title: Conversion from conventional in-centre thrice-weekly haemodialysis to short daily home haemodialysis ameliorates uremia-associated clinical parameters.
abstract: BACKGROUND
  Under physiological conditions, kidneys work continuously, 168 h/week. In contrast, patients with end-stage renal disease are usually dialysed only 12 h/week. Even if considered adequate by current Kt/V-based dose estimates, this unphysiological dose is associated with an unacceptable annual mortality rate of 10-20%. Increasing dialysis dose might ameliorate this mortality rate.
  
  
  METHODS
  Eleven patients were switched from their conventional haemodialysis (cHD, 3 × 4 h/week) to an intensified short daily home haemodialysis regimen (sdhHD, 6 × 3 h/week) and followed up for 12 months. Different parameters were evaluated before treatment conversion and quarterly during follow-up [i.e. dialysis efficacy, mean arterial pressure (MAP), antihypertensive drug score, haemoglobin, transferrin saturation, ferritin, dose of erythropoiesis-stimulating agents (ESA), iron requirement, parameters of nutrition (body weight, albumin, protein), C-reactive protein, calcium-phosphate product, alkaline phosphatase (AP), intact parathyroid hormone (iPTH) and amount of phosphate-binding pharmacotherapy].
  
  
  RESULTS
  HD efficacy as assessed by cumulative blood volume increased after dialysis intensification (P < 0.01). The pre- and post-dialytic MAP declined during the study period (P < 0.0001), while antihypertensive drugs could be reduced (P = 0.02). Haemoglobin levels improved (P < 0.0001). Additionally, the need for ESAs fell under intensified sdhHD (P = 0.008). Nutritional status improved [albumin, P = 0.03; total serum protein, P = 0.02; 'dry' body weight (BW) and body mass index (BMI) (both P < 0.001)]. The calcium-phosphate product declined (P < 0.01), without changes in the dose of phosphate binders.
  
  
  CONCLUSIONS
  Conversion from conventional in-centre to short daily home HD leads to an improvement in numerous dialysis-associated metabolic variables and thus represents an attractive treatment modality for selected patients.
authors.affiliation: Department of Medicine/Division of Nephrology and Hypertension, Hanover Medical School, Carl-Neuberg-Strasse 1, 30625 Hanover, Germany. J.M.Lorenzen@gmail.com
authors.forename: Johan M
authors.initials: JM
authors.lastname: Lorenzen
authors.forename: Thomas
authors.initials: T
authors.lastname: Thum
authors.forename: Georg M
authors.initials: GM
authors.lastname: Eisenbach
authors.forename: Hermann
authors.initials: H
authors.lastname: Haller
authors.forename: Jan T
authors.initials: JT
authors.lastname: Kielstein
mesh_terms: D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000959:Antihypertensive Agents / Q000008:administration & dosage; D001794:Blood Pressure; D001798:Blood Proteins / Q000378:metabolism; D015992:Body Mass Index; D001835:Body Weight; D002097:C-Reactive Protein / Q000378:metabolism; D002118:Calcium / Q000097:blood; D002614:Chelating Agents / Q000008:administration & dosage; D005260:Female; D005293:Ferritins / Q000097:blood; D006397:Hematinics / Q000008:administration & dosage; D006437:Hemodialysis, Home; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000628:therapy*; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D014168:Transferrin / Q000378:metabolism; D014511:Uremia / Q000097:blood* / Q000628:therapy
chemical_list: D000959:Antihypertensive Agents; D001798:Blood Proteins; D002614:Chelating Agents; D006397:Hematinics; D006454:Hemoglobins; D010281:Parathyroid Hormone; D010710:Phosphates; D012709:Serum Albumin; D014168:Transferrin; D002097:C-Reactive Protein; D005293:Ferritins; D000469:Alkaline Phosphatase; D002118:Calcium