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DAILY HOME DIALYSIS MAKES 'RESTLESS LEGS' BETTER
Short Daily Hemodialysis Reduces Common Symptom in Dialysis Patients
Washington, DC (March 11, 2011) — For dialysis patients, performing daily dialysis at
home can help alleviate sleep problems related to restless legs syndrome (RLS),
according to a study appearing in an upcoming issue of the Clinical Journal of the
American Society of Nephrology (CJASN). RLS, a common and troublesome problem for
dialysis patients, affects hemodialysis patients about four times as often as people in the
general population.
These results, from a study by lead author Bertrand L. Jaber, MD (St Elizabeth's Medical
Center, Boston) and colleagues, add to the growing list of quality-of-life benefits
received from home short daily hemodialysis (SDHD).
The preliminary report was part the FREEDOM study, which is evaluating SDHD as an
alternative to dialysis center treatment. In SDHD, patients perform dialysis at home for a
few hours, six days per week. "The FREEDOM Study is the largest U.S.-based
observational study examining the potential clinical and economic benefits of home
SDHD, which has witnessed an uptick in recent years," Jaber explains.
The researchers analyzed data on 235 patients to see how SDHD affected symptoms of
RLS. Patients with RLS have abnormal feelings—such as "pins and needles" or crawling
sensations—that are relieved by moving the legs. These feelings may lead to sleep
problems, such as insomnia and daytime sleepiness. Although the exact cause is
unknown, RLS has been linked to increased rates of cardiovascular complications and
death.
For the FREEDOM study patients, switching to SDHD led to significant improvement in
RLS-related symptoms. "Over 12 months, there was decline in the percentage of
patients reporting RLS and in those reporting moderate-to-severe symptoms," says
Jaber. The patients also reported lasting improvement in sleep disorders—even after
adjustment for the presence of RLS and for use of anti-anxiety and sedative drugs.
Future FREEDOM study results will determine how SDHD affects hospitalization rates
and overall non-treatment related costs in dialysis patients.
The study had some important limitations including selection bias—evident by the
recruitment of a relatively young (although not necessarily healthier) patient population.
The absence of a control group is another important limitation, although the observed
improvements in quality-of-life measures persisted beyond four months.
The FREEDOM study is sponsored and funded by NxStage Medical, Inc. (Lawrence,
MA). The following authors are members of the NxStage Scientific Advisory Board that
oversees the FREEDOM study: John M. Burkart, MD, Fredric O. Finkelstein, MD;
Bertrand L. Jaber, MD, MS; Michael A. Kraus, MD; Brent W. Miller, MD; and Brigitte
Schiller, MD.
Study co-authors were Brigitte Schiller, MD (Satellite Healthcare, San Jose, Calif), John
M. Burkart, MD (Wake Forest University Medical Center, Winston-Salem, NC), Rachid
Daoui, MD (Hortense & Louis Rubin Dialysis Center, Clifton Park, NY), Michael A. Kraus,
MD, Isaac Teitelbaum, MD (University of Colorado Hospital, Aurora, CO), Yoojin Lee, MS
(Tufts Medical Center, Boston, MA), Brent W. Miller, MD (Washington University School
of Medicine, St Louis), Amy W. Williams, MD, (Mayo Clinic College of Medicine), and
Fredric O. Finkelstein, MD (Yale University School of Medicine, New Haven, CT).
The article, entitled “Impact of At-home Short Daily Hemodialysis on Restless Legs
Symptoms and Sleep Disturbances” (doi 10.2215/CJN.10451110), will appear online at
http://cjasn.asnjournals.org/ on March 17, 2011.
The American Society of Nephrology (ASN) does not offer medical advice. All content in ASN
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| Talking Control Support in Hemodialysis Results in Higher Patient Satisfaction Survey Response |
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| Contribution of CA, phosphorus & 25-VitD to the excessive severity of sPTH in African-Americans with CKD |
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| Hemodialysis Access and Age-related Postoperative Outcomes: Which Fistula First? |
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| VDRA and improved survival in dialysis patients with serum intact PTH ≤150 pg/mL |
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| Complete Recovery From Acute Kidney Injury With Incident CKD Stage 3 and All-Cause Mortalit |
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| Depression and nonadherence predict mortality in hemodialysis treated ESRD patients Hemodialysis Int'l |
| Serum Metabolite Concentrations and Decreased GFR in the General Population AJKD |
| High Volume Peritoneal Dialysis in Acute Kidney Injury CJASN |
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| Darbepoetin-α Cardiovascular Geometry and CKD -Cardiorenal Med |
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| Essential trace element status and clinical outcomes in long-term dialysis |
| End-of-Life Decision-Making Confidence in Surrogates of AA Dialysis Patients Is Overly Optimistic |
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| Effect of Diuretic Use on 30-Day Postdialysis Mortality in Critically Ill Patients Receiving Acute Dialysis Dr. Ko |
| FGF23 predicts incident cardiovascular event before but not after the start of dialysis Dr. Isaka |
| Mortality Prediction by Surrogates of Body Composition: An Examination of the Obesity Paradox in Hemodialysis Using Composite Ranking Score Analysis: Drs. Miklos Z Molnar & Kamyar Kalantar-Zadeh |
| Plasma Sodium & Blood Pressure in Hemodialysis J.Human Hypertension |
| Increased Risk of Death in Young African American Dialysis Patient: Dr. Norman |
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| Postdialysis BP rise predicts outcomes in hemodialysis: Dr Yang BMC Nephrology |
| APOL1 allelic variants are associated with lower age of dialysis initiation Nephrology Dialysis Transplant |
| Effects of Six versus Three Times per Week Hemodialysis on Physical Performance, Health, and Functioning: Frequent Hemodialysis Network (FHN) Randomized Trials Dr. Hall CJASN |
| Variability of blood pressure in dialysis patients: a new marker of cardiovascular risk Dr. Di Iorio |
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| Potential Role of Active Vitamin D Treatment in Telomere Length in Hemodialysis: Dr Valdivielso |
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| Pedometer-Assessed Physical Activity in Children and Young Adults with CKD |
| Effect of Frequent or Extended Hemodialysis on Cardiovascular Parameters Amer J. Kidney Ds |
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Home Dialysis Summit Recommends Policy Changes to Increase Home Dialysis Usage
WASHINGTON, April 25, 2012 /PRNewswire -- On the heels of the first National Summit on Home Dialysis Policy, Summit organizers released a report reflecting the views of the delegates -- leaders in the kidney disease patient, clinician, facility and industry communities -- on federal policy steps to improve utilization of home dialysis for patients who can benefit from this often advantageous form of treatment. Many of the organizers also announced they have formed a new alliance, called the Alliance for Home Dialysis, to advance the recommendations identified at the Summit.
The Summit's "Report of the Delegates" highlights key findings from a March 29th meeting in Washington, DC where experts probed why, despite widely accepted and well-documented benefits of home dialysis -- improved outcomes, enhanced patient satisfaction, improved quality of life, and lower costs-- fewer than ten percent of the more than 390,000 current U.S. dialysis patients receive treatment at home. Current rates of home dialysis utilization reflect a steep decline from the 1970s, when almost 40% of U.S. dialysis patients were treated in-home.
Specifically, delegates found that policymakers should work with stakeholders in the dialysis community to confront three areas:
Accessibility: Patients and clinicians face array of hurdles in education, training, and infrastructure that hinder equalized access to home dialysis.
Accountability: Utilization of home dialysis can be improved through measures within government programs that are designed to recognize and support excellence in the delivery of home dialysis services.
Aligning Incentives: Reimbursement policies, regulation of new technologies and other policy incentives can be realigned to better support federal policy goals of expanding access to home dialysis.
The Report includes 15 recommendations to serve these goals, including that federal policymakers should:
Maintain parity for home and in-center dialysis in Medicare reimbursement;
Support home dialysis mentoring programs, particularly those that use existing patients as mentors; and
Align federal and state regulatory requirements for home therapies, such as revising the Centers for Medicare and Medicaid Services Conditions for Coverage requirements, to reflect differences in home and in-center dialysis.
Summit supporters will begin work through the new Alliance to dialogue with federal policymakers and advance policy improvements in the three consensus areas that emerged at the Summit.
SOURCE National Summit on Home Dialysis Policy
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National Kidney Foundation's Top 10 Things Every Dialysis Patient Should Know.
- You have treatment choices. Options exist for how, where and when you dialyze. Dialysis can be done in a hospital, in a dialysis unit that is not part of a hospital, or at home. You and your doctor will decide which place is best, based on your medical condition and your wishes. There are different types of dialysis - peritoneal and hemodialysis. Work with your health care team to determine a treatment plan that makes you feel comfortable. Recent studies show that the majority of patients beginning in-center hemodialysis (HD) know very little, if anything, about the option to dialyze at home. Once informed, 40% or more of patients are interested in this treatment option, and yet less than 10% actually begin home dialysis. If you're dissatisfied with the type of dialysis treatment that you're receiving, ask your healthcare team if another type of dialysis treatment would be better.
- You can compare in-center dialysis facilities online. Information on over 5,600 US-based dialysis centers is available online through the Medicare website. To help you make choices about your care, you can compare different facilities side-by-side and evaluate each facility based upon clinic characteristics and quality measures. You can search for dialysis facilities by name or geographic proximity. After completing an initial facility comparison to determine which facilities best meet your needs - such as the number of hemodialysis stations at a particular location and whether there are evening shifts available - visit the facilities that you're most interested in. Talk to the staff and other patients, as well as your doctor to ensure that this dialysis facility is a good fit for you.
- There are ways to prepare ahead for an emergency. Ask your dialysis facility about their emergency plan in case of a snow storm, fire, power outage or other natural disaster. As back up, make sure you have the names, locations and phone numbers of other dialysis units and hospitals in your area. Since regular community transportation services may not be working in an emergency, be prepared to make other arrangements for getting to dialysis. You may need to contact the police and Emergency Medical Services (EMS) for assistance. If you dialyze at home, make sure you have at least two weeks' worth of unexpired supplies on hand. If you have to miss a dialysis treatment, begin your emergency meal plan.
- There is an easy way to transfer patient records between clinics. There is an easy, secure way for your health care team to transfer your treatment records online. In 2009, the Centers for Medicare and Medicaid Services (CMS) created a centralized web-based data collection system called CROWNWeb to help reduce and eliminate patient treatment interruptions. This central system helps to streamline patient care regardless of the reason for changing dialysis centers. For example, if you've been admitted to the hospital, or if you needed to relocate during an emergency evacuation, your doctors and health care team can access up-to-date information about your dialysis so that you continue to receive appropriate care no matter where you are.
- You can travel while on dialysis.
Dialysis centers are located in every part of the United States and in many foreign countries. The treatment is standardized, but you need to plan ahead by making an appointment for dialysis at another center before you go. The staff at your center may help you make these appointments.
- You can be your own best advocate. Know what key questions to ask your doctor or other healthcare professionals. Take notes so that you can refer back to them later. Partner with your doctor and decide on a treatment plan together. Advocate for yourself and share how you're feeling.
- You have many rights. You as a patient have a great deal of control over your treatments. Patients have a bill of rights which includes receiving quality care, counseling about your medical information, and an expectation of privacy.
You also have responsibilities. Once you decide on a course of treatment, it's important to follow the recommendations of your health care team. If you decide to receive in-center dialysis, arrive at dialysis on time so that you can receive the full treatment without delays.
- You can receive insurance coverage. If you have end stage renal failure, you are likely eligible for Medicare insurance coverage. Speak with your health care team and social worker for help filling out insurance paperwork.
- You may need to follow a special diet. When your kidneys are not working properly, you may not be able to eat everything you like, and you may need to limit how much you drink. Your diet may vary according to the type of dialysis you receive. It is important to speak with a renal dietitian so that you are able to understand what you can and cannot eat based on your full health history.
- Dialysis patients can work. Many dialysis patients can go back to work or school after they have gotten used to dialysis. After establishing a dialysis routine, many patients have more energy and find that they are able to time to work around this new schedule. Some patients even find creative ways to work remotely from dialysis with the use of a laptop or cell phone, depending on their field of expertise.
More from National Kidney Foundation Press Releases
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New Book to Help Educate Patients with Chronic Kidney Disease who may be facing Dialysis or Hemodialysis: |
Help, I Need Dialysis!
How to have a good future with kidney disease
By Dori Schatell, MS and Dr. John Agar
An internationally known nephrologist and life-long kidney patient educator explain how dialysis works, each of the ways to do it, and how your treatment choice may affect your diet, energy level, work, travel, sexuality and fertility, sleep, and survival. Comprehensive and fully referenced, this book is a must-read if you face the life-changing choices that come with kidney failure. |
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