Frequency of Hemodialysis

This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for additional hemodialysis sessions. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for additional hemodialysis sessions and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site:

IOM Citations:

• CMS IOM Publication 100-01, Medicare General Information, Eligibility and Entitlement Manual
• Chapter 1, Section 10 General Program Benefits
• Chapter 2, Section 10 Hospital Insurance Entitlement
• CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 11, End Stage Renal Disease (ESRD)
• CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1
• Part 2, Section 110.10 Intravenous Iron Therapy; Section 110.15 Ultrafiltration, Hemoperfusion and Hemofiltration
• Part 4, Section 260.6 Dental Examination Prior to Kidney Transplantation
• CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 8 Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims, all sections including Section 140 Monthly Capitation Payment Method for Physicians’ Services Furnished to Patients on Maintenance Dialysis
• CMS IOM Publication 100-05, Medicare Secondary Payer Manual, Chapter 2, Section 20: Medicare Secondary Payer Provisions for End-Stage Renal Disease (ESRD) Beneficiaries
• CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.4 Reasonable and Necessary Provision in an LCD

Change Request References:

• Change Request 5039, Transmittal 1084, October 27, 2006: Line Item Billing Requirement for End Stage Renal Disease (ESRD) Claims
• Change Request 9989, Transmittal 1849, May 12, 2017: Implementation of Modifier CG for Type of Bill 72x
• Change Request 10901, Local Coverage Determinations (LCDs)

Social Security Act (Title XVIII) Standard References:

• Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.
• Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider for any claim that lacks the necessary information to process the claim.

Federal Register References:

• 42 CFR, Chapter IV, Subchapter G, Part 494, Subpart C,
• Section 494.80 Condition: Patient assessment
• Section 494.90 Condition: Patient plan of care
• CMS Final Rule CMS-1651-F published November 4, 2016

Note: Italicized font represents CMS manual titles, journal titles and/or CMS national NCD language/wording copied directly from CMS Manuals or CMS Transmittals. Contractors are prohibited from changing national NCD language/wording.

Compliance with the provisions in this policy may be monitored and addressed through post payment data analysis and subsequent medical review audits.

History/Background and/or General Information

According to the Kidney Disease Outcomes Quality Initiative (KDOQI) Practice Guideline for Hemodialysis Adequacy: 2015 update¹, over 400,000 patients are currently treated with hemodialysis (HD) in the United States, with Medicare spending approaching $90,000 per year of care in 2012. They note mortality rates remain higher than age-matched individuals in the general population. They also experience an average of 2 hospitalizations per year.

The KDOQI 2015 Update¹ states the following: Attempts to improve outcomes have included initiating dialysis at higher glomerular filtration rates (GFRs), increasing dialysis frequency and/or duration, using newer membranes, and employing supplemental or alternative hemofiltration. Efforts to increase the dose of dialysis administered 3 times weekly have not improved survival, indicating that something else needs to be addressed.

This guideline was also cited in the most recent CMS Final Rule CMS-1651-F published November 4, 2016.

Covered Indications

1. Metabolic conditions (acidosis, hyperkalemia, hyperphosphatemia)
2. Fluid positive status not controlled with routine dialysis
3. Pregnancy
4. Heart Failure
5. Pericarditis
6. Incomplete dialysis secondary to hypotension or access issues
   
   

Limitations

The following are considered not reasonable and necessary and therefore will be denied as not medically justified for payments.

1. Sessions furnished in excess of 3 sessions per week are not considered reasonable and necessary unless fully supported in the medical documentation as detailed in this policy
2. Planned inadequate or short dialysis
3. Sessions performed for convenience of patient or staff

There are documentation requirements in this LCD which if not followed will generate denials. Please refer to the Documentation Requirements section below.

While there are no set frequency limitations for these services, continued use of additional sessions by a given provider or for a given beneficiary or unusual patterns of billing, verification of need for services may generate reviews. Please refer to the Utilization Guidelines section below.

For coding guidelines, please refer to the companion article A55723 Billing and Coding: Frequency of Hemodialysis.

Notice: Services performed for any given diagnosis must meet all of the indications and limitations stated in this policy and associated A55723, Billing and Coding: Frequency of Hemodialysis; the general requirements for medical necessity as stated in CMS payment policy manuals; any and all existing CMS national coverage determinations; and all Medicare payment rules.

The redetermination process may be utilized for consideration of services performed outside of the reasonable and necessary requirements in this LCD.

HD at 3 times (3X) per week is noted to be ‘conventional’ treatment. Conventional HD remains the most common treatment modality for end stage renal disease (ESRD) worldwide and is usually performed for 3 to 5 hours, 3 days per week. CMS established payment for hemodialysis based on conventional treatment.

Hence, Medicare reimburses HD treatments 3 times per week (13/14 sessions per month depending on length of month). In CMS-1651-F (November 4, 2016), CMS outlines the process for medical justification aspect of the overall requirements of being reasonable and necessary for additional treatment payments.

This LCD sets out medical conditions likely to meet reasonable and necessary requirements for additional payments.

ESRD facilities establish parameters for treatment of any given patient through a Patient Plan of Care (POC). It is defined in the Conditions of Coverage for ESRD Services 42 CFR 494.90. Among other items, the POC developed by the Interdisciplinary Team must provide the necessary care and services to manage the patient’s volume status; and achieve and sustain the prescribed dose of dialysis to meet a hemodialysis Kt/V of at least 1.2 and a peritoneal dialysis weekly Kt/V of at least 1.7 or meet an alternative equivalent professionally-accepted clinical practice standard for adequacy of dialysis.

The prescription for chronic hemodialysis therapies includes the type of dialysis access, the type and amount of anticoagulant to be employed, blood flow rates, dialysate flow rate, ultrafiltration rate, dialysate temperature, type of dialysate (acetate versus bicarbonate) and composition of the electrolytes in the dialysate, size of hemodialyzer (surface area) and composition of the dialyzer membrane (conventional versus high flux), duration and frequency of treatments, the type and frequency of measuring indices of clearance, and intradialytic medications to be administered.

Those treatment sessions furnished to the beneficiary are paid by Medicare as 3X per week. If more than three sessions per week are furnished, such as 4-6 sessions per week, Medicare will pay the 3X per week amount unless there is a covered indication, appropriate use of the KX modifier occurs, and it is supported by medical documentation. Refer to Local Coverage Article A55723, Billing and Coding: Frequency of Hemodialysis for more information on appropriate use of the KX modifier.

However, on occasion, acute, and occasionally chronic, conditions may require additional sessions during the month. These may be considered for additional payment. The associated Local Coverage Article A55723, Billing and Coding: Frequency of Hemodialysis, provides a list of diagnoses felt to be consistent with such clinical conditions that could establish reasonable and necessary requirements for payment. Use of these diagnoses should be verified in the medical records to support any payment made.

Clinical conditions not seen listed in this policy may still be appropriate to allow payment. However, these claims may require additional review through the appeals process.

Medicare will monitor the frequency of additional sessions which may trigger Medical Review.

The POC reassessment is noted in 42 CFR 494.80(d).

Please note the Plan of Care does not establish medical necessity by itself and will need to be supported by other medical documentation as outlined in the documentation requirements below.

Repeated need for additional dialysis sessions is expected to be addressed in the medical documentation and addressed in the subsequent POC, including attempts to correct any issues, (See medical documentation requirements below).

This LCD establishes documentation requirements as listed in the appropriate section below.

KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update, Guideline¹ 4.1.1 states to 'Consider additional hemodialysis sessions or longer hemodialysis treatment times for patients with large weight gains, high ultrafiltration rates, poorly controlled blood pressure, difficulty achieving dry weight, or poor metabolic control (such as hyperphosphatemia, metabolic acidosis, and/or hyperkalemia).' This specific recommendation was ‘Not Graded’ in the Guidelines but based on expert opinions. However, these guidelines are determined by a panel of experts and are felt to have a STRONG level of evidence to follow.

While uncontrolled hypertension is noted to be an indication for additional dialysis frequency, the included diagnoses are felt to be adequate for the condition in lieu of an available ICD-10 diagnosis.

The Kidney Disease: Improving Global Outcomes (KDIGO) Guidelines² for the evaluation and management of chronic kidney disease (CKD) address the many facets of CKD. The guidelines discuss the management variables that may affect CKD. Indications are supportive of guidelines above.

The 2018 Seminars in Dialysis article, “When is more frequent hemodialysis beneficial?” Suri and Kliger³ discuss the unresolved issue pertaining to frequency of dialysis. They review 3 randomized trials, 15 comparative cohort studies and some case series for recommendations and adverse events related to increased frequency of dialysis. They note effect on mortality remains controversial with conflicting results. More frequent dialysis is noted as being associated with vascular access site problems. Recommendations for increased frequency of dialysis include pregnant women, patients who are unable to obtain a dry weight on 3X per week regimen and for minimal urine output patients with left ventricular hypertrophy.

National experts were also contacted for input during development of this policy.

Based on KDOQI Practice Guidelines as well as KDIGO Guidelines, and the Suri and Kliger article, the listed conditions in the LCD may meet reasonable and necessary requirements for additional payments.

Based on local collaborative data, Medicare contractors expect the list of diagnoses in associated Article A55723: Billing and Coding: Frequency of Hemodialysis would represent the great majority of claims for which additional payments may occur.

Facilities with sites in multiple states should be able to submit claims in a unified approach.

However, this LCD would not be the appropriate approach to change the payment methodology by CMS and reconsiderations to this LCD to potentially try to change the CMS payment process will be denied as invalid reconsideration to this LCD.

Refer to the Local Coverage Article: Billing and Coding: Frequency of Hemodialysis, A55723, for all billing and coding information. 

Documentation Requirements

1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
3. The medical record documentation must support the medical necessity of the services as stated in this policy.
4. The medical records documentation should include the order from the prescribing physician for the additional sessions. This should be available for each and every additional session outside the usual 13/14 treatments per month with the CG modifier appended as well as those described in this LCD with the KX modifier appended. Should the records not show the order and evaluation leading to additional sessions denials will occur.
5. Documentation should be available on request and may include: the updated Plan of Care, documents from recent hospital care, office visits, dialysis progress notes, or Monthly Capitation Payments (MCP) visits reflecting the clinician’s assessment and changes as indicated. Lack of this documentation will lead to denials.

Utilization Guidelines

In accordance with CMS Ruling 95-1 (V), utilization of these services should be consistent with locally acceptable standards of practice.

With continued utilization of additional sessions by a specific provider generally, or for a given beneficiary, providers should expect medical review of medical records by contractors.

Contractor is not responsible for the continued viability of websites listed.

Novitas Solutions, Inc., L35014 - Frequency of Dialysis

Other Contractor's Policies:

First Coast Service Options, L33970 - Frequency of Hemodialysis

Palmetto GBA, L34575 - Frequency of Dialysis

Contractor Medical Directors ESRD Workgroup

1. National Kidney Foundation. KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. Am J Kidney Dis. 2015; 66(5):884-930.
2. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013; 3(1):1-150.
3. Suri RS, Kliger AS. When is more frequent hemodialysis beneficial? Semin Dial. 2018; 00:1-11.
4. American Journal of Kidney Diseases (AJKD), Intensive Hemodialysis: Potential for Improving Outcomes. 2016; 68(5): Suppl 1: S1-S58.
5. Assimon MM, Wenger JB, Wang L, et al. Ultrafiltration rate and mortality in maintenance hemodialysis patients. Am J Kidney Dis. 2016; 68(6):911-922.
6. Ayus JC, Achinger SG, Mizani MR, et al. Phosphorus balance and mineral metabolism with 3 h daily hemodialysis. Kidney Int. 2007; 71(4):336-342. doi:10.1038/sj.ki.5002044.
7. Ayus JC, Mizani MR, Achinger SG, et al. Effects of short daily versus conventional hemodialysis on left ventricular hypertrophy and inflammatory markers: a prospective, controlled study. J Am Soc Nephrol. 2005; 16(9):2778-2788. doi:10.1681/ASN.2005040392.
8. Bansal N, McCulloch CE, Lin F, et al. Blood pressure and risk of cardiovascular events in patients on chronic hemodialysis: The CRIC Study (Chronic Renal Insufficiency Cohort). Hypertension. 2017; 70(2):435-443.
9. Banshodani M, Kawanishi H, Fukuma S, et al. The impact of hemodialysis schedules on the day of the week of hospitalization for cardiovascular and infectious diseases, over a period of 20 years. PLoS One. 2017; 12(7). DOI: 10.1371/journal.pone.0180577.
10. Buoncristiani U, Fagugli R, Ciao G, et al. Left ventricular hypertrophy in daily dialysis. Miner Electrolyte Metab. 1999; 25(1-2):90-94. doi: 10.1159/000057427.
11. Chan CT, Chertow GM, Daugirdas JT, et al. Effects of daily hemodialysis on heart rate variability: results from the Frequent Hemodialysis Network (FHN) Daily Trial. Nephrol Dial Transplant. 2014; 29(1):168-178. doi:10.1093/ndt/gft212.
12. Chan CT, Floras JS, Miller JA, et al. Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis. Kidney Int. 2002; 61(6):2235-2239. doi:10.1046/j.1523-1755.2002.00362.x.
13. Chan CT, Greene T, Chertow GM, et al. Determinants of left ventricular mass in patients on hemodialysis: Frequent Hemodialysis Network (FHN) Trials. Circ Cardiovasc Imaging. 2012; 5(2):251-261. doi:10.1161/CIRCIMAGJNG.111.969923.
14. Chazot C, Vo-Van C, Lorriaux C, et al. Even a moderate fluid removal rate during individualised hemodialysis session times is associated with decreased patient survival. Blood Purif. 2017; 44(2):89-97.
15. Chertow GM, Levin NW, Beck GJ, et al. In-center hemodialysis six times per week versus three times per week. N Engl J Med. 2010; 363(24):2287-2300.
16. Cullerton BF. Introduction. Canadian Society of Nephrology Clinical Practice Guidelines. J Am Soc Nephrol. 2006; 17(3 Suppl 1): S1-S3.
17. Culleton BF, Walsh M, Klarenbach SW, et al. Effect of frequent nocturnal hemodialysis vs conventional hemodialysis on left ventricular mass and quality of life: a randomized controlled trial. JAMA. 2007; 298(11):1291-1299.
18. Daugirdas JT, Chertow GM, Larive B, et al. Effects of frequent hemodialysis on measures of CKD mineral and bone disorder. J Am Soc Nephrol. 2012; 23(4):727-738. doi:10.1681/ASN.2011070688.
19. Evangelidis N, Tong A, Manns B, et al. Developing a set of core outcomes for trials in hemodialysis: an international Delphi survey. Am J Kidney Dis. 2017; 70(4):464-475.
20. Finkelstein FO, Schiller B, Daoui R, et al. At-home short daily hemodialysis improves the long-term health-related quality of life. Kidney Int. 2012; 82(5):561-569.
21. Flythe JE, Assimon MM, Overman RA. Target weight achievement and ultrafiltration rate thresholds: potential patient implications. BMC Nephrol. 2017; 18(1); 1-13.
22. Garg AX, Suri RS, Eggers P, et al. Patients receiving frequent hemodialysis have better health-related quality of life compared to patients receiving conventional hemodialysis. Kidney Int. 2017; 91(3):746-754.
23. Hall YN, Larive B, Painter P, et al. Effects of six versus three times per week hemodialysis on physical performance, health, and functioning: Frequent Hemodialysis Network (FHN) randomized trials. Clin J Am Soc Nephrol. 2012; 7(5):782-794.
24. Hanly PJ and Pierratos A. Improvement of sleep apnea in patients with chronic renal failure who undergo nocturnal hemodialysis. N Engl J Med. 2001; 344(2):102-107.
25. Heidenheim AP, Muirhead N, Moist L, et al. Patient quality of life on quotidian hemodialysis. Am J Kidney Dis. 2003; 42(1Suppl):S36-S41.
26. Hussein WF, Arramreddy R, Sun SJ, et al. Higher ultrafiltration rate is associated with longer dialysis recovery time in patients undergoing conventional hemodialysis. Am J Nephrol. 2017; 46(1):3-10.
27. Jaber BL, Lee Y, Collins AJ, et al. Effect of daily hemodialysis on depressive symptoms and postdialysis recovery time: interim report from the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study. Am J Kidney Dis. 2010; 56(3):531-539.
28. Jaber BL, Schiller B, Burkart JM, et al. Impact of short daily hemodialysis on restless legs symptoms and sleep disturbances. Clin J Am Soc Nephrol. 2011; 6(5):1049-1056.
29. Jefferies HJ, Virk B, Schiller B, et al. Frequent hemodialysis schedules are associated with reduced levels of dialysis induced cardiac injury (Myocardial Stunning). Clin J Am Soc Nephrol. 2011; 6(6):1326-1332. doi:10.2215/CJN.05200610.
30. Jindal K, Chan CT, Deziel C, et al. Canadian Society of Nephrology Clinical Practice Guidelines. J Am Soc Nephrol. 2006; 17(3 Suppl 1):S4-S27.
31. Karpetas A, Loutradis C, Bikos A, et al. Blood pressure variability is increasing from the first to the second day of the interdialytic interval in hemodialysis patients. J Hypertens. 2017; 35: 000-000. doi:10.1097/HJH.0000000000001478.
32. Kennedy C, Ryan SA, Kane T, et al. The impact of change of renal replacement therapy modality on sleep quality in patients with end·stage renal disease: a systematic review and meta-analysis. J Nephrol. 2017; 31(1): 61-70. doi:10.1007/s40620-017.0409-7.
33. Kotanko P, Garg AX, Depner T, et al. Effects of frequent hemodialysis on blood pressure: Results from the randomized frequent hemodialysis network trials. Hemodial Int. 2015; 19(3):386-401.
34. Kraus M, Burkart J, Hegeman R, et al. A comparison of center-based vs. home-based daily hemodialysis for patients with end-stage renal disease. Hemodial Int. 2007; 11(4):468-477. doi:10.1111/ j.1542-4758.2007.00229.x.
35. Laskin BL, Huang G, King E, et al. Short, frequent, 5-days-per-week, in-center hemodialysis versus 3-days-per week treatment: a randomized crossover pilot trial through the Midwest Pediatric Nephrology Consortium. Pediatr Nephrol. 2017; 32(8):1423-1432.
36. Lindsay RM, Heidenheim PA, Nesrallah G, et al. Minutes to recovery after a hemodialysis session: a simple health-related quality of life question that is reliable, valid, and sensitive to change. Clin J Am Soc Nephrol. 2006; 1(5):952·959. doi:10.2215/CJN.00040106.
37. Lockridge RS, Spencer M, Craft V, et al. Nightly home hemodialysis: five and one-half years of experience in Lynchburg, Virginia. Hemodial Int. 2004; 8(1):61-69. doi:10.1111/ j.1492· 7535.2004.00076.x.
38. Mactier R, Hoenich N, Breen C. Renal Association Clinical Practice Guideline on haemodialysis. Nephron Clin Pract. 2011; 118 Suppl 1:c241-286.
39. Manns BJ, Walsh MW, Culleton BF, et al. Nocturnal hemodialysis does not improve overall measures of quality of life compared to conventional hemodialysis. Kidney Int. 2008; 75(5):542-549. doi:10.1038/ki.2008.639.
40. Murashima M, Kumar D, Doyle AM, et al. Comparison of intradialytic blood pressure variability between conventional thrice-weekly hemodialysis and short daily hemodialysis. Hemodial Int. 2010; 14(3):270-277. doi:10.1111/J.1542·4758.2010.00438.x
41. National Kidney Foundation. KDOQI Clinical Practice Guideline for Diabetes and CKD: 2012 update. Am J Kidney Dis. 2012; 60(5):850-886.
42. Painter P, Krasnoff JB, Kuskowski M, et al. Effects of modality change on health-related quality of life. Hemodial Int. 2012; 16(3):377-386. doi:10.llll/j.1542-4758.2012.00676.x.
43. Raimann JG, Chan CT, Daugirdas JT, et al. The effect of increased frequency of hemodialysis on volume-related outcomes: a secondary analysis of the Frequent Hemodialysis Network Trials. Blood Purif. 2016; 41(4):277-286. doi:10.1159/000441966.
44. Rocco MV, Lockridge RS, Jr., Beck GJ, et al. The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial. Kidney Int. 2011; 80(10): 1-12.
45. Sarafidis PA, Persu A, Agarwal R, et al. Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension (ESH). J Hypertens. 2017; 35(4):657-676.
46. Silverstein DM. Frequent hemodialysis: history of the modality and assessment of outcomes. Pediatr Nephrol. 2017; 32(8):1293-1300.
47. Sirich TL, Fong K, Larive B, et al. Limited reduction in uremic solute concentrations with increased dialysis frequency and time in the Frequent Hemodialysis Network Daily Trial. Kidney Int. 2017; 91(5)1186-1192.
48. Suri RS, Li L, Nesrallah GE. The risk of hospitalization and modality failure with home dialysis. Kidney Int. 2015; 88(2):360-368. doi:10.1038/ki.2015.68.
49. Tattersall J, Martin-Malo A, Pedrini L, et al. EBPG guideline on dialysis strategies. Nephrol Dial Transplant. 2007; 22 Suppl 2:ii5-21.
50. Thomson BKA, Huang S-HS, Chan C, et al. Nocturnal home hemodialysis associates with improvement of electrocardiographic features linked to sudden cardiac death. ASAIO J. 2014; 60(1):99-105. doi:10.1097/ MAT.0000000000000023.
51. Ting GO, Kjellstrand C, Freitas T, et al. Long-term study of high-comorbidity ESRD patients converted from conventional to short daily hemodialysis. Am J Kidney Dis. 2003; 42(5):1020-1035.
52. Unruh ML, Larive B, Chertow GM, et al. Effects of 6-times-weekly versus 3-times-weekly hemodialysis on depressive symptoms and self- reported mental health: Frequent Hemodialysis Network (FHN) Trials. Am J Kidney Dis. 2013; 61(5):748-758. doi:10.1053/ j.ajkd.2012.11.047.
53. Watanabe Y, Kawanishi H, Suzuki K, et al. Japanese society for dialysis therapy clinical guideline for "Maintenance hemodialysis: hemodialysis prescriptions". Ther Apher Dial. 2015; 19 Suppl 1:67-92.
54. Weinhandl ED, GIibertson OT, Collins AJ. Mortality, hospitalization, and technique failure in daily home hemodialysis and matched peritoneal dialysis patients: a matched cohort study. Am J Kidney Dis. 2016; 67(1):98-110. doi:10.1053/j.ajkd.2015.07.014.
55. Weinhandl ED, Liu J, Gilbertson DT, et al. Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. J Am Soc Nephrol. 2012; 23(5):895-904.
56. Weinhandl ED, Nieman KM, Gilbertson DT, et al. Hospitalization in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. Am J Kidney Dis. 2015; 65(1):98-108. doi:10.1053/j.a]kd.2014.06.015.
57. Zoccali C, Moissl U, Chazot C, et al. Chronic fluid overload and mortality in ESRD. J Am Soc Nephrol. 2017; 28(8):2491-2497.