n this slide forum, researchers from
United States, Europe, and Japan presented
findings relevant to enhance-ment
of home hemodialysis.
Stephen Ash, MD, Ash Medical/
HemoCleanse, West Lafayette, Indiana,
presented the Lafayette Clinic experience
with concentrated citrate lock solution for
hemodialysis catheters. Citrate is not only
an anticoagulant, at hypertonic concentrations
it also has antibacterial activity.
As a result of this approach, both infections
and the use of urokinase for occluded
catheters were significantly reduced in
the dialysis unit.
A novel subcutaneous access device
combined with an anti-infective locking
solution was the subject of Dr. Klaus
Sodemann’s presentation (Dialysis Center
Lahr-Ettenheim, Lahr, Schwarzwald,
Germany). The device’s main advantage is
that the built-in valvular mechanism
ensures that, even in the event of disconnection,
there is no risk of bleeding or air
embolism, both inherent dangers with
fistula needles and catheter connections.
Rajiv Saran, MD, University of
Missouri, Columbia, Missouri, presented a
prospective observational study showing
the effectiveness, practicality, and safety of
outpatient, intradialytic, high-dose uroki-nase
infusion for the treatment of dialysis
catheter thrombosis.
Gill Harwood, RGN, Ipswich Hospital,
Ipswich, England, has reduced the duration
of training for home hemodialysis
from 2 to 3 months to 20 days, and even
less in some patients. A very precise program
includes daily training by a dedicated
home hemodialysis nurse who is also
responsible for the completion of training
in the home. This interesting program
seems particularly suitable for short daily
hemodialysis programs.
Toru Shinzato, MD, Nagoya
University, Nagoya, Nichi-ken, Japan,
described a very interesting method for
creating a fixed route for buttonhole
puncture. First, at the end of a usual
hemodialysis session, a guide wire was
inserted into the blood access through the
puncture needle. Then a 16G polycarbonate
hollow stick was inserted into the vessel
over the guide wire and left until the
next hemodialysis treatment. This created
a fixed route for the puncture needle.
Once the fixed route was established,
subsequent dull needle insertion into an
arteriovenous fistula by the buttonhole
technique was easy. This method, if confirmed
and widely implemented, could
contribute to more universal implementation
of the buttonhole method, which is
especially relevant for home hemodialysis.
Jules Traeger, MD, Association
Utilisation Rein Artificiel, Lyon, France,
presented a simple, safe, sterile machine
based on a new concept: pressurized
dialysate avoids the complexity of volumetric
or flow measurement systems for
the control of ultrafiltration. Instead,
ultrafiltration control is achieved by variation
of dialysate tank pressure and line
resistance, thus regulating the transmembrane
pressure. The use of preprepared
dialysate in plastic bags allows for rapid
“setup and cleaning” of the machine,
which is perfectly adapted for short daily
home hemodialysis. Both in vitro and
experimental in vivo results (normal and
uremic pigs) have shown the validity of
this new concept.
Roula Galland, MD, Association
Utilisation Rein Artificiel, Lyon, France,
showed that increased frequency is the
main factor responsible for superior clinical
results obtained by short, daily
hemodialysis. Maintaining daily frequency
while reducing either the duration of the
hemodialysis session or reducing the
dialysate flow to 250 mL/min did not
affect the quality of the clinical results
obtained with short, daily hemodialysis,
despite a lower Kt/V.
Peter Choi, MA, a senior medical student
from Loyola University in Chicago,
Illinois, highlighted the importance of
hypophosphatemia as a powerful predictor
for mortality in hemodialysis patients.
F. Nurhan Özdemir, Baskent
University, Ankara, Turkey, presented
the results of a study of 30 patients on
hemodialysis in whom protein intake
was reduced from 1.2 g/kg/day to
0.8 g/kg/day, keeping the calorie intake
constant. Both anthropometric and
biochemical markers declined as a result
of this reduction, reemphasizing that
malnutrition can be avoided by maintain-ing
protein intake of hemodialysis
patients at 1.2 g/kg/day.
