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Monday, February 11, 2013

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Yvanie

You're right: between the years 2000 and 2010, most of the french patients receiving in center daily HD were selected because they were so sick and daily HD was indeed a rescue option for them.
The results of the french registry were presented in a congress in Bordeaux in 2011. The speaker concluded by: "according to french data, daily HD is the
deadliest dialysis technic...".

Yvanie
France

SV

I'm a home hemodialysis patient, on dialysis since 2011 after 27 years of being transplanted.

I have a question about this and earlier studies on this topic. Has anyone done a meta-analysis using bias modeling methods such as those in Turner et al 2006? The kinds of objections you raise probably hold for many of these other studies; one can investigate them more formally.

@article{turner2008bias,
title={Bias modelling in evidence synthesis},
author={Turner, Rebecca M and Spiegelhalter, David J and Smith, Gordon and Thompson, Simon G},
journal={Journal of the Royal Statistical Society: Series A (Statistics in Society)},
volume={172},
number={1},
pages={21--47},
year={2008},
publisher={Wiley Online Library}
}

Such a study would be a very important contribution to the debate.

Chris Schwab

Thanks for pointing out once again how the waters of knowledge get muddied here in the U.S. with bad info.

Too bad clinics like Dr. John Agar's in Australia seem like a far-off dream:
http://www.greendialysis.org/

Peter Laird, MD

Dear SV, I hope all goes well with your home hemodialysis. I am not aware of any meta-analysis at this point. My own opinion is that the opposition to quotidian dialysis is based on financial principles instead of medical principles. Who can dispute Kjellstrand's Unphysiology Hypothesis from 1975?

As I noted, the current research into alternative dialysis technology embrace longer duration, more frequent dialysis with significantly higher clearances. The target for many of these devices is a weekly Kt/V of 7 or higher.

The government remains hypocritical by supporting new dialysis technology based on the expanded principles of quotidian dialysis while at the same not supporting more frequent and longer duration with current technology.

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