Dialysis methods currently used in the long-term treatment of patients with ESRD have major disadvantages. Hemodialysis (HD) requires skilled nursing care and is associated with unacceptable swings in levels of toxic solutes and blood pressure. Although peritoneal dialysis (PD) is a continuous home therapy, it is inefficient in clearing toxic solutes. We hope to develop a new therapy, Slow Intensive Home Dialysis (SIHD), which will combine the benefits of home therapy (PD) with intensified highly efficient technology (HD) by training patients to perform slow hemodialysis while sleeping at night. We postulate SIHD will be a safe therapy which is more effective than standard therapy and will ultimately deliver more dialysis per unit cost. Furthermore, we hypothesize that SIHD will effect improved clearance of the immune activation product beta2 microglobulin and the advanced glycation end-products (AGEs) which may lead to improved immune function in dialysis patients. Prior to entry into the study the patient must undergo training in home dialysis and the SIHD technique. We estimate, that the average length of training will be six weeks. The training program will consist of the pre-treatment, learning and solo phases. During the week long pre-treatment phase, patients will undergo a series of baseline tests. During this week the patient will continue to dialyze via conventional therapy. The learning phase will occur in weeks two through five. The patient will be dialyzed daily by the SIHD nurse who will be a registered nurse (RN) with both hemodialysis and peritoneal/home dialysis experience. The SIHD nurse will initially perform the entire procedure while simultaneously teaching the patient the basic principles and practice of the dialytic technique. Gradually over the course of the following weeks, under the supervision of the nurse, the patient will assume increasing responsibility for carrying out the treatments until the patient is able to perform the whole procedure competently. The sixth week of the training period is the solo phase. The patient is admitted to the CRC for a week of nighttime treatments to simulate the home dialysis experience. During this week, the patient will be completely responsible for the dialysis sessions but will be observed by CRC staff for technique breaks which may cause safety problems. At the end of the solo phase, the patient will be discharged to home to begin SIHD. Of the three patients who were trained, one (Pt#3) failed the GCRC trial week due to unsafe technique and was withdrawn from the program. Two patients have successfully completed the training and have dialyzed safely at home.
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