1
|
Wing-Shing Fung W, Park HC, Hirakawa Y, Arruebo S, Bello AK, Caskey FJ, Damster S, Donner JA, Jha V, Johnson DW, Levin A, Malik C, Nangaku M, Okpechi IG, Tonelli M, Ueda S, Ye F, Suzuki Y, Wang AYM. Capacity for the management of kidney failure in the International Society of Nephrology North and East Asia region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl (2011) 2024; 13:97-109. [PMID: 38618501 PMCID: PMC11010612 DOI: 10.1016/j.kisu.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 04/16/2024] Open
Abstract
Globally, there remain significant disparities in the capacity and quality of kidney care, as evidenced by the third edition of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA). In the ISN North and East Asia region, the chronic kidney disease (CKD) burden varied widely; Taiwan had the heaviest burden of treated kidney failure (3679 per million population [pmp]) followed by Japan and South Korea. Except in Hong Kong, hemodialysis (HD) was the main dialysis modality for all other countries in the region and was much higher than the global median prevalence. Kidney transplantation services were generally available in the region, but the prevalence was much lower than that of dialysis. Most countries had public funding for kidney replacement therapy (KRT). The median prevalence of nephrologists was 28.7 pmp, higher than that of any other ISN region, with variation across countries. Home HD was available in only 17% of the countries, whereas conservative kidney management was available in 50%. All countries had official registries for dialysis and transplantation; however, only China and Japan had CKD registries. Advocacy groups for CKD, kidney failure, and KRT were uncommon throughout the region. Overall, all countries in the region had capacity for KRT, albeit with some shortages in their kidney care workforce. These data are useful for stakeholders to address gaps in kidney care and to reduce workforce shortages through increased use of multidisciplinary teams and telemedicine, policy changes to promote prevention and treatment of kidney failure, and increased advocacy for kidney disease in the region.
Collapse
Affiliation(s)
- Winston Wing-Shing Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hyeong Cheon Park
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
| | - Yosuke Hirakawa
- Division of Nephrology and Endocrinology, University of Tokyo School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David W. Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia; Australasian Kidney Trials Network at the University of Queensland, Brisbane, Queensland, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Seiji Ueda
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
2
|
Scofano R, Monteiro A, Motta L. Evaluation of the experience with the use of telemedicine in a home dialysis program-a qualitative and quantitative study. BMC Nephrol 2022; 23:190. [PMID: 35590287 PMCID: PMC9117587 DOI: 10.1186/s12882-022-02824-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Assisted home hemodialysis is a therapeutic modality for patients diagnosed with end-stage renal disease who require dialysis replacement therapy and have concomitant health limitations that prevent them from attending a satellite dialysis unit or performing their own treatment. OBJECTIVE The main objective of this study was to evaluate whether telemedicine provided through telemonitoring can improve the ongoing relationship between the doctor, the nurse and the patient. METHOD This prospective longitudinal, qualitative and quantitative study analyzes the impact of telemedicine through an evaluation of the experiences of patients and nurses. During the study, we performed remote weekly monitoring for 6 months. RESULTS A total of 17 patients and 12 nurses were included. We observed that the patients and nurses had positive experiences with telemonitoring and highlighted feelings of being cared for and improved confidence, although they indicated that telemonitoring does not replace face-to-face visits. CONCLUSION Telemonitoring is a useful tool to increase satisfaction with and confidence in home hemodialysis.
Collapse
Affiliation(s)
- Raquel Scofano
- Telessaúde UERJ, Universidade do Estado do Rio de Janeiro, UERJ, Avenida Vinte Oito de setembro 77, 3° andar, Rio de Janeiro-RJ, Vila Isabel CEP, 20551-030, Brazil.
| | - Alexandra Monteiro
- Telessaúde UERJ, Universidade do Estado do Rio de Janeiro, UERJ, Avenida Vinte Oito de setembro 77, 3° andar, Rio de Janeiro-RJ, Vila Isabel CEP, 20551-030, Brazil
| | - Luciana Motta
- Telessaúde UERJ, Universidade do Estado do Rio de Janeiro, UERJ, Avenida Vinte Oito de setembro 77, 3° andar, Rio de Janeiro-RJ, Vila Isabel CEP, 20551-030, Brazil
| |
Collapse
|
3
|
Chan CT. Can We Modify the Elevated Mortality Associated With Kidney Replacement Therapy Transitions With Integrated Care? Am J Kidney Dis 2021; 79:5-6. [PMID: 34600744 DOI: 10.1053/j.ajkd.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/18/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Christopher T Chan
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada.
| |
Collapse
|
4
|
Khan I, Pintelon L, Martin H, Khan RA. Exploring stakeholders and their requirements in the process of home hemodialysis: A literature review. Semin Dial 2021; 35:15-24. [PMID: 34505311 DOI: 10.1111/sdi.13019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 06/16/2021] [Accepted: 07/26/2021] [Indexed: 11/27/2022]
Abstract
Providing home hemodialysis (HHD) therapy is a complex process that not only requires the use of a complex technology but also involves a diverse group of stakeholders, and each stakeholder has their requirements and may not share a common interest. Bringing them together will require the alignment of their interests. A process management perspective can help to accomplish the alignment of their interests. To align their interests, it is crucial to identify interest groups and understand their interests. The main objective of this paper is to identify the stakeholders and represents their interests as a list of requirements in the HHD process. An extensive literature review has been carried out and PubMed was used for literature extraction. In total, 1848 articles were retrieved of which 80 have fulfilled the inclusion criteria. A large array of actors is identified and their interests/requirements at different stages of the HHD process are represented in the form of a list. They have both common and conflicting requirements in the HHD process. If these requirements are aligned and balanced, a stakeholder's driven treatment process will be developed and a real improvement will be achieved in the treatment process.
Collapse
Affiliation(s)
- Ilyas Khan
- Center for Industrial Management, KU Leuven, Leuven, Belgium
| | | | - Harry Martin
- Faculty of Management, Sciences & Technology, Dutch Open University, Heerlen, The Netherlands
| | | |
Collapse
|
5
|
Morin C, Gionest I, Laurin LP, Goupil R, Nadeau-Fredette AC. Risk of hospitalization, technique failure, and death with increased training duration in 3-days-a-week home hemodialysis. Hemodial Int 2021; 25:457-464. [PMID: 34169633 DOI: 10.1111/hdi.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Quality training is a core component of successful home hemodialysis (HHD) and training duration varies significantly between dialysis centers as well as at the patient level. This study aimed to assess the adverse outcomes associated with HHD training duration. METHODS All HHD patients successfully trained in a single dialysis center between January 2005 and July 2017 were included. A multivariable multiple-events (Andersen-Gill) survival model was built to evaluate the association between training time and main adverse events, including hospitalizations, technique failure, and death on HHD. Potential confounding factors were defined a priori (age, diabetes, coronary artery disease, and year of training start). Adjusted risk of vascular interventions (arteriovenous fistula angioplasties and central venous catheter replacements) was assessed as the secondary outcome in a negative binomial regression. FINDINGS Forty-eight patients were included in the study. Median HHD training duration was 86 (67-108) days, using a thrice weekly training schedule. Over a follow-up median time of 2.0 (0.7-3.3) years, three patients died while on HHD, 10 had a definitive transfer to HD, and 18 experienced a least 1 hospitalization (38 hospitalizations in total). Training duration was associated with a higher risk of hospitalization, technique failure, and death in unadjusted (hazard ratio [HR] 1.16 per month, 95% confidence interval [CI] 1.08-1.24) and adjusted multiple events model (HR 1.21, 95% CI 1.04-1.43). Risk of vascular access intervention was also significantly higher with increased training time (adjusted incidence rate ratio 1.31, 95% CI 1.03-1.64, per training month). DISCUSSION In this single-center observational study, HHD training duration was associated with a higher risk of adverse events including, death, technique failure, hospitalizations, and vascular access intervention. Enhanced clinical follow-up and home support should be offered to these more vulnerable patients to mitigate this heightened risk.
Collapse
Affiliation(s)
- Catherine Morin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Isabelle Gionest
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.,Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Rémi Goupil
- Hospital and Research Center, Sacré-Coeur de Montreal Hospital, Montreal, Quebec, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.,Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| |
Collapse
|
6
|
Paterson B, Fox DE, Lee CH, Riehl-Tonn V, Qirzaji E, Quinn R, Ward D, MacRae JM. Understanding Home Hemodialysis Patient Attrition: A Cohort Study. Can J Kidney Health Dis 2021; 8:20543581211022195. [PMID: 34178360 PMCID: PMC8207266 DOI: 10.1177/20543581211022195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/01/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Home hemodialysis (HHD) offers a flexible, patient-centered modality for patients with kidney failure. Growth in HHD is achieved by increasing the number of patients starting HHD and reducing attrition with strategies to prevent the modifiable reasons for loss. Objective: Our primary objective was to describe a Canadian HHD population in terms of technique failure and time to exit from HHD in order to understand reasons for exit. Our secondary objectives include the following: (1) determining reasons for training failure, (2) reasons for early exit from HHD, and (3) timing of program exit. Design: A retrospective cohort study of incident adult HHD patients between January 1, 2013—June 30, 2020. Setting: Alberta Kidney Care South, AKC-S HHD program. Participants: Patients who started training for HHD in AKC-S. Methods: A retrospective, cohort study of incident adult HHD patients with primary outcome time on home hemodialysis, secondary outcomes include reason for train failure, time to and reasons for technique failure. Cox-proportional hazard model to determine associations between patient characteristics and technique failure. The cumulative probability of technique failure over time was reported using a competing risks model. Results: A total of 167 patients entered HHD. Training failure occurred in 20 (12%), at 3.1 [2.0, 5.5] weeks; these patients were older (P < .001) and had 2 or more comorbidities (P < .001). Reasons for HHD exit after training included transplant (35; 21%), death (8; 4.8%), and technique failure (24; 14.4%). Overall, the median time to HHD exit, was 23 months [11, 41] and the median time of technique failure was 17 months [8.9, 36]. Reasons for technique failure included: psychosocial reasons (37%) at a median time 8.9 months [7.7, 13], safety (12.5%) at 19 months [19, 36], and medical (37.5%) at 26 months [11, 50]. Limitations: Small patient population with quality of data limited by the electronic-based medical record and non-standardized definitions of reasons for exit. Conclusions: Training failure is a particularly important source of patient loss. Reasons for exit differ according to duration on HHD. Early interventions aimed at reducing train failure and increasing psychosocial supports may help program growth.
Collapse
Affiliation(s)
- Bailey Paterson
- Cumming School of Medicine, University of Calgary, AB, Canada
| | - Danielle E Fox
- Department of Community Health Sciences, University of Calgary, AB, Canada
| | - Chel Hee Lee
- Department of Mathematics and Statistics, University of Calgary, AB, Canada
| | - Victoria Riehl-Tonn
- Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Elena Qirzaji
- Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Rob Quinn
- Department of Community Health Sciences, University of Calgary, AB, Canada.,Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada
| | - David Ward
- Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Jennifer M MacRae
- Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada.,Department of Cardiac Sciences, University of Calgary, AB, Canada
| |
Collapse
|
7
|
Cushen B, Madden A, Long D, Whelan Y, O'Brien ME, Carroll D, O'Flynn D, Forde M, Pye V, Grogan L, Casey M, Farrell K, Costello RW, Lewis C. Integrating hospital and community care: using a community virtual ward model to deliver combined specialist and generalist care to patients with severe chronic respiratory disease in their homes. Ir J Med Sci 2021; 191:615-621. [PMID: 33956325 PMCID: PMC8100740 DOI: 10.1007/s11845-021-02633-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/01/2021] [Indexed: 11/26/2022]
Abstract
Background Chronic respiratory diseases are responsible for significant patient morbidity, mortality, and healthcare use. Community virtual ward (CVW) models of care have been successfully implemented to manage patients with complex medical conditions. Aims To explore the feasibility and clinical outcomes of a CVW model of care in patients with chronic respiratory disease. Methods Patients known to specialist respiratory services with Chronic Obstructive Pulmonary Disease (COPD) and/or asthma were admitted to the CVW for disease optimisation and exacerbation management. Individualised management plans were delivered in the patients’ home by hospital-based respiratory and community nursing teams, incorporating remote technology to monitor vital signs. Symptoms and health status at admission and discharge were compared. Results Twenty patients were admitted. One-quarter of patients had asthma, 50% COPD, and 25% combined asthma/COPD. Patients had severe disease, mean (SD) FEV1 50(20) % predicted, and an average 6.4(5.7) exacerbations of disease in the previous 12 months. Patients received personalised disease and self-management education. All acute exacerbations (n = 11) were successfully treated in the community. The average length of CVW admission was 10(4) days. By discharge, 60% of COPD and 66% of asthma patients recorded improvements in symptoms score exceeding the minimal clinically important difference. Fifty percent had clinically meaningful improvements in health status. Conclusion A CVW model facilitates the delivery of combined specialist and generalist care to patients with chronic respiratory disease in the community and improves symptoms and health status. The principles of the model are transferable to other conditions to improve overall health and reduce emergency hospital care.
Collapse
Affiliation(s)
- Breda Cushen
- Department of Respiratory Medicine, Beaumont Hospital, Dublin 9, Dublin, Ireland.
| | - Aisling Madden
- Department of Respiratory Medicine, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | - Deirdre Long
- Department of Respiratory Medicine, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | - Yvonne Whelan
- Department of Respiratory Medicine, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | | | - Deirdre Carroll
- Community Intervention Team, Community Healthcare Organisation Dublin North Central and County, Area 9 (CHO 9 DNCC), Dublin North City, Ireland
| | - Des O'Flynn
- Community Intervention Team, Community Healthcare Organisation Dublin North Central and County, Area 9 (CHO 9 DNCC), Dublin North City, Ireland
| | - Michelle Forde
- Community Intervention Team, Community Healthcare Organisation Dublin North Central and County, Area 9 (CHO 9 DNCC), Dublin North City, Ireland
| | - Virginia Pye
- Office of the Nursing and Midwifery Services Director, Health Service Executive, Dublin South City, Ireland
| | - Loretto Grogan
- Office of the Nursing and Midwifery Services Director, Health Service Executive, Dublin South City, Ireland
| | - Margaret Casey
- Office of the Nursing and Midwifery Services Director, Health Service Executive, Dublin South City, Ireland
| | | | - Richard W Costello
- Department of Respiratory Medicine, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | - Clare Lewis
- Department of Health, Chief Nurse's Office, Dublin, Ireland
| |
Collapse
|
8
|
Lavoie-Cardinal M, Nadeau-Fredette AC. Physical Infrastructure and Integrated Governance Structure for Home Hemodialysis. Adv Chronic Kidney Dis 2021; 28:149-156. [PMID: 34717861 DOI: 10.1053/j.ackd.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 02/11/2021] [Accepted: 02/25/2021] [Indexed: 01/17/2023]
Abstract
In view of the growing enthusiasm for home dialysis use, new dialysis centers may build or expend their home hemodialysis program in the next few years. This review will discuss the main challenges faced by small and large home hemodialysis programs in terms of physical spaces, human resource, training considerations, and overall governance. We will elaborate on the inclusion of home hemodialysis in the kidney replacement therapy care continuum, with a specific interest for collaboration and transition between peritoneal dialysis and home hemodialysis programs.
Collapse
|