John Agar

Nocturnal haemodialysis: An Australian cost comparison with conventional satellite haemodialysis (Review Article)

SUMMARY:  Dialysis is an expensive therapy, particularly considering its recurrent, protracted nature while patient numbers are also increasing. To afford dialysis for those in need, smarter, more efficient use of limited funds is mandatory. Newer techniques and improved equipment now permit safe, highly effective haemodialysis (HD) at home, alone and while asleep. Indeed, the increase in treatment hours and frequency achieved through nocturnal HD both increase HD efficiency and reduce cardiovascular stress when comparing nocturnal HD (6 nights/week for 8 h/treatment) to conventional daytime HD (4 h/treatment, three times/week). This study compares the expenditure of two distinct HD programmes in the same renal service during the Australian financial year 2003/2004. A conventional satellite HD unit (SHDU) and a nocturnal home HD programme (NHHD6) are compared, with both programmes ‘notionalised’ to 30 patients. The state‐derived funding models under which these programmes operate are explained. All wage costs, recurrent expenditure, fixed costs and the estimated costs of building and infrastructure are included. The total NHHD6 programme expenditure was

Ocular manifestations of autosomal recessive Alport syndrome

A33 392/patient per year (

How Australian nephrologists view home dialysis: Results of a national survey

103.82/treatment) and was

Nocturnal haemodialysis in Australia and New Zealand (Review Article)

3892/patient per year less (a 10.75% saving) when compared with the SHDU expenditure of

Outcomes of Extended-Hours Hemodialysis Performed Predominantly at Home

36 284/patient per year (

Calcium phosphate metabolism and bone mineral density with nocturnal hemodialysis

232.58/treatment). This represented an annual

Establishing Core Outcome Domains in Hemodialysis: Report of the Standardized Outcomes in Nephrology–Hemodialysis (SONG-HD) Consensus Workshop

116 750 programme saving for a 30 patient cohort. Potential additional NHHD6 savings in erythropoietin, hospitalization and social security dependence were also identified. Home‐based therapies are clinically sound, effective and fiscally prudent and efficient. Funding models should reward home‐based HD. Health services should encourage home training and support systems, sustaining patients at home wherever possible.

Review: understanding sorbent dialysis systems.

Ocular abnormalities are common in X-linked Alport syndrome, but they have not been studied in patients with the rarer autosomal recessive disease. We have examined the eyes of a family with autosomal recessive Alport syndrome. Four of the eight offspring of a consanguineous marriage had renal failure and deafness by the age of 20 years. The diagnosis of Alport syndrome was confirmed on the ultrastructural demonstration of a lamellated glomerular basement membrane (GBM) in one affected family member. Autosomal recessive inheritance was suggested by the lack of linkage to the COL4A5/COL4A6 locus, and by linkage to the COL4A3/COL4A4 locus. All four affected family members had anterior lenticonus (or had had a lens replacement for this) and the three who were examined had a dot-and-fleck retinopathy. Neither of the two unaffected offspring who were examined nor the father had these abnormalities. The ocular manifestations of autosomal recessive Alport syndrome are probably identical to those for the X-linked form. Although the mutations in these diseases affect genes for different type IV collagen chains, these chains occur together in the basement membranes of the kidney, eye and ear, and abnormalities in any one may result in the same clinical phenotype.

Recommendations for the use of icodextrin in peritoneal dialysis patients.

Aim:  Australias 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.

Using water wisely: new, affordable, and essential water conservation practices for facility and home hemodialysis.

SUMMARY:  Although early experience in Australia and New Zealand confirmed home haemodialysis to be well tolerated, effective and with lower morbidity and mortality compared with centre‐based haemodialysis, the advent of ambulatory peritoneal dialysis and ‘satellite’ haemodialysis has led to a steadily declining home haemodialysis population. However, the emergence of nocturnal haemodialysis, as a safe and highly effective therapy, has added to the modality choices now available and offers a new, highly attractive home‐based option with many advantages over centre‐based dialysis. For the patient, nocturnal haemodialysis means fluid and dietary freedom, less antihypertensive medication, the abolition of phosphate binders, the return of daytime freedom and the capacity for full‐time employment. Potential biochemical benefits include normalization of the blood urea, serum creatinine, albumin, β2 microglobulin, homocysteine and triglyceride levels and other nutritional markers. Improved quality of life and sleep patterns and a resolution of sleep apnoea have been shown. Left ventricular function has also shown marked improvement. For the provider, nocturnal home haemodialysis offers clear cost advantages by avoiding high‐cost nursing and infrastructure expenditure. Although consumable and equipment costs are higher, the savings on wage and infrastructure far outweigh this added expenditure. These combined factors make nocturnal haemodialysis an irresistible addition to comprehensive dialysis services, both from a clinical outcome and fiscal perspective.