International Quotidian Dialysis Registry: Annual report 2010.

The International Quotidian Dialysis Registry (IQDR) is a global initiative designed to study practices and outcomes associated with the use of hemodialysis (HD) regimens of increased frequency and/or duration. The IQDR grew out of the initiative that lead to the randomized prospective studies of nocturnal HD and short hours daily dialysis vs. conventional thrice weekly HD that are conducted by the Frequent Hemodialysis Network sponsored by the National Institutes of Health. These 2 separate studies are drawing to a close and the first results are expected to be reported later this year. These studies use surrogate outcomes for their primary endpoints as they are not powered to look at outcomes of mortality and hospitalization. The IQDR attempts to aggregate long-term follow-up data from centers utilizing alternative HD regimens worldwide and will have adequate statistical power to examine those important outcomes. To date, the IQDR has enrolled patients from Canada, the United States, Australia, New Zealand, and France and has linked with commercial databases and national registries. This sixth annual report of the IQDR describes: (1) An update on the governance structure; (2) The recommendations made at the first general meetings of the IQDR Scientific Committee and Advisory Board; (3) The status of those recommendations; (4) A summary of current data sources and participating registries; (5) The status of recruitment to date; (6) The creation of a specific Canadian IQDR data set and; (7) The current research agenda.

International Quotidian Dialysis Registry: annual report 2009.

The International Quotidian Dialysis Registry (IQDR) is a global initiative designed to study practices and outcomes associated with the use of hemodialysis regimens of increased frequency and/or duration. Several small studies suggest that compared with conventional hemodialysis (HD), short-daily, nocturnal, and long conventional HD regimens may improve surrogate endpoints and quality of life. However, methodologically robust comparisons on hard outcomes are sorely lacking. The IQDR represents the first-ever attempt to aggregate long-term follow-up data from centers utilizing alternative HD regimens worldwide, and will have adequate statistical power to examine the effects of these regimens on multiple clinical endpoints, including mortality. To date, the IQDR has enrolled patients from Canada, the United States, Australia, and New Zealand, with plans in place to begin linking with additional commercial databases and national registries. This fifth annual report of the IQDR describes (1) a proposed governance structure that will facilitate international collaboration, stakeholder input and funding; (2) data sources and participating registries; (3) recruitment to date and patient baseline characteristics; and (4) an agenda for future research.

The International Quotidian Hemodialysis Registry: rationale and challenges.

Outcomes from conventional thrice-weekly hemodialysis (CHD) are disappointing for a life-saving therapy. The results of the HEMO Study show that the recommended minimum dose (Kt/V) for adequacy is also the optimum attainable with CHD. Interest is therefore turning to alternative therapies exploring the effects of increased frequency and time of hemodialysis (HD) treatment. The National Institutes of Health have sponsored 2 randomized prospective trials comparing short hours daily in-center HD and long hours slow nightly home HD with CHD. An International Registry has also been created to capture observational data on patients receiving short hours daily in-center HD, long hours slow nightly home HD, and other alternative therapies. Participation by individual centers, other registries and the major dialysis chains is growing and currently data from nearly 3000 patients have been collected. Pitfalls in data collection have been identified and are being corrected. A matched cohort (patients in other registries) study is planned to obtain information regarding hard outcomes expected from these therapies. The Registry may become the most important source of information required by governments, providers, and the nephrological community in assessing the utility of such therapies.

The International Quotidian Dialysis Registry: annual report 2007.

In view of the need to study both intermediate and definitive outcomes associated with daily and extended-hours hemodialysis (HD), our group has undertaken the design and implementation of an international registry to collect data describing the treatments and outcomes of patients treated with these regimens. The International Quotidian Dialysis Registry began recruiting patients in June 2004. There are currently 229 patients enrolled in the registry, up from 199 last year. The projected growth is 2000 patients by 2008. This paper constitutes the third annual report of progress of patient and center recruitment, and includes descriptive data drawn from the 3 primary patient groups currently tracked by the registry: home nocturnal, home short-daily, and in-center short-daily HD. As the cohort grows, patients will be compared with control subjects drawn from their respective national registries, and comparative analyses will follow.

An international registry to compare quotidian dialysis regimens with conventional thrice-weekly hemodialysis: why, how, and potential pitfalls.

Thrice-weekly hemodialysis is the most commonly used form of renal replacement therapy, yet it is associated with unacceptably high morbidity and mortality. Attempts to improve outcomes for hemodialysis patients by increasing their per-session dose of dialysis have recently proven unsatisfactory in the multicentered Hemodialysis (HEMO) study. Interest has thus turned to increasing dialysis frequency. Short daily and long nocturnal dialysis, which are typically performed 6 days per week, are gaining acceptance and are associated with significant improvements in secondary outcomes, including nutrition, left ventricular hypertrophy, hypertension, anemia, and calcium-phosphorus balance. Studies to date have not been adequately powered to detect the survival benefits that these changes may confer. Large-scale randomized studies are planned, but will likely not answer the survival question for several years. Until this issue is resolved, funding policies are unlikely to change, confining current dialysis patients to potentially suboptimal therapy. By capturing data from current and future daily dialysis patients using an international registry, a survival benefit might be demonstrated more quickly. Such a project will soon be undertaken by the London Daily/Nocturnal Study Group with endorsement from the International Society for Hemodialysis and the U.S. National Institutes of Health. This database will also provide useful descriptive data that will help develop methodologies in this growing field. Historically the interpretation of dialysis registry data has been plagued with various methodological problems. These are briefly reviewed, and some potential solutions and necessary precautions are discussed.

The International quotidian hemodialysis registry: rationale and methods.

The HEMO study has provided evidence that a higher dialysis dose per session does not improve survival in conventional three times a week hemodialysis (HD). Attention has therefore shifted to HD schedules that vary in frequency and/or duration of dialysis. Although observational data favoring the use of frequent dialysis are steadily accumulating, compelling evidence supporting its superiority is still lacking. Several advances have recently been made with a view to put this form of therapy on much more solid footing. Upcoming research initiatives including clinical trials of frequent HD and the quotidian HD registry will provide a wealth of analytic and descriptive data that will help define the role for frequent HD regimens as a therapy for end-stage renal disease.