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Home haemodialysis

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Haemodialysis (HD) began as an intensive care treatment offered to a very select number of patients in an attempt to keep them alive. Outcomes were extremely poor, and the procedure was cumbersome and labor intensive. With increasing expertise and advances in dialysis equipment, HD is now recognised as a life-sustaining treatment that is considered a standard of care for children with end stage renal disease (ESRD). Assessment of efficacy has evolved from mere survival, through achieving minimal standards of “adequate” dialysis with reduced morbidity, towards the provision of “optimal dialysis”, which includes attempts to more closely mimic normal renal function, and of individualised care that maximizes the patient’s health, psychosocial well-being and life potential. There is a renewed interest in dialysis, and the research profile has extended, exploring themes around convective versus diffusive treatments, HD time versus frequency and home versus in-centre dialysis. The results thus far have led dialysis care full circle from prolonged, home-based therapies to shorter, intense in-centre dialysis back to the belief that long or frequent HD at home achieves the best outcomes.

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  1. Graham T (1854) The Bakerian lecture on osmotic force. Philos Trans R Soc Lond 144:177–228

    Article  Google Scholar 

  2. Abel JJ, Rountree LG, Turner BB (1913) The removal of diffusible substances from the circulating blood by means of dialysis. Tn Assoc Am Physicians 28:51

    Google Scholar 

  3. Paskalev DN (2001) Georg Haas (1886–1971) The forgotten hemodialysis pioneer. Dialysis and Transplantation 30:828–832 Available at:

  4. Kolff WJ, Berk HTJ (1944) Artificial kidney, dialyzer with great area. Geneesk gids 21:1944

    Google Scholar 

  5. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (2010) Contributions to dialysis. NIDDK, Bethesda

  6. Baillod R, Comty C, Shaldon S (1965) Overnight haemodialysis in the home. Proc Eur Dial Transplant Assoc 2:99–104

    Google Scholar 

  7. Müller D, Zimmering M, Chan CT, McFarlane PA, Pierratos A, Querfeld U (2008) Intensified hemodialysis regimens: neglected treatment options for children and adolescents. Pediatr Nephrol 23:1729–3176

    Article  PubMed  Google Scholar 

  8. Ferris ME, Gipson DS, Kimmel PL, Eggers PW (2006) Trends in treatment and outcomes of survival of adolescents initiating end-stage renal disease care in the United States of America. Pediatr Nephrol 21:1020–1026

    Article  PubMed  Google Scholar 

  9. US Renal Data System: USRDS (2003) Annual report. The National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda

  10. Eknoyan G, Beck GJ, Cheung AK, Daugirdas JT, Greene T, Kusek JW, Allon M, Bailey J, Delmez JA, Depner TA, Dwyer JT, Levey AS, Levin NW, Milford E, Ornt DB, Rocco MV, Schulman G, Schwab SJ, Teehan BP, Toto R, Hemodialysis (HEMO) Study Group (2002) Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 347:2010–2019

    Article  PubMed  Google Scholar 

  11. Port FK, Ashby VB, Dhingra RK, Roys EC, Wolfe RA (2002) Dialysis dose and body mass index are strongly associated with survival in hemodialysis patients. J Am Soc Nephrol 13:1061–1066

    PubMed  Google Scholar 

  12. Daugirdas JT, Hanna MG, Becker-Cohen R, Langman CB (2010) Dose of dialysis based on body surface area is markedly less in younger children than in older adolescents. Clin J Am Soc Nephrol 5:821–827

    Article  PubMed  Google Scholar 

  13. Saran R, Bragg-Gresham JL, Levin NW, Twardowski ZJ, Wizemann V, Saito A, Kimata N, Gillespie BW, Combe C, Bommer J, Akiba T, Mapes DL, Young EW, Port FK (2006) Longer treatment time and slower ultrafiltration in hemodialysis: associations with reduced mortality in the DOPPS. Kidney Int 69:1222–1228

    Article  PubMed  CAS  Google Scholar 

  14. Marshall MR, Byrne BG, Kerr PG, McDonald SP (2006) Associations of hemodialysis dose and session length with mortality risk in Australian and New Zealand patients. Kidney Int 69:1229–1236

    Article  PubMed  CAS  Google Scholar 

  15. Ting GO, Kjellstrand C, Freitas T, Carrie BJ, Zarghamee S (2003) Long-term study of high-comorbidity ESRD patients converted from conventional to short daily hemodialysis. Am J Kidney Dis 42:1020–1035

    Article  PubMed  Google Scholar 

  16. Puñal J, Lema LV, Sanhez-Guisande D, Ruano-Ravina A (2008) Clinical effectiveness and quality of life of conventional haemodialysis versus short daily haemodialysis: a systematic review. Nephrol Dial Transplant 23:2634–2646

    Article  PubMed  Google Scholar 

  17. Hall YN, Larive B, Painter P, Kaysen GA, Lindsay RM, Nissenson AR, Unruh ML, Rocco MV, Chertow GM, Frequent Hemodialysis Network Trial Group (2012) Effects of six versus three times per week hemodialysis on physical performance, health, and functioning: Frequent Hemodialysis Network (FHN) randomized trials. Clin J Am Soc Nephrol 7:782–794

    Article  PubMed  Google Scholar 

  18. Chertow GM, Levin NW, Beck GJ, Depner TA, Eggers PW, Gassman JJ, Gorodetskaya I, Greene T, James S, Larive B, Lindsay RM, Mehta RL, Miller B, Ornt DB, Rajagopalan S, Rastogi A, Rocco MV, Schiller B, Sergeyeva O, Schulman G, Ting GO, Unruh ML, Star RA, Kliger AS, FHN Trial Group (2010) In-center hemodialysis six times per week versus three times per week. N Engl J Med 363:2287–2300

    Article  PubMed  CAS  Google Scholar 

  19. Johansen KL, Zhang R, Huang Y, Chen SC, Blagg CR, Goldfarb-Rumyantzev AS, Hoy CD, Lockridge RS Jr, Miller BW, Eggers PW, Kutner NG (2009) Survival and hospitalization among patients using nocturnal and short daily compared to conventional hemodialysis: a USRDS study. Kidney Int 76:984–990

    Article  PubMed  CAS  Google Scholar 

  20. Pauly RP, Gill JS, Rose CL, Asad RA, Chery A, Pierratos A, Chan CT (2009) Survival among nocturnal home haemodialysis patients compared to kidney transplant recipients. Nephrol Dial Transplant 24:2915–2919

    Article  PubMed  Google Scholar 

  21. Chan CT, Liu PP, Arab S, Jamal N, Messner HA (2009) Nocturnal hemodialysis improves erythropoietin responsiveness and growth of hematopoietic stem cells. J Am Soc Nephrol 20:665–671

    Article  PubMed  Google Scholar 

  22. Culleton BF, Walsh M, Klarenbach SW, Mortis G, Scott-Douglas N, Quinn RR, Tonelli M, Donnelly S, Friedrich MG, Kumar A, Mahallati H, Hemmelgarn BR, Manns BJ (2007) Effect of frequent nocturnal hemodialysis vs conventional hemodialysis on left ventricular mass and quality of life. A randomized controlled trial. JAMA 298:1291–1299

    Article  PubMed  CAS  Google Scholar 

  23. Jefferies HJ, Virk B, Schiller B, Moran J, McIntyre CW (2011) Frequent hemodialysis schedules are associated with reduced levels of dialysis-induced cardiac injury (myocardial stunning). Clin J Am Soc Nephrol 6:1326–1332

    Article  PubMed  Google Scholar 

  24. Bergman A, Fenton SS, Richardson RM, Chan CT (2008) Reduction in cardiovascular related hospitalization with nocturnal home hemodialysis. Clin Nephrol 69:33–39

    PubMed  CAS  Google Scholar 

  25. Perl J, Lok CE, Chan CT (2006) Central venous catheter outcomes in nocturnal hemodialysis. Kidney Int 70:1348–1354

    Article  PubMed  CAS  Google Scholar 

  26. Fong E, Bargman JM, Chan CT (2007) Cross-sectional comparison of quality of life and illness intrusiveness in patients who are treated with nocturnal home hemodialysis versus peritoneal dialysis. Clin J Am Soc Nephrol 2:1195–1200

    Article  PubMed  Google Scholar 

  27. Tom A, McCauley L, Bell L, Rodd C, Espinosa P, Yu G, Yu J, Girardin C, Sharma A (1999) Growth during maintenance hemodialysis: impact of enhanced nutrition and clearance. J Pediatr 134:464–471

    Article  PubMed  CAS  Google Scholar 

  28. Fischbach M, Terzic J, Menouer S, Dheu C, Seuge L, Zalosczic A (2010) Daily on line haemodiafiltration promotes catch-up growth in children on chronic dialysis. Nephrol Dial Transplant 25:867–873

    Article  PubMed  CAS  Google Scholar 

  29. Goldstein SL, Silverstein DM, Leung JC, Feig DI, Soletsky B, Knight C, Warady BA (2008) Frequent hemodialysis with NxStage system in pediatric patients receiving maintenance hemodialysis. Pediatr Nephrol 23:129–135

    Article  PubMed  Google Scholar 

  30. Simonsen O (2000) Slow nocturnal dialysis as a rescue treatment for children and young patients with end-stage renal failure. J Am Soc Nephrol 11:327A

    Google Scholar 

  31. Hothi DK, Piva E, Keating L, Secker D, Harvey E, Geary D (2006) Calcium and phosphate balance in children on home nocturnal hemodialysis. Pediatr Nephrol 21:835–841

    Article  PubMed  Google Scholar 

  32. Geary DF, Piva E, Tyrrell J, Gajaria MJ, Picone G, Keating LE, Harvey EA (2005) Home nocturnal hemodialysis in children. J Pediatr 147:383–387

    Article  PubMed  Google Scholar 

  33. Mackenzie P, Mactier RA (1998) Home haemodialysis in the 1990’s. Nephrol Dial Transplant 13:1944–1948

    Article  PubMed  CAS  Google Scholar 

  34. Hoenich N, Mactier R, Boyle G, Harrington M, Lindley E, Morgan I, Rylance P, O’Donoghue D (2012) Guideline on water treatment facilities, dialysis water and dialysis fluid quality for haemodialysis and related therapies. Renal Association, UK

    Google Scholar 

  35. NxStage Medical (2006) APM120 Rev. B Basic Primer. NxStage Medical, Lawrence

  36. Kidney Disease: Improving Global Outcomes (KDIGO) (2002) European best practices guidelines for hemodialysis [Part 1]. Section II: hemodialysis adequacy. Nephrol Dial Transplant 17[Suppl 7]:17–20

  37. National Kidney Foundation KDOQI GUIDELINES (2006) Clinical practice guidelines and clinical practice recommendations: Hemodialysis adequacy. National Kidney Foundation, Washington DC

  38. Daugirdas JT, Leypoldt JK, Akonur A, Greene T, Depner TA, the FHN Trial Group (2012) Improved equation for estimating single-pool Kt/V at higher dialysis frequencies. Nephrol Dial Transplant. doi:10.1093/ndt/gfs115

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Correspondence to Daljit K. Hothi.

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Hothi, D.K., Stronach, L. & Harvey, E. Home haemodialysis. Pediatr Nephrol 28, 721–730 (2013).

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