Knowing what we do and doing what we should: quality assurance in hemodialysis.

An international group of around 50 nephrologists and scientists, including representatives from large dialysis provider organisations, formulated recommendations on how to develop and implement quality assurance measures to improve individual hemodialysis patient care, population health and cost effectiveness. Discussed were methods thought to be of highest priority, those clinical indicators which might be most related to meaningful patient outcomes, tools to control treatment delivery and the role of facilitating computerized expert systems. Emphasis was given to the use of new technologies such as measurement of online dialysance and ways of assessing fluid status.

A randomized controlled trial evaluating the erythropoiesis stimulating agent sparing potential of a vitamin E-bonded polysulfone dialysis membrane.

Background: Vitamin E (VE) bonded polysulfone dialysis membranes have putative erythropoiesis stimulating agent (ESA)-sparing and anti-inflammatory properties based on data from a small number of studies. We sought to investigate this in a large, prospective 12-month randomized controlled trial.

Methods: Two-hundred and sixty prevalent haemodialysis (HD) patients were randomized to dialysis with VE-bonded polysulfone membranes or non-VE-bonded equivalents.

Online haemodiafiltration: definition, dose quantification and safety revisited.

The general objective assigned to the EUropean DIALlysis (EUDIAL) Working Group by the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) was to enhance the quality of dialysis therapies in Europe in the broadest possible sense. Given the increasing interest in convective therapies, the Working Group has started by focusing on haemodiafiltration (HDF) therapies. Several reports suggest that those therapies potentially improve the outcomes for end-stage renal disease patients.

A predictive algorithm for the management of anaemia in haemodialysis patients based on ESA pharmacodynamics: better results for less work.

Background: Many anaemia management algorithms recommend changes to erythropoiesis-stimulating agent (ESA) doses based on frequent measurement of haemoglobin levels in keeping with the ESA datasheets. We designed a predictive anaemia algorithm based on ESA pharmacodynamics, which we hoped would improve compliance with haemoglobin targets and reduce workload.

Methods: A new algorithm was designed which predicted the 3-month steady-state haemoglobin concentration following a change in ESA dose and only recommended a change if it was outside the range 10.

Automated monitoring of hemodialysis adequacy by dialysis machines: potential benefits to patients and cost savings.

Hemodialysis adequacy can be quantified using ultraviolet absorbance of the spent dialysate, or by analysis of dialysate conductivity at the dialyzer inlet and outlet in response to changes in dialysate electrolyte concentration. These measurements can be made at every dialysis, including initial and acute treatments and can help detect access recirculation. No disposables or reagents are required.

The clinical significance of early proteinuria after renal transplantation.

Background: Late-onset proteinuria after renal transplantation has been universally associated with poor allograft outcomes. However, the significance of early low-grade posttransplant proteinuria remains uncertain.

Methods: We analyzed the effect of proteinuria 3 months posttransplantation on death-censored graft loss, death with a functioning graft, vascular events within the graft's life, and estimated glomerular filtration rate at 5 years.

Long-term outcomes in online hemodiafiltration and high-flux hemodialysis: a comparative analysis.

Background And Objectives: Theoretical advantages exist of online hemodiafiltration (HDF) over high-flux hemodialysis (HD), but outcome data are scarce. Our objective was to compare outcomes between these modalities.

Design, Setting, Participants, & Measurements: We studied 858 incident patients in our incremental high-flux HD and online HDF program during an 18-yr period.

A comparison of methods for determining urea distribution volume for routine use in on-line monitoring of haemodialysis adequacy.

Background: The availability of haemodialysis machines equipped with on-line clearance monitoring (OCM) allows frequent assessment of dialysis efficiency and adequacy without the need for blood samples. Accurate estimation of the urea distribution volume 'V' is required for Kt/V calculated from OCM to be consistent with conventional blood sample-based methods.

Methods: Ten stable HD patients were monitored monthly for 6 months.

Identical decline of residual renal function in high-flux biocompatible hemodialysis and CAPD.

Background: Patients on conventional hemodialysis lose residual renal function more rapidly than patients on continuous ambulatory peritoneal dialysis (CAPD). The effect of dialysis using synthetic membranes and ultrapure water is less clear.

Methods: The decline of urea clearance was compared in a cohort of 475 incident end-stage renal failure patients who received treatment with CAPD (N=175) or hemodialysis (HD) utilizing high-flux polysulphone membranes, ultrapure water, and bicarbonate as the buffer (N=300).