Intensive Home Hemodialysis: An Eye at the Past Looking for the Hemodialysis of the Future.
Multiple observational studies along with a limited number of randomized clinical trials suggest that intensive hemodialysis (IHD) not only improves outcomes for uremic patients undergoing chronic dialysis but does so with a more favorable cost/benefit ratio compared with conventional hemodialysis. As a result of this, there has been a rapid increase in the interest in home hemodialysis (HHD) as HHD represents the easiest means of implementing IHD. While HHD has generated increased interest given its association with better outcomes/reduced hospitalizations, there are very few randomized controlled trials comparing HHD with other hemodialysis methods. Reported HHD-associated increased survival benefits compared with in-center hemodialysis are from uncontrolled studies, which raise patient selection bias as underlying the differences found. Thus, while HHD draws increasing attention, studies that pay careful attention to the psychosocial, demographic, and clinical factors associated with patients selected to undergo HHD will be needed to ultimately demonstrate its benefits, clarify the clinical applications, and determine the limits of IHD use in dialysis patients.
Department of Medicine, Nephrology, University of Padova-Azienda Ospedaliera di Padova, Padova, Italy.
Agostino
A
Naso
Department of Medicine, Nephrology, University of Padova-Azienda Ospedaliera di Padova, Padova, Italy.
Giuseppe
G
Scaparrotta
Department of Medicine, Nephrology, University of Padova-Azienda Ospedaliera di Padova, Padova, Italy.
Elena
E
Naso
Department of Medicine, Nephrology, University of Padova-Azienda Ospedaliera di Padova, Padova, Italy.
Lorenzo A
LA
Calò
D002986:Clinical Trials as Topic; D005060:Europe; D006437:Hemodialysis, Home / Q000009:adverse effects / Q000266:history / Q000295:instrumentation / Q000379:methods*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D012959:Socioeconomic Factors; D014481:United States
Hemodialysis; Home hemodialysis; Nocturnal extended hemodialysis; NxStage; Short daily hemodialysis; Uremia