Comparison of graft and patient outcomes following kidney transplantation in extended hour and conventional haemodialysis patients.

Aim: Differences in early graft function between kidney transplant recipients previously managed with either haemodialysis (HD) or peritoneal dialysis are well described. However, only two single-centre studies have compared graft and patient outcomes between extended hour and conventional HD patients, with conflicting results.

Methods: This study compared the outcomes of all extended hour (≥24 h/week) and conventional HD patients transplanted in Australia and New Zealand between 2000 and 2014.

Green dialysis survey: Establishing a baseline for environmental sustainability across dialysis facilities in Victoria, Australia.

Aim: The Green Dialysis Survey aimed to (i) establish a baseline for environmental sustainability (ES) across Victorian dialysis facilities; and (ii) guide future initiatives to reduce the environmental impact of dialysis delivery.

Methods: Nurse unit managers of all Victorian public dialysis facilities received an online link to the survey, which asked 107 questions relevant to the ES of dialysis services.

Results: Responses were received from 71/83 dialysis facilities in Victoria (86%), representing 628/660 dialysis chairs (95%).

Intensive Hemodialysis and Mortality Risk in Australian and New Zealand Populations.

Background: Intensive hemodialysis (HD) is characterized by increased frequency and/or session length compared to conventional HD. Previous analyses from Australia and New Zealand did not suggest benefit with intensive HD, although recent research suggests that relationships have changed. We present updated analyses.

Climate change and us: What nephrologists should know.

Global warming poses significant risks to human health and the planet. If allowed to continue unchecked, its consequences will be devastating. While all populations will be effected with time, vulnerable groups, including those with kidney disease, are likely to be at primary risk.

Temporal Changes in Mortality Risk by Dialysis Modality in the Australian and New Zealand Dialysis Population.

Background: In most studies, home dialysis associates with greater survival than facility hemodialysis (HD). However, the relationship between mortality risk and modality can vary by era. We describe and compare changes in survival with facility HD, peritoneal dialysis, and home HD over a 15-year period using data from The Australia and New Zealand Dialysis and Transplant Registry (ANZDATA).

Home hemodialysis: infrastructure, water, and machines in the home.

We describe the infrastructure that is necessary for hemodialysis in the home focusing on physical requirements, the organization of plumbing and water, and the key features that should guide the selection of machines that are suitable for home use.

Home hemodialysis needs you!

This special supplement of Hemodialysis International focuses on home hemodialysis (HD). It has been compiled by a group of international experts in home HD who were brought together throughout 2013-2014 to construct a home HD "manual." Drawing upon both the literature and their own extensive expertise, these experts have helped develop this supplement that now stands as an A-to-Z guide for any who may be unfamiliar or uncertain about how to establish and maintain a successful home HD program.

Personal viewpoint: Limiting maximum ultrafiltration rate as a potential new measure of dialysis adequacy.

While the solute clearance marker (Kt/Vurea ) is widely used, no effective marker for volume management exists. Two principles apply to acute volume change in hemodialysis: (1) the plasma refill rate, the maximum rate the extracellular fluid can replace a contracting intravascular volume (±5 mL/kg/hour) and (2) the rate of intravascular volume contraction where coronary hypoperfusion, myocardial stun, and vascular risk escalates (observed at ≥10 mL/kg/hour). In extended hour and higher frequency hemodialysis, intravascular contraction rates are usually equilibrated by the plasma refill rate, but in "conventional" in-center hemodialysis, volume contraction rates commonly exceed the capabilities of the plasma refill rate, resulting in inevitable hypovolemia.

Green dialysis: the environmental challenges ahead.

The US Environmental Protection Agency Resource Conservation website begins: "Natural resource and energy conservation is achieved by managing materials more efficiently--reduce, reuse, recycle," yet healthcare agencies have been slow to heed and practice this simple message. In dialysis practice, notable for a recurrent, per capita resource consumption and waste generation profile second to none in healthcare, efforts to: (1) minimize water use and wastage; (2) consider strategies to reduce power consumption and/or use alternative power options; (3) develop optimal waste management and reusable material recycling programs; (4) design smart buildings that work with and for their environment; (5) establish research programs that explore environmental practice; all have been largely ignored by mainstream nephrology. Some countries are doing far better than others.

The carbon footprint of an Australian satellite haemodialysis unit.

Objectives: This study aimed to better understand the carbon emission impact of haemodialysis (HD) throughout Australia by determining its carbon footprint, the relative contributions of various sectors to this footprint, and how contributions from electricity and water consumption are affected by local factors.

Methods: Activity data associated with HD provision at a 6-chair suburban satellite HD unit in Victoria in 2011 was collected and converted to a common measurement unit of tonnes of CO2 equivalents (t CO2-eq) via established emissions factors. For electricity and water consumption, emissions factors for other Australian locations were applied to assess the impact of local factors on these footprint contributors.

Outcomes of extended-hours hemodialysis performed predominantly at home.

Background: Recent evidence suggests that increased frequency and/or duration of dialysis are associated with improved outcomes. We aimed to describe the outcomes associated with patients starting extended-hours hemodialysis and assess for risk factors for these outcomes.

Study Design: Case series.

Risk factors for dialysis withdrawal: an analysis of the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, 1999-2008.

Background And Objectives: Dialysis withdrawal (DW) in patients with ESRD is increasing in importance. This study assessed causes of death and risk factors for DW in Australia and New Zealand in the first year of dialysis.

Design, Setting, Participants, & Measurements: This retrospective observational cohort study included all adult Australians and New Zealanders beginning renal replacement therapy in 1999-2008.

Solar-assisted hemodialysis.

Background And Objectives: Hemodialysis resource use-especially water and power, smarter processing and reuse of postdialysis waste, and improved ecosensitive building design, insulation, and space use-all need much closer attention. Regarding power, as supply diminishes and costs rise, alternative power augmentation for dialysis services becomes attractive. The first 12 months of a solar-assisted dialysis program in southeastern Australia is reported.

Alternate night nocturnal hemodialysis: the Australian experience.

Alternate night nocturnal hemodialysis (HD) is a popular modality in Australia. This modality grew out of a desire to increase the availability and accessibility of nocturnal HD without incurring excessive costs. It has proven popular with staff, patients, and administrators.

Home hemodialysis in Australia and New Zealand: how and why it has been successful.

After early strong support, home hemodialysis (HHD) has all but disappeared as a viable modality in most western countries--except in Australia and New Zealand (ANZ), where a mean 12.9% of all HD (June 2010) is home-based. The reasons for this unique difference are neither demographic nor geographic; rather, they result from a strong belief held by ANZ nephrologists, nurses, and funding agencies in the clinical outcome and economic benefits of HHD.

Personal viewpoint: hemodialysis--water, power, and waste disposal: rethinking our environmental responsibilities.

While medical health professionals are trained to detect, treat, and comfort, they are not trained to consider the environmental impact of the services they provide. Dialysis practitioners seem particularly careless in the use of natural resources—especially water and power—and seem broadly ignorant of the profound medical waste issues created by single use dialysis equipment. If the data we have collected is an indication, then extrapolation of this data to a dialysis population currently estimated at ~2 million patients worldwide, a “world dialysis service” would use ~156 billion liters of water and discard ~2/3 of that during reverse osmosis.

Home hemodialysis and mortality risk in Australian and New Zealand populations.

Background: There is a resurgence of interest in home hemodialysis (HD), especially frequent or extended forms involving unconventionally frequent (>3 times/wk) and/or long (>6 hours) treatments. This resurgence is driven by cost containment and experience suggesting lower mortality risk compared with facility HD and peritoneal dialysis (PD).

Study Design: We performed an observational cohort study using the Australia and New Zealand Dialysis and Transplant Registry, using marginal structural modeling to adjust for time-varying medical comorbidity as both a source of selection bias and an intermediary variable on the causal pathway to death.

How Australian nephrologists view home dialysis: results of a national survey.

Aim: Australia's commitment to home dialysis therapies has been significant. However, there is marked regional variation in the uptake of home haemodialysis (HD) and peritoneal dialysis (PD) suggesting further scope for the expansion of these modalities.

Methods: Between 1 April and 5 August 2009, Australian nephrologists were invited to complete an online survey.

Conserving water in and applying solar power to haemodialysis: 'green dialysis' through wiser resource utilization.

Natural resources are under worldwide pressure, water and sustainable energy being the paramount issues. Haemodialysis, a water-voracious and energy-hungry healthcare procedure, thoughtlessly wastes water and leaves a heavy carbon footprint. In our service, 100 000 L/week of previously discarded reverse osmosis reject water--water which satisfies all World Health Organisation criteria for potable (drinking) water--no longer drains to waste but is captured for reuse.

Review: understanding sorbent dialysis systems.

Although maintenance haemodialysis once had the benefit of two distinctly different dialysate preparation and delivery systems - (1) a pre-filtration and reverse osmosis water preparation plant linked to a single pass proportioning system and (2) a sorbent column dependent dialysate regeneration and recirculation system known as the REDY system - the first came to dominate the market and the second waned. By the early 1990s, the REDY had disappeared from clinical use. The REDY system had strengths.

Home haemodialysis in Australia - is the wheel turning full circle?

In the mid 1970s, home haemodialysis accounted for nearly half of all patients on dialysis, both in Australia and elsewhere. The advent of both peritoneal dialysis (itself a home therapy) and satellite haemodialysis resulted in a gradual attrition in the use of home haemodialysis. Since 2000, the introduction of nocturnal home haemodialysis has begun to change this pattern in Australia, with a sharp growth in the uptake of home haemodialysis.