Nocturnal Home Hemodialysis: Which of Your Patients Should Choose This Modality?
Bibliographic record
Abstract
Nocturnal home hemodialysis (HD) was conceived in the 1960s, but fell out of favor in the 1970s, only to be resurrected in a modified form in the 1990s. This modality is now used by patients on 4 continents, but still accounts for only a very small number of patients who receive chronic HD therapy. Nocturnal home HD provides a weekly Kt/V urea in the range of 4.5-6, and provides superior clearance of a number of middle molecules as well as some protein-bound and charged molecules. The first randomized trials of nocturnal home HD compared to conventional 3 times per week HD were performed in the first decade of the 21st century. In the Alberta trial, 52 patients were randomized to either nocturnal home HD conducted 5-6 times per week or conventional HD conducted 3 times per week; the patients were followed for 6 months. In this trial, subjects who received nocturnal home HD had a decrease in left ventricular mass, and improvement in the management of hypertension and hyperphosphatemia, but no significant benefit in either quality of life or anemia management. There was a decrease in systolic blood pressure, despite a decrease in the number of antihypertensive medications prescribed. There was also a decrease in serum phosphorus levels as well as a marked reduction or elimination of phosphate binders in more than two thirds of the nocturnal subjects. In the Frequent Hemodialysis Network study of Nocturnal Hemodialysis, 87 patients were randomized to either nocturnal home HD (6 times per week) or conventional (3 times per week) dialysis, and were followed for 12 months. Results from this trial will be published in 2011. It is likely that the results from these 2 trials will influence the update to the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative HD guidelines that will be published in 2012.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.013 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".