Since World Health Organization (WHO) declared a global Health Emergency at the end of January 2020 caused by the novel coronavirus 2019-nCoV, the rapid spread of this pandemic poses unprecedented ...challenges throughout the world. Hemodialysis patients are more susceptible to SARS-CoV-2 pneumonia than the general population. Dialysis physicians, health workers should have clinical knowledge of epidemic COVID-19, epidemic prevention tools, and required guidelines. This paper aims to focus on the Moroccan society of nephrology recommendations and the Ministry of Health guidelines to protect both healthcare workers and hemodialysis patients from the virus. A package of measures has been recommended by the Ministry of Health to ensure continuity of health services for hemodialysis patients with Covid-19. Besides, the Moroccan society of nephrology recommendations has been adopted to ensure quality care for this vulnerable category throughout the epidemic.
Background Few data are available regarding the long-term mortality rate for patients receiving nocturnal home hemodialysis. Study Design Posttrial observational study. Setting & Participants ...Frequent Hemodialysis Network (FHN) Nocturnal Trial participants who consented to extended follow-up. Intervention The FHN Nocturnal Trial randomly assigned 87 individuals to 6-times-weekly home nocturnal hemodialysis or 3-times-weekly hemodialysis for 1 year. Patients were enrolled starting in March 2006 and follow-up was completed by May 2010. After the 1-year trial concluded, FHN Nocturnal participants were free to modify their hemodialysis prescription. Outcomes & Measurements We obtained dates of death and kidney transplantation through July 2011 using linkage to the US Renal Data System and queries of study centers. We used log-rank tests and Cox regression to relate mortality to the initial randomization assignment. Results Median follow-up for the trial and posttrial observational period was 3.7 years. In the nocturnal arm, there were 2 deaths during the 12-month trial period and an additional 12 deaths during the extended follow-up. In the conventional arm, the numbers of deaths were 1 and 4, respectively. In the nocturnal dialysis group, the overall mortality HR was 3.88 (95% CI, 1.27-11.79; P = 0.01). Using as-treated analysis with a 12-month running treatment average, the HR for mortality was 3.06 (95% CI, 1.11-8.43; P = 0.03). Six-month running treatment data analysis showed an HR of 1.12 (95% CI, 0.44-3.22; P = 0.7). Limitations These results should be interpreted cautiously due to a surprisingly low (0.03 deaths/patient-year) mortality rate for individuals randomly assigned to conventional home hemodialysis, low statistical power for the mortality comparison due to the small sample size, and the high rate of hemodialysis prescription changes. Conclusions Patients randomly assigned to nocturnal hemodialysis had a higher mortality rate than those randomly assigned to conventional dialysis. The implications of this result require further investigation.
Home hemodialysis (HHD) has many benefits, but less is known about relative outcomes when comparing different home-based hemodialysis modalities. Here, we compare patient and treatment survival for ...patients receiving short daily HHD (2-3 hours/5 plus sessions per week), nocturnal HHD (6-8 hours/5 plus sessions per week) and conventional HHD (3-6 hours/2-4 sessions per week). A nationally representative cohort of Canadian HHD patients from 1996-2012 was studied. The primary outcome was death or treatment failure (defined as a permanent return to in-center hemodialysis or peritoneal dialysis) using an intention to treat analysis and death-censored treatment failure as a secondary outcome. The cohort consisted of 600, 508 and 202 patients receiving conventional, nocturnal, and short daily HHD, respectively. Conventional-HHD patients were more likely to use dialysis catheter access (43%) versus nocturnal or short daily HHD (32% and 31%, respectively). Although point estimates were in favor of both therapies, after multivariable adjustment for patient and center factors, there was no statistically significant reduction in the relative hazard for the death/treatment failure composite comparing nocturnal to conventional HHD (hazard ratio 0.83 95% confidence interval 0.66-1.03) or short daily to conventional HHD (0.84, 0.63-1.12). Among those with information on vascular access, patients receiving nocturnal HHD had a relative improvement in death-censored treatment survival (0.75, 0.57-0.98). Thus, in this national cohort of HHD patients, those receiving short daily and nocturnal HHD had similar patient/treatment survival compared with patients receiving conventional HHD.
Background
Regional anticoagulation in hemodialysis avoids the use of heparin, which is responsible for both hemorrhagic and non‐hemorrhagic complications. Typically, blood is decalcified by ...injecting citrate into the arterial line of the extracorporeal circuit. Calcium‐free dialysate improves anticoagulation efficacy but requires injection of a calcium‐containing solution into the venous line and strict monitoring of blood calcium levels. Recent improvements have made regional anticoagulation with calcium‐free dialysate safer and easier.
Observations
(1) Adjusting the calcium injection rate to ionic dialysance avoids the risk of dyscalcemia, thus making unnecessary the monitoring of blood calcium levels. This adjustment could be carried out automatically by the hemodialysis monitor. (2) As calcium‐free dialysate reduces the amount of citrate required, this can be supplied by dialysate obtained from currently available concentrates containing citric acid. This avoids the need for citrate injection and the risk of citrate overload. (3) Calcium‐free dialysate no longer needs the dialysate acidification required for avoiding calcium carbonate precipitation in bicarbonate‐containing dialysate.
Conclusions
Regional anticoagulation with calcium‐free dialysate enables an acid‐ and heparin‐free procedure that is more biocompatible and environmentally friendly than conventional bicarbonate hemodialysis. The availability of specific acid‐free concentrates and adapted hemodialysis monitors is required to extend this procedure to maintenance hemodialysis.
This review shows how some improvements in regional anticoagulation enable a safe and easy‐to‐use hemodialysis procedure that is more biocompatible and environmentally friendly.
Prior small studies have shown multiple benefits of frequent nocturnal hemodialysis compared to conventional three times per week treatments. To study this further, we randomized 87 patients to three ...times per week conventional hemodialysis or to nocturnal hemodialysis six times per week, all with single-use high-flux dialyzers. The 45 patients in the frequent nocturnal arm had a 1.82-fold higher mean weekly stdKt/Vurea, a 1.74-fold higher average number of treatments per week, and a 2.45-fold higher average weekly treatment time than the 42 patients in the conventional arm. We did not find a significant effect of nocturnal hemodialysis for either of the two coprimary outcomes (death or left ventricular mass (measured by MRI) with a hazard ratio of 0.68, or of death or RAND Physical Health Composite with a hazard ratio of 0.91). Possible explanations for the left ventricular mass result include limited sample size and patient characteristics. Secondary outcomes included cognitive performance, self-reported depression, laboratory markers of nutrition, mineral metabolism and anemia, blood pressure and rates of hospitalization, and vascular access interventions. Patients in the nocturnal arm had improved control of hyperphosphatemia and hypertension, but no significant benefit among the other main secondary outcomes. There was a trend for increased vascular access events in the nocturnal arm. Thus, we were unable to demonstrate a definitive benefit of more frequent nocturnal hemodialysis for either coprimary outcome.
Chronic renal failure is a public health problem and hemodialysis is considered an invasive and exhausting long-term process. Patients usually report feelings of helplessness and dependence, and ...ludic activities might provide involvement, joy and pleasure. A insuficiência renal crônica é um problema da saúde pública e a hemodiálise é um tratamento invasivo e desgastante, do qual os pacientes relatam sentimentos de impotência e dependência. A pesquisa teve como objetivos propor atividades lúdicas e relaxamento durante sessões de hemodiálise e investigar opinião dos pacientes sobre o trabalho, bem como conhecer vivências e percepções quanto à doença e tratamento. La enfermedad renal crónica es un problema de salud pública y la hemodiálisis es un tratamiento invasivo y agotador del que los pacientes reportan sentimientos de impotencia y dependencia. La investigación tuvo como objetivo ofrecer actividades lúdicas y de relajación durante las sesiones de hemodiálisis, investigar la opinión de los pacientes acerca de la propuesta de trabajo y conocer las experiencias y percepciones acerca de la enfermedad y el tratamiento.
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