The Division of Nephrology at UHN has played a pivotal role in the field of home dialysis since its early development, from innovations in peritoneal dialysis, to the recent emerging body of knowledge regarding clinical outcomes in nocturnal home dialysis. The Home Dialysis Centre serves approximately 240 prevalent end-stage renal disease patients (100 nocturnal hemodialysis and 120 peritoneal dialysis). In addition to high clinical activity, research is focused on translational biology, and clinical outcomes. Dr. Christopher Chan, Division Director of Nephrology at UHN, also supervises fellowships in home dialysis.
The focus of home dialysis research activities at UHN relates to applied clinical research in the field of intensive dialysis. The Division has coordinated and led a network of peer-reviewed funded research teams dedicated to examining the clinical and basic aspects of optimal dialysis delivery. The centre was one of the leading sites for several clinical trials in peritoneal dialysis. In home hemodialysis, research has led to the awareness and clinical application of nocturnal home hemodialysis for patients with refractory hypertension and ventricular dysfunction. The team has investigated the impact of increased dialysis dose and frequency on anemia management and bone marrow biology. Through a fruitful collaborative network, the research team has also examined emerging e-Health technologies to assure quality and safety of remote complex care delivery.
The documentation of cardiovascular advantages with the conversion to nocturnal hemodialysis is well substantiated. As a result, UHN is part of the NIH-sponsored Frequent Hemodialysis Network randomized controlled trial examining nocturnal hemodialysis as an established renal replacement therapy. The Division staff had an active role in the drafting and implementation of The Canadian Society of Nephrology (CSN) guidelines in peritoneal dialysis and intensive hemodialysis. The CSN has also recommended the use of nocturnal hemodialysis as a preferred dialytic method for patients with refractory hypertension and hemodynamic instability. Most recently, the team has shown that patients undergoing nocturnal home hemodialysis have survival comparable to a matched cohort of renal transplant recipients.