20 Home HD represents 11% of the dialysis population in Australia

20 Home HD represents 11% of the dialysis population in Australia, and although this percentage has declined over the last 20 years, the absolute number of home HD patients has increased.21 Patients dialysing at home in Australia are generally split between conventional HD (4–5 h) and NHD (typically 7–8 h), although there is huge variability between states and even among different institutions in the PI3K Inhibitor Library price same state. A recent resurgence in home HD has been attributed to the institution of NHD, especially the alternate-night regimen.22,23 NHD now comprises more than 30% of all home HD in Australia where as SDHD is relatively uncommon. Even conventional HD at home has tended to involve longer

hours of dialysis with the mean figure being closer to 5 than to 4 h. These changes may reflect increasing information demonstrating considerable improvement in survival for those receiving HD of longer duration. Data from the Australian and New Zealand Dialysis and Transplant Association (ANZDATA) registry have identified improved survival in those undertaking longer HD (more than 95% of whom are home

HD patients), although this is based on observational registry data and is subject to bias by indication.24 As home HD patients are not locked into an institutional schedule, many dialyse on a strictly alternate-day regimen, including conventional and NHD patients; and this has now been adopted by 45% of home HD patients.23 This schedule has several advantages including providing more dialysis as well as avoiding the long break therefore avoiding more fluid and solute find protocol accumulation that occurs over the ‘weekend’ in conventional in-centre dialysis. Volume control is subsequently improved with concomitant improvement in hypertension. Despite the reported benefits of alternative HD regimens, there is much variation in the practice of these therapies globally.25 The International Quotidian Dialysis Registry (IQDR) is a global initiative designed to

N-acetylglucosamine-1-phosphate transferase study practices and outcomes associated with the use of alternative HD regimens. The fifth annual report from the registry was recently published and involved 223, 1244 and 1204 patients from Canada, the USA and Australia/New Zealand, respectively.6 Australia and New Zealand are the only countries with complete recruitment as data on all HD patients are captured by ANZDATA. The IQDR is a collaborative, international effort to provide detailed information on alternative HD regimens to allow comparative studies with conventional HD addressing hard clinical end-points such as mortality, cardiovascular events and hospitalizations. The IQDR has also provided data on prescription practices of alternative HD worldwide. The latest annual report shows that in Australia/New Zealand, 63% of patients were undertaking NHD in the home and 20% in-centre.

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