialysis patients, yet there are limited data on the epidemiology of hypertension in these patients in the United States.
Methods
We assessed the prevalence, treatment, and control of hypertension in a cohort of 2535 clinically stable, adult hemodialysis patients who participated in a multicenter study of the safety and tolerability of an intravenous iron preparation. Hypertension was defined as an average predialysis systolic blood pressure >150 mm Hg or diastolic blood pressure >85 mm Hg, or the use of antihypertensive medications.
Results
Hypertension was documented in 86% (n = 2173) of patients. The prevalence of hypertension, in contrast to that observed in the general population, did not increase linearly with age and was not affected by sex or ethnicity. Hypertension was controlled adequately in only 30% (n = 659) of the hypertensive patients. In the remaining patients, hypertension was either untreated (12% [252/2173]) or treated inadequately (58% [1262/2173]).
Conclusion
Control of hypertension, particularly systolic hypertension, in chronic hemodialysis patients in the United States is inadequate, despite recognition of its prevalence and the frequent use of antihypertensive drugs. Optimizing the use of medications and closer attention to nonpharmacologic interventions, such as adjustment of dry weight, a low-sodium diet, and exercise, may improve control.
Reference：http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6TDC-49FPDSS-6-5&_cdi=5195&_user=10&_orig=search&_coverDate=09%2F30%2F2003&_sk=998849995&view=c&wchp=dGLbVlb-zSkWA&md5=72caf4d84308b64af0d69ba96b17b7eb&ie=/sdarticle.pdf