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Slon-Roblero MF, Sanchez-Alvarez JE, Bajo-Rubio MA. Personalized peritoneal dialysis prescription-beyond clinical or analytical values. Clin Kidney J 2024; 17:i44-i52. [PMID: 38846417 PMCID: PMC11151113 DOI: 10.1093/ckj/sfae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Indexed: 06/09/2024] Open
Abstract
Traditionally, dialysis adequacy has been assessed primarily by determining the clearance of a single small solute, urea. Nevertheless, it has become increasingly evident that numerous other factors play a crucial role in the overall well-being, outcomes and quality of life of dialysis patients. Consequently, in recent years, there has been a notable paradigm shift in guidelines and recommendations regarding dialysis adequacy. This shift represents a departure from a narrow focus only on the removal of specific toxins, embracing a more holistic, person-centered approach. This new perspective underscores the critical importance of improving the well-being of individuals undergoing dialysis while simultaneously minimizing the overall treatment burden. It is based on a double focus on both clinical outcomes and a comprehensive patient experience. To achieve this, a person-centered approach must be embraced when devising care strategies for each individual. This requires a close collaboration between the healthcare team and the patient, facilitating an in-depth understanding of the patient's unique goals, priorities and preferences while striving for the highest quality of care during treatment. The aim of this publication is to address the existing evidence on this all-encompassing approach to treatment care for patients undergoing peritoneal dialysis and provide a concise overview to promote a deeper understanding of this person-centered approach.
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Affiliation(s)
- María Fernanda Slon-Roblero
- Department of Nephrology, Hospital Universitario de Navarra, IdiSNA (Instituto de Investigación Sanitaria de Navarra), Navarra, Spain
| | - J Emilio Sanchez-Alvarez
- Department of Nephrology, Hospital Universitario de Cabueñes, RICORS (Redes de Investigación Cooperativa Orientadas a Resultados en Salud), Gijón, Spain
| | - Maria Auxiliadora Bajo-Rubio
- Department of Nephrology, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Hospital de la Princesa, RICORS (Redes de Investigación Cooperativa Orientadas a Resultados en Salud), Madrid, Spain
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2
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Hull KL, Bramham K, Brookes CL, Cluley V, Conefrey C, Cooper NJ, Eborall H, Fotheringham J, Graham-Brown MPM, Gray LJ, Mark PB, Mitra S, Murphy GJ, Quann N, Rooshenas L, Warren M, Burton JO. The NightLife study - the clinical and cost-effectiveness of thrice-weekly, extended, in-centre nocturnal haemodialysis versus daytime haemodialysis using a mixed methods approach: study protocol for a randomised controlled trial. Trials 2023; 24:522. [PMID: 37573352 PMCID: PMC10422763 DOI: 10.1186/s13063-023-07565-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND In-centre nocturnal haemodialysis (INHD) offers extended-hours haemodialysis, 6 to 8 h thrice-weekly overnight, with the support of dialysis specialist nurses. There is increasing observational data demonstrating potential benefits of INHD on health-related quality of life (HRQoL). There is a lack of randomised controlled trial (RCT) data to confirm these benefits and assess safety. METHODS The NightLife study is a pragmatic, two-arm, multicentre RCT comparing the impact of 6 months INHD to conventional haemodialysis (thrice-weekly daytime in-centre haemodialysis, 3.5-5 h per session). The primary outcome is the total score from the Kidney Disease Quality of Life tool at 6 months. Secondary outcomes include sleep and cognitive function, measures of safety, adherence to dialysis and impact on clinical parameters. There is an embedded Process Evaluation to assess implementation, health economic modelling and a QuinteT Recruitment Intervention to understand factors that influence recruitment and retention. Adults (≥ 18 years old) who have been established on haemodialysis for > 3 months are eligible to participate. DISCUSSION There are 68,000 adults in the UK that need kidney replacement therapy (KRT), with in-centre haemodialysis the treatment modality for over a third of cases. HRQoL is an independent predictor of hospitalisation and mortality in individuals on maintenance dialysis. Haemodialysis is associated with poor HRQoL in comparison to the general population. INHD has the potential to improve HRQoL. Vigorous RCT evidence of effectiveness is lacking. The NightLife study is an essential step in the understanding of dialysis therapies and will guide patient-centred decisions regarding KRT in the future. TRIAL REGISTRATION Trial registration number: ISRCTN87042063. Registered: 14/07/2020.
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Affiliation(s)
- Katherine L Hull
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - Kate Bramham
- King's Kidney Care, King's College Hospital, London, UK
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Victoria Cluley
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Carmel Conefrey
- Bristol Population Health Science Institute, University of Bristol Medical School, Bristol, UK
| | - Nicola J Cooper
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Helen Eborall
- College of Medicine and Veterinary Medicine, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - James Fotheringham
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Matthew P M Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Laura J Gray
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sandip Mitra
- Manchester Institute of Nephrology and Transplantation, Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Gavin J Murphy
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
- Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Niamh Quann
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Leila Rooshenas
- Bristol Population Health Science Institute, University of Bristol Medical School, Bristol, UK
| | | | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
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3
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Tran E, Karadjian O, Chan CT, Trinh E. Home hemodialysis technique survival: insights and challenges. BMC Nephrol 2023; 24:205. [PMID: 37434110 PMCID: PMC10337160 DOI: 10.1186/s12882-023-03264-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 07/06/2023] [Indexed: 07/13/2023] Open
Abstract
Home hemodialysis (HHD) offers several clinical, quality of life and cost-saving benefits for patients with end-stage kidney disease. While uptake of this modality has increased in recent years, its prevalence remains low and high rates of discontinuation remain a challenge. This comprehensive narrative review aims to better understand what is currently known about technique survival in HHD patients, elucidate the clinical factors that contribute to attrition and expand on possible strategies to prevent discontinuation. With increasing efforts to encourage home modalities, it is imperative to better understand technique survival and find strategies to help maintain patients on the home therapy of their choosing. It is crucial to better target high-risk patients, examine ideal training practices and identify practices that are potentially modifiable to improve technique survival.
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Affiliation(s)
- Estelle Tran
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Oliver Karadjian
- Division of Nephrology, Department of Medicine, McGill University Health Center, 1650 Av Cedar, L4-510, Montreal, QC, H3G 1A4, Canada
| | | | - Emilie Trinh
- Division of Nephrology, Department of Medicine, McGill University Health Center, 1650 Av Cedar, L4-510, Montreal, QC, H3G 1A4, Canada.
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4
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Huang M, Vincent Johnson A, Pourafshar N, Malhotra R, Yang J, Shah M, Balogun R, Chopra T. Pathways to improve nephrologist comfort in managing patients on in-center or home self-care dialysis. Hemodial Int 2023. [PMID: 37157127 DOI: 10.1111/hdi.13093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 03/29/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
In end-stage kidney disease (ESKD), patient engagement and empowerment are associated with improved survival and complications. However, patients lack education and confidence to participate in self-care. The development of in center self-care hemodialysis can enable motivated patients to allocate autonomy, increase satisfaction and engagement, reduce human resource intensiveness, and cultivate a curiosity about home dialysis. In this review, we emphasize the role of education to overcome barriers to home dialysis, strategies of improving home dialysis utilization in the COVID 19 era, the significance of in-center self-care dialysis (e.g., cost containment and empowering patients), and implementation of an in-center self-care dialysis as a bridge to home hemodialysis (HHD).
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Affiliation(s)
- Minghui Huang
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Anita Vincent Johnson
- Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Negiin Pourafshar
- Division of Nephrology, Department of Medicine, MedStar Georgetown University, Washington, DC, USA
| | - Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Jason Yang
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Monarch Shah
- Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Rasheed Balogun
- Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Tushar Chopra
- Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
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5
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Al Sahlawi MA, Dahlan RA. Nephrologists' Perspectives of the Potential Utilization of Home Hemodialysis in Saudi Arabia. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:730-737. [PMID: 38018714 DOI: 10.4103/1319-2442.390252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Home hemodialysis (HD) is an attractive renal replacement modality that has been shown to provide several benefits to the patient and health-care system. However, home HD programs have not been well-established in Saudi Arabia. We aimed to explore the perspectives of adult nephrology consultants in Saudi Arabia about the potential utilization of home HD via a survey-based cross-sectional study. The survey was distributed via email to all adult nephrology consultants practicing in Saudi Arabia and registered in the Saudi Society of Nephrology and Transplantation. Out of 236 invited consultants, 151 (64%) participated in the study. Half of the participants defined home HD as a trained patient who can independently perform his/her HD sessions at home. Eighty-one (54%) consultants have never managed a patient on home HD during their nephrology training period. More than 70% of participants believed that home HD provides advantages over in-center HD, and that its utilization in Saudi Arabia would be feasible. Although 40% of participants worked in centers with no accredited nephrology training program, most of the remaining participants believed that the local training program did not provide enough teaching about home HD to trainees. Patients' refusal, the nephrologists' lack of motivation and experience, a lack of administrative support, and the lack of infrastructure and nursing support were identified by most participants as the major barriers to the utilization of home HD in Saudi Arabia. Addressing these barriers would be the first step to facilitate initiatives aiming to establish home HD programs in this country.
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Affiliation(s)
- Muthana A Al Sahlawi
- Department of Internal Medicine, College of Medicine, King Faisal University, Al-Hasa, Saudi Arabia
| | - Randah A Dahlan
- Department of Internal Medicine, Section of Nephrology, King Abdullah Medical City, Makkah, Saudi Arabia
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6
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Ang YTI, Gan SWS, Liow CH, Phang CC, Choong HLL, Liu P. Patients’ perspectives of home and self-assist haemodialysis and factors influencing dialysis choices in Singapore. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00430-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The rise in end stage kidney disease (ESKD) prevalence globally calls for a need to deliver quality and cost-effective dialysis. While most are familiar with centre-based haemodialysis (HD), there is a move to increase uptake of home-based modalities (peritoneal dialysis (PD) or home haemodialysis (HHD)) and self-assist haemodialysis (SAHD) due to the economic, clinical and lifestyle advantages they confer. However, HHD and SAHD are not yet widely adopted in Singapore with majority of patients receiving in-centre HD. Although much research has examined patient decision-making around dialysis modality selection, there is limited literature evaluating patient’s perspectives of HHD and SAHD in Asia where the prevalence of these alternative modalities remained low. With this background, we aimed to evaluate patient’s perspectives of HHD and SAHD and the factors influencing their choice of dialysis modality in Singapore to determine the challenges and facilitators to establishing these modalities locally.
Methods
Semi-structured interviews were conducted with 17 patients on dialysis from a tertiary hospital in Singapore in this exploratory qualitative study. Data collected from one-to-one interviews were analysed via thematic content analysis and reported via an interpretative approach.
Results
The findings were segregated into: (1) factors influencing choices of dialysis modality; (2) perspectives of HHD; and (3) perspectives of SAHD. Modality choices were affected by environmental, personal, social, financial, information and family-related factors. Most perceived HHD as providing greater autonomy, convenience and flexibility while SAHD was perceived as a safer option than HHD. For both modalities, patients were concerned about self-care and burdening their family.
Conclusions
The findings provided a framework for healthcare providers to understand the determinants affecting patients’ dialysis modality decisions and uncovered the facilitators and challenges to be addressed to establish HHD and SAHD modalities in Singapore.
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Gao C, Zhang Q, Yang Y, Li Y, Lin W. Recent trends in therapeutic application of engineered blood purification materials for kidney disease. Biomater Res 2022; 26:5. [PMID: 35120554 PMCID: PMC8815201 DOI: 10.1186/s40824-022-00250-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022] Open
Abstract
Blood purification is a commonly used method to remove excess metabolic waste in the blood in renal replacement therapy. The sufficient removal of these toxins from blood can reduce complications and improve survival lifetime in dialysis patients. However, the current biological blood purification materials in clinical practice are not ideal, where there is an unmet need for producing novel materials that have better biocompatibility, reduced toxicity, and, in particular, more efficient toxin clearance rates and a lower cost of production. Given this, this review has carefully summarized newly developed engineered different structural biomedical materials for blood purification in terms of types and structure characteristics of blood purification materials, the production process, as well as interfacial chemical adsorption properties or mechanisms. This study may provide a valuable reference for fabricating a user-friendly purification device that is more suitable for clinical blood purification applications in dialysis patients.
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Affiliation(s)
- Cui Gao
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China
| | - Qian Zhang
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China
| | - Yi Yang
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China.
- Department of Nephology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China.
- International Institutes of Medicine, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China.
| | - Yangyang Li
- Key Laboratory of Women's Reproductive Health Research of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China.
- Cancer Center, Zhejiang University, Hangzhou, 310058, Zhejiang, China.
| | - Weiqiang Lin
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China.
- International Institutes of Medicine, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China.
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8
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Jones LA, Gordon EJ, Hogan TP, Fiandaca CA, Smith BM, Stroupe KT, Fischer MJ. Challenges, Facilitators, and Recommendations for Implementation of Home Dialysis in the Veterans Health Administration: Patient, Caregiver, and Clinician Perceptions. KIDNEY360 2021; 2:1928-1944. [PMID: 35419547 PMCID: PMC8986044 DOI: 10.34067/kid.0000642021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 09/21/2021] [Indexed: 02/04/2023]
Abstract
Background Home dialysis confers similar survival and greater quality of life than in-center hemodialysis for adults with ESKD but remains underutilized. We examined challenges and facilitators to implementation of home dialysis and identified stakeholder-centered strategies for improving it. Methods We conducted a qualitative, cross-sectional, multisite evaluation that included five geographically dispersed Veterans Health Administration (VHA) home dialysis programs. Participants included patients with ESKD receiving home dialysis, their informal caregivers, and home dialysis staff. Semistructured telephone interviews were conducted and audio-recorded from 2017 through 2018, to assess perceived barriers and facilitators to patient home dialysis use in VHA. Transcribed interviews were analyzed thematically by each participant group. Results Participants included 22 patients receiving home dialysis (18 on peritoneal dialysis [PD] and four hemodialysis [HD]); 20 informal caregivers, and 19 home dialysis program staff. Ten themes emerged as challenges to implementing home dialysis, of which six (60%) spanned all groups: need for sterility, burden of home dialysis tasks, lack of suitable home environment, physical side effects of home dialysis, negative psychosocial effects of home dialysis, and loss of freedom. Four themes (40%), identified only by staff, were insufficient self-efficacy, diminished peer socialization, geographic barriers, and challenging health status. Twelve themes emerged as facilitators to implementing home dialysis, of which seven (58%) spanned all groups: convenience, freedom, avoidance of in-center HD, preservation of autonomy, adequate support, favorable disposition, and perceptions of improved health. Two themes (17%) common among patients and staff were adequate training and resources, and physical and cognitive skills for home dialysis. Recommendations to promote implementation of home dialysis common to all participant groups entailed incorporating mental health care services, offering peer-to-peer coaching, increasing home visits, providing health data feedback, and reducing patient burden. Conclusions Stakeholder-centered challenges were rigorously identified. Facilitators and recommendations can inform efforts to support home dialysis implementation.
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Affiliation(s)
- Lindsey A. Jones
- Veterans Affairs Information Resource Center, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois
| | - Elisa J. Gordon
- Department of Surgery-Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois
| | - Timothy P. Hogan
- Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial Hospital, Bedford Veterans Affairs Medical Center, Bedford, Massachusetts,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Cindi A. Fiandaca
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois
| | - Bridget M. Smith
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois
| | - Kevin T. Stroupe
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois
| | - Michael J. Fischer
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois,Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois,Medicine/Nephrology, University of Illinois at Chicago, Chicago, Illinois
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9
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Gupta N. Strategic Planning for Starting or Expanding a Home Hemodialysis Program. Adv Chronic Kidney Dis 2021; 28:143-148. [PMID: 34717860 DOI: 10.1053/j.ackd.2021.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/23/2020] [Accepted: 02/05/2021] [Indexed: 01/08/2023]
Abstract
The American Advancing Kidney Health Initiative has renewed interest in home hemodialysis (HHD). Many perceived barriers exist for adoption of HHD despite well-reported clinical benefits. A well-designed program ensures patient success further engaging more patients. The initial planning regarding the surrounding patient population, stakeholders, economics, and physical location is essential. The services offered including modality education and different kinds of HHD modalities depend on local expertise and economics. The program should fulfill conditions for coverage requirements for personnel, physical infrastructure, and quality metrics to begin operations. The patient recruitment is facilitated by a patient-centric modality education program developed by the multidisciplinary team. If the patient is interested, a training schedule should be discussed with the patient and caregiver. A system to ensure remote patient monitoring, respite care, and 24 hours on-call availability should be established. These practical considerations ensure initial success and future growth of the program.
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Reid KRY, Queheillalt S, Martin T. Nursing's Response to the Executive Order to Advance American Kidney Health. Policy Polit Nurs Pract 2020; 22:51-62. [PMID: 33081574 DOI: 10.1177/1527154420965932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The state of American kidney health is currently under the microscope. In the United States, approximately 20,000 persons advance to end-stage renal disease annually. Trends indicate accelerating increases in cost of care and a high mortality rate among patients with end-stage renal disease, with only 57% of patients surviving after 3 years. An executive order by the White House has placed the transformation of kidney care at the forefront of the country's health care agenda. The order focuses on key issues including improving outcomes, reducing treatment-related expenditures and increasing kidney donations. Mobilization of health care resources directed toward policymaking, workforce growth and development, and research will be critical to effectively achieve this executive order. Nursing's response, as the health care profession with the most members, will be crucial to achieving response implementation and success of the order. This article describes immediate and future actions including policy, leadership, clinical, educational, and research initiatives that the nursing profession should take to advance kidney health. It calls for specific actions by nursing and focuses on nursing organizations, nursing research, quality improvement initiatives, nursing innovation, advanced practice nursing, and the nephrology and transplant nursing workforce in order to improve kidney health nationally. The impact of the SARS-CoV-2 pandemic on kidney health and the implications for the profession of nursing are outlined. Although there are still many unknowns about the pandemic, nursing's voice is necessary to ensure the ongoing delivery of high-quality care.
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Affiliation(s)
- Kimone R Y Reid
- Hospital Medicine, Cleveland Clinic Martin Health, Stuart, Florida, United States
| | - Suzanne Queheillalt
- University of Virginia Transplant Center, University of Virginia Health, Charlottesville, United States
| | - Tamara Martin
- Hendrick Provider Network Nephrology Practice, Abilene, Texas, United States
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11
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Plumb TJ, Alvarez L, Ross DL, Lee JJ, Mulhern JG, Bell JL, Abra GE, Prichard SS, Chertow GM, Aragon MA. Self-care training using the Tablo hemodialysis system. Hemodial Int 2020; 25:12-19. [PMID: 33047477 PMCID: PMC7891342 DOI: 10.1111/hdi.12890] [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: 04/28/2020] [Revised: 08/19/2020] [Accepted: 09/18/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Recently published results of the investigational device exemption (IDE) trial using the Tablo hemodialysis system confirmed its safety and efficacy for home dialysis. This manuscript reports additional data from the Tablo IDE study on the training time required to be competent in self-care, the degree of dependence on health care workers and caregivers after training was complete, and participants' assessment of the ease-of-use of Tablo. METHODS We collected data on the time required to set up concentrates and the Tablo cartridge prior to treatment initiation. We asked participants to rate system setup, treatment, and takedown on a Likert scale from 1 (very difficult) to 5 (very simple) and if they had required any assistance with any aspect of treatment over the prior 7 days. In a subgroup of 15 participants, we recorded the number of training sessions required to be deemed competent to do self-care dialysis. FINDINGS Eighteen men and 10 women with a mean age of 52.6 years completed the study. Thirteen had previous self-care experience using a different dialysis system. Mean set up times for the concentrates and cartridge were 1.1 and 10.0 minutes, respectively. Participants with or without previous self-care experience had similar set-up times. The mean ease-of-use score was 4.5 or higher on a scale from 1 to 5 during the in-home phase. Sixty-five percent required no assistance at home and on average required fewer than four training sessions to be competent in managing their treatments. Results were similar for participants with or without previous self-care experience. CONCLUSIONS Participants in the Tablo IDE trial were able to quickly learn and manage hemodialysis treatments in the home, found Tablo easy to use, and were generally independent in performing hemodialysis.
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Affiliation(s)
- Troy J Plumb
- University of Nebraska, Nebraska Medical Center, Omaha, Nebraska, 68198, USA
| | - Luis Alvarez
- Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, California, 94301, USA
| | - Dennis L Ross
- Kansas Nephrology Research Institute, 1007 N. Emporia, Wichita, Kansas, 67214, USA
| | - Joseph J Lee
- Nephrology Associates Medical Group, 3660 Park Sierra #208, Riverside, California, 92505, USA
| | - Jeffrey G Mulhern
- Fresenius Kidney Care Pioneer Valley Dialysis, 208 Ashley Ave, West Springfield, Massachusetts, 01089, USA
| | - Jeffrey L Bell
- Southwest Georgia Nephrology Clinic, 1200 North Jefferson Street, Albany, Georgia, 31701, USA
| | - Graham E Abra
- Stanford University, 300 Pasteur Drive, 1st floor, Suite A175, Stanford, California, 94305, USA
| | | | - Glenn M Chertow
- Stanford University School of Medicine, 1070 Arastradero Road, Palo Alto, California, 94034, USA
| | - Michael A Aragon
- DaVita Grapevine at Home, 1600 W. Northwest Hwy, Suite 100, Grapevine, Texas, 76051, USA
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12
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Lin E, Ginsburg PB, Chertow GM, Berns JS. The "Advancing American Kidney Health" Executive Order: Challenges and Opportunities for the Large Dialysis Organizations. Am J Kidney Dis 2020; 76:731-734. [PMID: 32763259 DOI: 10.1053/j.ajkd.2020.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/08/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Eugene Lin
- Division of Nephrology, Department of Medicine, University of Southern California, Los Angeles, CA; Leonard D Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA; University Kidney Research Organization, Kidney Research Center, Los Angeles, CA.
| | - Paul B Ginsburg
- Leonard D Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA; Sol Price School of Public Policy, University of Southern California, Los Angeles, CA; Brookings Institution, Washington, DC
| | - Glenn M Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
| | - Jeffrey S Berns
- Division of Nephrology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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13
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Abstract
BACKGROUND Uninsured patients with end-stage renal disease face barriers to peritoneal dialysis (PD), a type of home dialysis that is associated with improved quality of life and reduced Medicare costs. Although uninsured patients using PD at dialysis start receive retroactive Medicare coverage for required predialysis services, coverage only applies for the calendar month of dialysis start. Thus, initiating dialysis later in the month yields longer retroactive coverage. OBJECTIVES To examine whether differences in retroactive Medicare were associated with decreased long-term PD use. RESEARCH DESIGN We exploited the dialysis start date using a regression discontinuity design on a national cohort from the US Renal Data System. SUBJECTS 36,256 uninsured adults starting dialysis between January 1, 2006 and December 31, 2014. MEASURES PD use at dialysis days 1, 90, 180, and 360. RESULTS Starting dialysis on the first versus last day of the calendar month was associated with an absolute decrease in PD use of 2.7% [95% confidence interval (CI), 1.5%-3.9%], or a relative decrease of 20% (95% CI, 12%-27%) at dialysis day 360. The absolute decrease was 5.5% (95% CI, 3.5%-7.2%) after Medicare established provider incentives for PD in 2011 and 7.2% (95% CI, 2.5%-11.9%) after Medicaid expansion in 2014. Patients were unlikely to switch from hemodialysis to PD after the first month of dialysis (probability of 6.9% in month 1, 1.5% in month 2, and 0.9% in month 4). CONCLUSIONS Extending retroactive coverage for preparatory dialysis services could increase PD use and reduce overall Medicare spending in the uninsured.
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Abstract
The cost and health burden of ESRD continues to increase globally. Total Medicare expenditure on dialysis has increased from 229 million USD in 1973 to 35.4 billion USD in 2016. Dialysis access can represent almost a tenth of these costs. Central venous catheters have been recognized as a significant factor driving costs and mortality in this population. Home dialysis, which includes peritoneal dialysis and home hemodialysis, is an effective way of reducing costs related to renal replacement therapy, reducing central venous catheter usage and in many cases improving the clinical and psychosocial aspects of patients' health. Addressing access-related issues for peritoneal dialysis, urgent-start peritoneal dialysis and home hemodialysis can have impact on the success of home dialysis. This article reviews issues related to dialysis access for home therapies.
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15
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Fabrication of Water Absorbing Nanofiber Meshes toward an Efficient Removal of Excess Water from Kidney Failure Patients. FIBERS 2019. [DOI: 10.3390/fib7050039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Excellent water-absorbing nanofiber meshes were developed as a potential material for removing excess fluids from the blood of chronic renal failure patients toward a wearable blood purification system without requiring specialized equipment. The nanofiber meshes were successfully fabricated from poly(acrylic acid) (PAA) under various applied voltages by appropriately setting the electrospinning conditions. The electrospun PAA nanofibers were thermally crosslinked via heat treatment and then neutralized from their carboxylic acid form (PAA) to a sodium carboxylate form poly(sodium acrylate) (PSA). The PSA nanofiber meshes exhibited a specific surface area 393 times that of the PSA film. The PSA fiber meshes showed a much faster and higher swelling than its corresponding film, owing to the higher capillary forces from the fibers in addition to the water absorption of the PSA gel itself. The proposed PSA fibers have the potential to be utilized in a new approach to remove excess water from the bloodstream without requiring specialized equipment.
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Andersen‐Hollekim TE, Kvangarsnes M, Landstad BJ, Talseth‐Palmer BA, Hole T. Patient participation in the clinical pathway-Nurses' perceptions of adults' involvement in haemodialysis. Nurs Open 2019; 6:574-582. [PMID: 30918708 PMCID: PMC6419140 DOI: 10.1002/nop2.241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 10/03/2018] [Accepted: 01/07/2019] [Indexed: 12/11/2022] Open
Abstract
AIM To develop knowledge of nurses' perceptions of participation for patients treated with haemodialysis and their next of kin. DESIGN A qualitative study with a hermeneutic approach. METHODS The data were collected in 2015 through focus groups with 13 nurses in Central Norway. RESULTS The nurses reported that patient participation ranging from non-involvement to shared decision-making was related to whether dialysis was initiated as acute or scheduled. The restrictions required in chronic haemodialysis limited participation. The next of kin were not involved. The nurses highlighted interventions on both the individual and system levels to strengthen participation. CONCLUSION Dialysis units should develop strategies for participation related to individual needs and design treatment in cooperation with patients and their families, ensuring involvement early in the clinical pathway. Further research is needed on issues related to next of kin, including their desired level of involvement.
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Affiliation(s)
- Tone E. Andersen‐Hollekim
- Clinic of Medicine and RehabilitationMøre and Romsdal Hospital TrustÅlesundNorway
- Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Marit Kvangarsnes
- Department of Health Sciences, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyÅlesundNorway
- Research UnitMøre and Romsdal Hospital TrustÅlesundNorway
| | - Bodil J. Landstad
- Department of Health SciencesMid Sweden UniversityÖstersundSweden
- Levanger HospitalNord‐Trøndelag Hospital TrustLevangerNorway
| | - Bente A. Talseth‐Palmer
- Clinic of Medicine and RehabilitationMøre and Romsdal Hospital TrustÅlesundNorway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- School of Biomedical Science and Pharmacy, Faculty of Health and MedicineUniversity of Newcastle and Hunter Medical Research InstituteNewcastleAustralia
| | - Torstein Hole
- Clinic of Medicine and RehabilitationMøre and Romsdal Hospital TrustÅlesundNorway
- Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
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17
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Seshasai RK, Wong T, Glickman JD, Shea JA, Dember LM. The home hemodialysis patient experience: A qualitative assessment of modality use and discontinuation. Hemodial Int 2019; 23:139-150. [DOI: 10.1111/hdi.12713] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/19/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Rebecca Kurnik Seshasai
- Department of Medicine, Renal, Electrolyte and Hypertension DivisionPerelman School of Medicine Philadelphia Pennsylvania USA
| | - Tiffany Wong
- Department of Medicine, Renal, Electrolyte and Hypertension DivisionPerelman School of Medicine Philadelphia Pennsylvania USA
| | - Joel D. Glickman
- Department of Medicine, Renal, Electrolyte and Hypertension DivisionPerelman School of Medicine Philadelphia Pennsylvania USA
| | - Judy A. Shea
- Department of Medicine, Division of General Internal MedicinePerelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
| | - Laura M. Dember
- Department of Medicine, Renal, Electrolyte and Hypertension DivisionPerelman School of Medicine Philadelphia Pennsylvania USA
- Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and BiostatisticsPerelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
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18
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Pauly RP, Rosychuk RJ, Usman I, Reintjes F, Muneer M, Chan CT, Copland M, Lindsay R, MacRae J, Nesrallah G, Pierratos A, Zimmerman DL, Komenda P. Technique Failure in a Multicenter Canadian Home Hemodialysis Cohort. Am J Kidney Dis 2019; 73:230-239. [DOI: 10.1053/j.ajkd.2018.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 08/26/2018] [Indexed: 12/18/2022]
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19
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Chan CT, Wallace E, Golper TA, Rosner MH, Seshasai RK, Glickman JD, Schreiber M, Gee P, Rocco MV. Exploring Barriers and Potential Solutions in Home Dialysis: An NKF-KDOQI Conference Outcomes Report. Am J Kidney Dis 2018; 73:363-371. [PMID: 30545707 DOI: 10.1053/j.ajkd.2018.09.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/27/2018] [Indexed: 11/11/2022]
Abstract
Home dialysis therapy, including home hemodialysis and peritoneal dialysis, is underused as a modality for the treatment of chronic kidney failure. The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative sponsored a home dialysis conference in late 2017 that was designed to identify the barriers to starting and maintaining patients on home dialysis therapy. Clinical, operational, policy, and societal barriers were identified that need to be overcome to ensure that dialysis patients have the freedom to choose their treatment modality. Education of patients and patient partners, as well as health care providers, about home dialysis therapy, if offered at all, is often provided in a cursory manner. Lack of exposure to home dialysis therapies perpetuates a lack of familiarity and thus a hesitancy to refer patients to home dialysis therapies. Patient and care partner support, both psychosocial and financial, is also critical to minimize the risk for burnout leading to dropout from a home dialysis modality. Thus, the facilitation of home dialysis therapy will require a systematic change in chronic kidney disease education and the approach to dialysis therapy initiation, the creation of additional incentives for performing home dialysis, and breakthroughs to simplify the performance of home dialysis modalities. The home dialysis work group plans to develop strategies to overcome these barriers to home dialysis therapy, which will be presented at a follow-up home dialysis conference.
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Affiliation(s)
| | - Eric Wallace
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | - Joel D Glickman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Patrick Gee
- Quality Insights Renal Network 5, Mid-Atlantic Renal Coalition, North Chesterfield, VA
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20
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De la décision du mode de prise en charge à la mise en place d’un traitement à domicile : quels challenges pour le néphrologue dans l’accompagnement du patient ? Nephrol Ther 2018; 14:6S12-6S16. [DOI: 10.1016/s1769-7255(18)30646-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Bevilacqua MU, Er L, Copland MA, Singh RS, Jamal A, Dunne ÓM, Brumby C, Levin A. Prevalence-Based Targets Underestimate Home Dialysis Program Activity and Requirements for Growth. Perit Dial Int 2018; 38:200-205. [PMID: 29437142 DOI: 10.3747/pdi.2017.00171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/19/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Many renal programs have targets to increase home dialysis prevalence. Data from a large Canadian home dialysis program were analyzed to determine if home dialysis prevalence accurately reflects program activity and whether prevalence-based assessments adequately reflect the work required for program growth. METHODS Data from home dialysis programs in British Columbia, Canada, were analyzed from 2005 to 2015. Prevalence data were compared to dialysis activity data including intakes and exits to describe program turnover. Using current attrition rates, recruitment rates needed to increase home dialysis prevalence proportions were identified. RESULTS We analyzed 7,746 patient-years of peritoneal dialysis (PD) and 1,362 patient-years of home hemodialysis (HHD). The proportion of patients on home dialysis increased by 3.34% over the ten years examined, while the number of prevalent home dialysis patients increased 2.65% per year and the number of patients receiving home dialysis at any time in the year increased 4.04% per year. For every 1 patient net home dialysis growth, 13.6 new patients were recruited. Patient turnover included higher rates of transplantation in home dialysis than facility-based HD. Overall, the proportion dialyzing at home increased from 29.3 to 32.6%. CONCLUSIONS There is high patient turnover in home dialysis such that program prevalence is an incomplete marker of total program activity. This turnover includes high rates of transplantation, which is a desirable interaction that affects home dialysis prevalence. The shortcomings of this commonly used metric are important for renal programs to consider, and better understanding of the activities that support home dialysis and the complex trajectories that home dialysis patients follow is needed.
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Affiliation(s)
- Micheli U Bevilacqua
- University of British Columbia, Vancouver, BC, Canada .,British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | - Lee Er
- British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | | | | | - Abeed Jamal
- University of British Columbia, Vancouver, BC, Canada
| | | | | | - Adeera Levin
- University of British Columbia, Vancouver, BC, Canada.,British Columbia Provincial Renal Agency, Vancouver, BC, Canada
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22
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Campbell-Crofts S, Stewart G. How perceived feelings of "wellness" influence the decision-making of people with predialysis chronic kidney disease. J Clin Nurs 2018; 27:1561-1571. [PMID: 29240277 DOI: 10.1111/jocn.14220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2017] [Indexed: 12/20/2022]
Abstract
AIMS AND OBJECTIVES To identify the subjective meanings attached to decisions made by people living with chronic kidney disease as they consider their transition to renal replacement therapy. BACKGROUND Within the challenging world of chronic illness, people draw upon their temporal life experiences to help them make the best or most balanced primary healthcare decisions. Understanding the risks and benefits associated with these decisions has been an area of intense interest in health research. DESIGN An exploratory qualitative descriptive design. METHOD A convenience sample of twelve people, at stages 3B to 5 of chronic kidney disease, attending two predialysis renal clinics in Sydney, Australia, consented to be interviewed. The semi-structured interviews centred on their decision-making experiences as they considered their transition to renal replacement therapy. RESULTS Three themes emerged from participant narratives which have been framed into the following questions: (i) Do I need renal replacement therapy? (ii) What is the "right" renal replacement therapy for me? and (iii) When should I start renal replacement therapy? Decisions about the transition to renal replacement therapy were impacted upon by the participants' perceived feelings of wellness and the belief that renal replacement therapy would not be needed at any time in the foreseeable future. CONCLUSION This study highlights the importance of optimising person-centred care and raises important issues for the education and management of people with chronic kidney disease in the predialysis stages of the illness. RELEVANCE TO CLINICAL PRACTICE In order to facilitate the transition to renal replacement therapy, renal clinicians have a responsibility to more fully understand the patient journey during the predialysis stages of chronic kidney disease. A clearer understanding of patients' perceptions and decision-making experiences creates a space for mutual understanding. This is essential for the future development and implementation of collaborative, person-centred educational strategies and long-term renal healthcare outcomes.
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Affiliation(s)
| | - Glenn Stewart
- Concord Repatriation General Hospital, Concord, NSW, Australia
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23
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Yu JZ, Rhee CM, Ferrey A, Li A, Jin A, Chang Y, Reddy U, Lau WL, Chou J, Inrig J, Kalantar-Zadeh K. There's no place like home: 35-year patient survival on home hemodialysis. Semin Dial 2017; 31:300-304. [PMID: 29265477 DOI: 10.1111/sdi.12660] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The vast majority of maintenance dialysis patients suffer from poor long-term survival rates and lower levels of health-related quality of life. However, home hemodialysis is a historically significant dialysis modality that has been associated with favorable outcomes as well as greater patient autonomy and control, yet only represents a small minority of the total dialysis performed in the United States. Some potential disadvantages of home hemodialysis include vascular access complications, infection-related hospitalizations, patient fatigue, and attrition. In addition, current barriers and challenges in expanding the utilization of this modality include limited patient and provider education and technical expertise. Here we report a 65-year old male with end-stage renal disease due to Alport's syndrome who has undergone 35 years of uninterrupted thrice-weekly home hemodialysis (ie, every Sunday, Tuesday, and Thursday evening, each session lasting 3 to 3¼ hours in length) using a conventional hemodialysis machine who has maintained a high functional status allowing him to work 6-8 hours per day. The patient has been able to liberalize his dietary and fluid intake while only requiring 3-4 liters of ultrafiltration per treatment, despite having absence of residual kidney function. Through this case of extraordinary longevity and outcomes after 35 years of dialysis and a review of the literature, we illustrate the history of home hemodialysis, its significant clinical and psychosocial advantages, as well as the barriers that hinder its widespread adaptation.
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Affiliation(s)
- Jerry Z Yu
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA, USA
| | - Connie M Rhee
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA, USA
| | | | - Alex Li
- Northwest Kidney Center, Snoqualmie, WA, USA
| | - Anna Jin
- Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, USA
| | - Yongen Chang
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA, USA
| | - Uttam Reddy
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA, USA
| | - Wei Ling Lau
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA, USA
| | - Jason Chou
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA, USA
| | - Jula Inrig
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA, USA.,St Joseph's Medical Center, Orange, CA, USA
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24
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Rosner MH, Lew SQ, Conway P, Ehrlich J, Jarrin R, Patel UD, Rheuban K, Robey RB, Sikka N, Wallace E, Brophy P, Sloand J. Perspectives from the Kidney Health Initiative on Advancing Technologies to Facilitate Remote Monitoring of Patient Self-Care in RRT. Clin J Am Soc Nephrol 2017; 12:1900-1909. [PMID: 28710094 PMCID: PMC5672984 DOI: 10.2215/cjn.12781216] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Telehealth and remote monitoring of a patient's health status has become more commonplace in the last decade and has been applied to conditions such as heart failure, diabetes mellitus, hypertension, and chronic obstructive pulmonary disease. Conversely, uptake of these technologies to help engender and support home RRTs has lagged. Although studies have looked at the role of telehealth in RRT, they are small and single-centered, and both outcome and cost-effectiveness data are needed to inform future decision making. Furthermore, alignment of payer and government (federal and state) regulations with telehealth procedures is needed along with a better understanding of the viewpoints of the various stakeholders in this process (patients, caregivers, clinicians, payers, dialysis organizations, and government regulators). Despite these barriers, telehealth has great potential to increase the acceptance of home dialysis, and improve outcomes and patient satisfaction while potentially decreasing costs. The Kidney Health Initiative convened a multidisciplinary workgroup to examine the current state of telehealth use in home RRTs as well as outline potential benefits and drawbacks, impediments to implementation, and key unanswered questions.
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Affiliation(s)
| | | | - Paul Conway
- American Association of Kidney Patients, St. Petersburg, Florida
| | | | | | | | | | - R. Brooks Robey
- Geisel School of Medicine at Dartmouth and US Department of Veterans Affairs, Hanover, New Hampshire
| | - Neal Sikka
- George Washington University, Washington, DC
| | - Eric Wallace
- University of Alabama at Birmingham, Birmingham, Alabama
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25
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Shafi T, Jaar BG. Maintaining Patients on Home Hemodialysis: The Journey Matters as Does the Destination. Clin J Am Soc Nephrol 2017; 12:1209-1211. [PMID: 28739574 PMCID: PMC5544511 DOI: 10.2215/cjn.06890617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Tariq Shafi
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland; and
| | - Bernard G. Jaar
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland; and
- Nephrology Center of Maryland, Baltimore, Maryland
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26
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Hanson CS, Chapman JR, Craig JC, Harris DC, Kairaitis LK, Nicdao M, Mikaheal M, Tong A. Patient experiences of training and transition to home haemodialysis: A mixed-methods study. Nephrology (Carlton) 2017; 22:631-641. [DOI: 10.1111/nep.12827] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/23/2016] [Accepted: 05/24/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Camilla S Hanson
- Sydney School of Public Health; The University of Sydney; Sydney New South Wales Australia
- Centre for Kidney Research; The Children's Hospital at Westmead; Sydney New South Wales Australia
| | - Jeremy R Chapman
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research; The University of Sydney; Sydney New South Wales Australia
| | - Jonathan C Craig
- Sydney School of Public Health; The University of Sydney; Sydney New South Wales Australia
- Centre for Kidney Research; The Children's Hospital at Westmead; Sydney New South Wales Australia
| | - David C Harris
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research; The University of Sydney; Sydney New South Wales Australia
| | - Lukas K Kairaitis
- Department of Renal Medicine; Westmead Hospital; Sydney New South Wales Australia
- School of Medicine; Western Sydney University; Sydney New South Wales Australia
| | - Maryann Nicdao
- Department of Renal Medicine; Westmead Hospital; Sydney New South Wales Australia
| | - Mary Mikaheal
- Department of Renal Medicine; Westmead Hospital; Sydney New South Wales Australia
| | - Allison Tong
- Sydney School of Public Health; The University of Sydney; Sydney New South Wales Australia
- Centre for Kidney Research; The Children's Hospital at Westmead; Sydney New South Wales Australia
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27
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Bernardo AA, Marbury TC, McFarlane PA, Pauly RP, Amdahl M, Demers J, Hutchcraft AM, Leypoldt JK, Minkus M, Muller M, Stallard R, Culleton BF. Clinical safety and performance of VIVIA: a novel home hemodialysis system. Nephrol Dial Transplant 2017; 32:685-692. [PMID: 27190336 DOI: 10.1093/ndt/gfw044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 02/10/2016] [Indexed: 11/14/2022] Open
Abstract
Background The VIVIA Hemodialysis System (Baxter Healthcare Corporation, Deerfield, IL, USA) was designed for patient use at home to reduce the burden of treatment and improve patient safety. It has unique features including extended use of the dialyzer and blood set through in situ hot-water disinfection between treatments; generation of on-line infusible-quality dialysate for automated priming, rinseback and hemodynamic support during hypotension and a fully integrated access disconnect sensor. Methods The safety and performance of VIVIA were assessed in two clinical studies. A first-in-man study was a prospective, single-arm study that involved 22 prevalent hemodialysis (HD) patients who were treated for ∼4 h, four times a week, for 10 weeks. A second clinical study was a prospective, single-arm study (6-8 h of dialysis treatment at night three times a week) that involved 17 prevalent patients treated for 6 weeks. Results There were 1114 treatments from the two studies (first-in-man study, 816; extended duration study, 298). Adverse events (AEs) were similar in the two studies to those expected for prevalent HD patients. No deaths and no device-related serious AEs occurred. Adequacy of dialysis ( Kt / V ) urea in both clinical trials was well above the clinical guidelines. VIVIA performed ultrafiltration accurately as prescribed in the two studies. The majority of patients achieved 10 or more uses of the dialyzer. Endotoxin levels and bacterial dialysate sampling met infusible-quality dialysate standards. Conclusion These results confirm the safety and expected performance of VIVIA.
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Affiliation(s)
- Angelito A Bernardo
- Baxter Healthcare Corporation (DF5-1N), One Baxter Parkway, Deerfield and Round Lake, IL, USA
| | | | | | | | - Michael Amdahl
- Baxter Healthcare Corporation (DF5-1N), One Baxter Parkway, Deerfield and Round Lake, IL, USA
| | - Jason Demers
- DEKA Research & Development Corporation, Manchester, NH, USA
| | - Audrey M Hutchcraft
- Baxter Healthcare Corporation (DF5-1N), One Baxter Parkway, Deerfield and Round Lake, IL, USA
| | - John K Leypoldt
- Baxter Healthcare Corporation (DF5-1N), One Baxter Parkway, Deerfield and Round Lake, IL, USA
| | - Mark Minkus
- Baxter Healthcare Corporation (DF5-1N), One Baxter Parkway, Deerfield and Round Lake, IL, USA
| | - Matt Muller
- Baxter Healthcare Corporation (DF5-1N), One Baxter Parkway, Deerfield and Round Lake, IL, USA
| | - Ruth Stallard
- Baxter Healthcare Corporation (DF5-1N), One Baxter Parkway, Deerfield and Round Lake, IL, USA
| | - Bruce F Culleton
- Baxter Healthcare Corporation (DF5-1N), One Baxter Parkway, Deerfield and Round Lake, IL, USA
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28
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Walker RC, Howard K, Morton RL. Home hemodialysis: a comprehensive review of patient-centered and economic considerations. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 9:149-161. [PMID: 28243134 PMCID: PMC5317253 DOI: 10.2147/ceor.s69340] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Internationally, the number of patients requiring treatment for end-stage kidney disease (ESKD) continues to increase, placing substantial burden on health systems and patients. Home hemodialysis (HD) has fluctuated in its popularity, and the rates of home HD vary considerably between and within countries although there is evidence suggesting a number of clinical, survival, economic, and quality of life (QoL) advantages associated with this treatment. International guidelines encourage shared decision making between patients and clinicians for the type of dialysis, with an emphasis on a treatment that aligned to the patients’ lifestyle. This is a comprehensive literature review of patient-centered and economic impacts of home HD with the studies published between January 2000 and July 2016. Data from the primary studies representing both efficiency and equity of home HD were presented as a narrative synthesis under the following topics: advantages to patients, barriers to patients, economic factors influencing patients, cost-effectiveness of home HD, and inequities in home HD delivery. There were a number of advantages for patients on home HD including improved survival and QoL and flexibility and potential for employment, compared to hospital HD. Similarly, there were several barriers to patients preferring or maintaining home HD, and the strategies to overcome these barriers were frequently reported. Good evidence reported that indigenous, low-income, and other socially disadvantaged individuals had reduced access to home HD compared to other forms of dialysis and that this situation compounds already-poor health outcomes on renal replacement therapy. Government policies that minimize barriers to home HD include reimbursement for dialysis-related out-of-pocket costs and employment-retention interventions for home HD patients and their family members. This review argues that home HD is a cost-effective treatment, and increasing the proportion of patients on this form of dialysis compared to hospital HD will result in a more equitable distribution of good health outcomes for individuals with ESKD.
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Affiliation(s)
- Rachael C Walker
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Hawke's Bay District Health Board, Hastings, New Zealand
| | - Kirsten Howard
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Sydney Medical School, University of Sydney, Sydney, Australia
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29
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Affiliation(s)
- Emilie Trinh
- Division of Nephrology; University Health Network; Toronto Ontario Canada
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30
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Wilcox SB, Carver M, Yau M, Sneeringer P, Prichard S, Alvarez L, Chertow GM. Results of human factors testing in a novel Hemodialysis system designed for ease of patient use. Hemodial Int 2016; 20:643-649. [DOI: 10.1111/hdi.12430] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - May Yau
- Outset Medical, Inc; San Jose California 95112 USA
| | | | | | - Luis Alvarez
- Division of Nephrology; Department of Medicine; Palo Alto Medical Foundation; Palo Alto California USA
| | - Glenn M. Chertow
- Division of Nephrology; Department of Medicine; Stanford University School of Medicine; Stanford California USA
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Rivara MB, Soohoo M, Streja E, Molnar MZ, Rhee CM, Cheung AK, Katz R, Arah OA, Nissenson AR, Himmelfarb J, Kalantar-Zadeh K, Mehrotra R. Association of Vascular Access Type with Mortality, Hospitalization, and Transfer to In-Center Hemodialysis in Patients Undergoing Home Hemodialysis. Clin J Am Soc Nephrol 2016; 11:298-307. [PMID: 26728588 DOI: 10.2215/cjn.06570615] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/14/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES In individuals undergoing in-center hemodialysis (HD), use of central venous catheters (CVCs) is associated with worse clinical outcomes compared with use of arteriovenous access. However, it is unclear whether a similar difference in risk by vascular access type is present in patients undergoing home HD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Our study examined the associations of vascular access type with all-cause mortality, hospitalization, and transfer to in-center HD in patients who initiated home HD from 2007 to 2011 in 464 facilities in 43 states in the United States. Patients were followed through December 31, 2011. Data were analyzed using competing risks hazards regression, with vascular access type at the start of home HD as the primary exposure in a propensity score-matched cohort (1052 patients; 526 with CVC and 526 with arteriovenous access). RESULTS Over a median follow-up of 312 days, 110 patients died, 604 had at least one hospitalization, and 202 transferred to in-center hemodialysis. Compared with arteriovenous access use, CVC use was associated with higher risk for mortality (hazard ratio, 1.73; 95% confidence interval, 1.18 to 2.54) and hospitalization (hazard ratio, 1.19; 95% confidence interval, 1.02 to 1.39). CVC use was not associated with increased risk for transfer to in-center HD. The results of analyses in the entire unmatched cohort (2481 patients), with vascular access type modeled as a baseline exposure at start of home HD or a time-varying exposure, were similar. Analyses among a propensity score-matched cohort of patients undergoing in-center HD also showed similar risks for death and hospitalization with use of CVCs. CONCLUSIONS In a large cohort of patients on home HD, CVC use was associated with higher risk for mortality and hospitalization. Additional studies are needed to identify interventions which may reduce risk associated with use of CVCs among patients undergoing home HD.
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Affiliation(s)
- Matthew B Rivara
- Department of Medicine, Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington;
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Irvine, California
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Irvine, California
| | - Miklos Z Molnar
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Irvine, California
| | - Alfred K Cheung
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah
| | - Ronit Katz
- Department of Medicine, Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California; University of California, Los Angeles (UCLA), Center for Health Policy Research, Los Angeles, California
| | - Allen R Nissenson
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California; and Office of the Chief Medical Officer, DaVita, Inc., El Segundo, California
| | - Jonathan Himmelfarb
- Department of Medicine, Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Irvine, California
| | - Rajnish Mehrotra
- Department of Medicine, Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington
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A Comparison of Clinical Parameters and Outcomes over 1 Year in Home Hemodialysis Patients Using 2008K@home or NxStage System One. ASAIO J 2015; 62:182-9. [PMID: 26692402 DOI: 10.1097/mat.0000000000000315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The prevalence of home hemodialysis (HHD) in the United States is growing, driven in part by improvements in dialysis machines for home use. We assessed clinical parameters and outcomes in HHD patients using either Fresenius 2008K@home or NxStage System One over 1 year. Patients were 18 years or older and received HHD for ≥30 days between January 1, 2009, and June 30, 2010. A propensity score match was used to control for differences in baseline characteristics, and 2008K@home patients were stratified by frequency of use. Data for outcome measures were analyzed using generalized linear mixed models. Treatment frequency was lower for 2008K@home groups than System One. Mean standardized Kt/V (stdKt/V) was 2.75 for 2008K@home ≥3.5x/week users and 1.99 for System One users (p < 0.001). Erythropoiesis-stimulating agent use tended to be lower for patients using System One. There were no statistically significant differences across groups in serum albumin, calcium, phosphorus, hemoglobin, or parathyroid hormone levels, normalized protein catabolic rate, body mass index, number of hospitalizations, or hospitalized days. Clinical parameters and outcomes for HHD patients using 2008K@home and System One were largely equivalent, although 2008K@home use was associated with higher stdKt/V. Further studies will be required to establish whether these differences in stdKt/V relate to differences in technology, treatment schedule, or a combination thereof.
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Seshasai RK, Mitra N, Chaknos CM, Li J, Wirtalla C, Negoianu D, Glickman JD, Dember LM. Factors Associated With Discontinuation of Home Hemodialysis. Am J Kidney Dis 2015; 67:629-37. [PMID: 26709066 DOI: 10.1053/j.ajkd.2015.11.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/07/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Home hemodialysis (HHD) is associated with improved clinical and quality-of-life outcomes compared to in-center hemodialysis, but remains an underused modality in the United States. Discontinuation from HHD therapy may be an important contributor to the low use of this modality. This study aimed to describe the rate and timing of HHD therapy discontinuation, or technique failure, and identify contributing factors. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Using data from a large dialysis provider, we identified a nationally representative cohort of patients who initiated HHD therapy from 2007 to 2009 (N=2,840). FACTORS Demographics, end-stage renal disease duration, kidney transplant listing status, comorbid conditions, level of urbanization or rurality based on residence zip code, socioeconomic status based on residence zip code, and dialysis facility factors. OUTCOMES Discontinuation from HHD therapy, defined as 60 or more days with no HHD treatments. MEASUREMENTS Competing-risk models were used to produce cumulative incidence plots and identify sociodemographic and clinical variables associated with HHD therapy discontinuation. Transplantation and death were treated as competing risks for HHD therapy discontinuation. RESULTS The 1-year incidence of discontinuation was 24.9%, and the 1-year mortality estimate was 7.6%. Median end-stage renal disease duration prior to initiating HHD therapy was 2.1 years. Diabetes and smoking/alcohol/drug use were associated with increased risk for HHD discontinuation (HRs of 1.34 [95% CI, 1.07-1.68] and 1.34 [95% CI, 1.01-1.78], respectively). Listing for kidney transplantation and rural residence (rural-urban commuting area ≥ 7) were associated with decreased risk for HHD therapy discontinuation (HRs of 0.73 [95% CI, 0.61-0.87] and 0.78 [95% CI, 0.59-1.02], respectively). LIMITATIONS Limited to variables available within the DaVita dialysis and US Renal Data System data sets. CONCLUSIONS A substantial proportion of patients discontinue HHD therapy within the first 12 months of use of the modality. Patients with diabetes, substance use, nonlisting for kidney transplantation, and urban residence are at greater risk for discontinuation. Targeting high-risk patients for increased support from clinical teams is a potential strategy for reducing HHD therapy discontinuation and increasing technique survival.
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Affiliation(s)
- Rebecca Kurnik Seshasai
- Division of Nephrology and Hypertension. Department of Medicine, Drexel University College of Medicine, Philadelphia, PA.
| | - Nandita Mitra
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - C Michael Chaknos
- Renal, Electrolyte and Hypertension Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jiaqi Li
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Christopher Wirtalla
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dan Negoianu
- Renal, Electrolyte and Hypertension Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Joel D Glickman
- Renal, Electrolyte and Hypertension Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Laura M Dember
- Renal, Electrolyte and Hypertension Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
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Raphael MJ, Nadeau-Fredette AC, Tennankore KK, Chan CT. A virtual ward for home hemodialysis patients - a pilot trial. Can J Kidney Health Dis 2015; 2:37. [PMID: 26527130 PMCID: PMC4628781 DOI: 10.1186/s40697-015-0072-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 08/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with end-stage renal disease (ESRD) have a high rate of hospitalization and are prone to care gaps that may occur during the transition from hospital to home. The virtual ward (VW) is an innovative model that provides short-term transitional care to patients upon hospital discharge. The VW may be an effective intervention to address care gaps. OBJECTIVES The primary objective of the pilot study was to assess the feasibility and practicality of implementing the Home Dialysis VW (HDVW) on a broader scale. DESIGN The HDVW Pilot Study enrolled home hemodialysis patients following one of four inclusion criteria: 1. Discharge from hospital, 2. Completion of an in-hospital medical procedure, 3. Prescription of an antibiotic, 4. Completion of home hemodialysis training. Patients were followed in the HDVW for 14 days and during this time were assessed serially with a clinician-led telephone interview for one of three transitional care gaps: 1. Requirement for change in hemodialysis prescription, 2. Requirement for coordination of follow-up care, 3. Requirement for medication change. SETTING The study was conducted in Toronto, Ontario, Canada at a quaternary care academic teaching hospital from 2012-2013. PATIENTS This study included 52 HDVW admissions among 35 patients selected from the existing home hemodialysis program. MEASUREMENTS The primary outcome was the identification of the number of care gaps at each HDVW admission. Secondary outcomes included the identification of potential predictors of care gaps and description of clinical adverse events following HDVW admission (readmissions, emergency department visits, unplanned visits to the home hemodialysis in-center). RESULTS The implementation and execution of the HDVW Pilot Study proved to be technically feasible and practical. A care gap was identified in 35 (67 %) of the HDVW admissions. In total, the cohort experienced 85 care gaps. There were no baseline demographic characteristics predictive of experiencing a care gap. In the total cohort observed for 2912 patient days, there were 9 readmissions, 13 visits to the emergency department, and 7 unplanned visits to the home hemodialysis in-center unit. LIMITATIONS The results of this study are limited by the small study size and single-center experience. CONCLUSION The implementation of a virtual ward for home hemodialysis patients is practical, feasible and identifies many care gaps which have the potential to result in subsequent adverse events. A larger, multi-center prospective clinical trial is justified to identify if the HDVW can prevent adverse events among home dialysis patients.
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Affiliation(s)
- Michael J Raphael
- Division of Nephrology, Toronto General Hospital - University Health Network, University of Toronto, Toronto, ON Canada
| | | | - Karthik K Tennankore
- Division of Nephrology, Dalhousie University/Nova Scotia Health, Halifax, NS Canada
| | - Christopher T Chan
- Division of Nephrology, Toronto General Hospital - University Health Network, University of Toronto, Toronto, ON Canada
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Yau M, Carver M, Alvarez L, Block GA, Chertow GM. Understanding barriers to home-based and self-care in-center hemodialysis. Hemodial Int 2015; 20:235-41. [DOI: 10.1111/hdi.12357] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- May Yau
- Clinical Operations; Outset Medical, Inc.; San Jose California USA
| | - Michelle Carver
- Clinical Operations; Outset Medical, Inc.; San Jose California USA
| | - Luis Alvarez
- Division of Nephrology; Department of Medicine and Nephrology; Palo Alto Medical Foundation; Palo Alto California USA
| | | | - Glenn M. Chertow
- Division of Nephrology; Department of Medicine and Nephrology; Stanford University School of Medicine; Stanford California USA
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36
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Barbieri AR, Gonçalves CCM, Cheade MDFM, Souza C, Tsuha DH, Ferreira KC, Rasi L, Paranhos Filho AC. Hemodialysis services: are public policies turned to guaranteeing the access? CAD SAUDE PUBLICA 2015; 31:1505-16. [PMID: 26248105 DOI: 10.1590/0102-311x00073514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 02/05/2015] [Indexed: 11/22/2022] Open
Abstract
The increasing incidence of chronic renal failure in Brazil and the consequential expansion of hemodialysis as a choice for treatment in final stage have to be taken into account to guarantee access to those in need. The ecological study conducted in Mato Grosso do Sul State, Brazil, in 2012, using data from the Brazilian Health Informatics Department (DATASUS) and from the analysis of medical records in 12 clinics, identified and mapped patients on hemodialysis, the distance they travelled and the estimated number of patients. The prevalence of hemodialysis patients in Mato Grosso do Sul State, about 55 per 100,000 inhabitants, is similar to the national average. The analyses indicated concentration of patients in counties with clinics and also geographical gaps that generate displacement of over 100km for more than 16% of patients. The results point to the necessity of strengthening public policies that consider, for decision-making, the decentralization of service, the expansion of home care and the follow-up education for professionals.
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Affiliation(s)
| | | | | | - Cristina Souza
- Universidade Federal de Mato Grosso do Sul, Campo Grande, Brasil
| | | | | | - Lucas Rasi
- Serviço Nacional de Aprendizagem Industrial, Campo Grande, Brasil
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Abstract
PURPOSE OF REVIEW To discuss the changing landscape of home dialysis in the United States over the past decade, including recent research on clinical outcomes in patient undergoing peritoneal dialysis and home hemodialysis, and to describe the impact of recent payment reforms for patients with end-stage renal disease. RECENT FINDINGS Accumulating evidence supports the conclusion that clinical outcomes for patients treated with peritoneal dialysis or home hemodialysis are as good as or better than for patients treated with conventional in-center hemodialysis. The recent implementation of the Medicare-expanded prospective payment system for the care of end-stage renal disease patients has resulted in substantial growth in the utilization of peritoneal dialysis in the United States. Utilization of home hemodialysis has also grown, but the contribution of the expanded prospective payment system to this growth is less certain. SUMMARY Home dialysis, including peritoneal dialysis and home hemodialysis, represents an important alternative to in-center hemodialysis that is effective and patient-centered. Over the coming decade, the growth in the number of end-stage renal disease patient treated with home dialysis modalities should prompt further comparative and cost-effectiveness research, increased attention to racial and ethnic disparities, and investments in home dialysis education for both patients and providers. VIDEO ABSTRACT http://links.lww.com/CONH/A13.
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38
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Walker RC, Blagg CR, Mendelssohn DC. Systems to cultivate suitable patients for home dialysis. Hemodial Int 2015; 19 Suppl 1:S52-8. [PMID: 25925824 DOI: 10.1111/hdi.12203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The key to developing, initiating, and maintaining a strong home dialysis program is a fundamental commitment by the entire team to identify and cultivate patients who are suitable candidates to perform home dialysis. This process must start as early as possible in the disease trajectory, and must include a passionate and daily focus by physicians, nurses, social workers, and other members of the multidisciplinary team. This effort must be constant and sustained over months, with active promotion of home dialysis for suitable patients at every opportunity. Cultivation of suitable patients must become a defining and overarching mission for the entire program. This article reviews some of the components involved in this worthwhile effort and provides practical tips and links to resources.
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Affiliation(s)
- Rachael C Walker
- Renal Department, Hawke's Bay District Health Board, Hastings, New Zealand; School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Marshall MR, Young BA, Fox SJ, Cleland CJ, Walker RJ, Masakane I, Herold AM. The home hemodialysis hub: physical infrastructure and integrated governance structure. Hemodial Int 2015; 19 Suppl 1:S8-S22. [PMID: 25925827 DOI: 10.1111/hdi.12273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An effective home hemodialysis program critically depends on adequate hub facilities and support functions and on transparent and accountable organizational processes. The likelihood of optimal service delivery and patient care will be enhanced by fit-for-purpose facilities and implementation of a well-considered governance structure. In this article, we describe the required accommodation and infrastructure for a home hemodialysis program and a generic organizational structure that will support both patient-facing clinical activities and business processes.
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Affiliation(s)
- Mark R Marshall
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Renal Medicine, Counties Manukau District Health Board, Auckland, New Zealand
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Bennett PN, Schatell D, Shah KD. Psychosocial aspects in home hemodialysis: A review. Hemodial Int 2015; 19 Suppl 1:S128-34. [DOI: 10.1111/hdi.12258] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Paul N. Bennett
- Western Health; Deakin University; Melbourne Victoria Australia
| | - Dori Schatell
- Medical Education Institute, Inc.; Madison Wisconsin USA
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Naso A, Scaparrotta G, Naso E, Calò LA. Intensive Home Hemodialysis: An Eye at the Past Looking for the Hemodialysis of the Future. Artif Organs 2015; 39:736-40. [DOI: 10.1111/aor.12458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Agostino Naso
- Department of Medicine, Nephrology; University of Padova-Azienda Ospedaliera di Padova; Padova Italy
| | - Giuseppe Scaparrotta
- Department of Medicine, Nephrology; University of Padova-Azienda Ospedaliera di Padova; Padova Italy
| | - Elena Naso
- Department of Medicine, Nephrology; University of Padova-Azienda Ospedaliera di Padova; Padova Italy
| | - Lorenzo A. Calò
- Department of Medicine, Nephrology; University of Padova-Azienda Ospedaliera di Padova; Padova Italy
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Suri RS, Li L, Nesrallah GE. The risk of hospitalization and modality failure with home dialysis. Kidney Int 2015; 88:360-8. [PMID: 25786099 PMCID: PMC4526768 DOI: 10.1038/ki.2015.68] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/20/2015] [Accepted: 01/22/2015] [Indexed: 12/13/2022]
Abstract
While home dialysis is being promoted, there are few comparative effectiveness studies of home-based modalities to guide patient decisions. To address this, we matched 1116 daily home hemodialysis (DHD) patients by propensity scores to 2784 contemporaneous USRDS patients receiving home peritoneal dialysis (PD), and compared hospitalization rates from cardiovascular, infectious, access-related or bleeding causes (prespecified composite), and modality failure risk. We performed similar analyses for 1187 DHD patients matched to 3173 USRDS patients receiving in-center conventional hemodialysis (CHD). The composite hospitalization rate was significantly lower with DHD than with PD (0.93 vs. 1.35/patient-year, hazard ratio=0.73 (95% CI=0.67–0.79)). DHD patients spent significantly fewer days in hospital than PD patients (5.2 vs. 9.2 days/patient-year), and significantly more DHD patients remained admission-free (52% DHD vs. 32% PD). In contrast, there was no significant difference in hospitalizations between DHD and CHD (DHD vs. CHD: 0.93 vs. 1.10/patient-year, hazard ratio 0.92 (0.85–1.00)). Cardiovascular hospitalizations were lower with DHD than with CHD (0.68 (0.61–0.77)), while infectious and access hospitalizations were higher (1.15 (1.04–1.29) and 1.25 (1.08–1.43), respectively). Significantly more PD than DHD patients switched back to in-center HD (44% vs. 15% 3.4 (2.9–4.0)). In this prevalent cohort, home DHD was associated with fewer admissions and hospital days than PD, and a substantially lower risk of modality failure.
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Affiliation(s)
- Rita S Suri
- 1] Department of Medicine, Section of Nephrology, Centre de Recherche, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada [2] Division of Nephrology, Western University, London, Ontario, Canada
| | - Lihua Li
- Division of Nephrology, Western University, London, Ontario, Canada
| | - Gihad E Nesrallah
- 1] Department of Nephrology, Humber River Regional Hospital, Toronto, Ontario, Canada [2] The Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
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Walker RC, Hanson CS, Palmer SC, Howard K, Morton RL, Marshall MR, Tong A. Patient and Caregiver Perspectives on Home Hemodialysis: A Systematic Review. Am J Kidney Dis 2015; 65:451-63. [DOI: 10.1053/j.ajkd.2014.10.020] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 10/19/2014] [Indexed: 11/11/2022]
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Golper TA. The possible impact of the US prospective payment system ("bundle") on the growth of peritoneal dialysis. Perit Dial Int 2014; 33:596-9. [PMID: 24335120 DOI: 10.3747/pdi.2013.00212] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Thomas A Golper
- Division of Nephrology and Hypertension Vanderbilt University Medical Center Nashville, Tennessee, USA
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Osterlund K, Mendelssohn D, Clase C, Guyatt G, Nesrallah G. Identification of Facilitators and Barriers to Home Dialysis Selection by Canadian Adults with ESRD. Semin Dial 2014; 27:160-72. [DOI: 10.1111/sdi.12183] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Katherine Osterlund
- The Lawson Health Research Institute; Western University; London Ontario Canada
| | - David Mendelssohn
- Department of Nephrology; Humber River Hospital; Toronto Ontario Canada
| | - Catherine Clase
- Department of Health Research Methodology; McMaster University; Hamilton Ontario Canada
| | - Gordon Guyatt
- Department of Health Research Methodology; McMaster University; Hamilton Ontario Canada
| | - Gihad Nesrallah
- Department of Nephrology; Humber River Hospital; Toronto Ontario Canada
- The Li Ka Shing Knowledge Institute; Keenan Research Centre; St. Michael's Hospital; Toronto Ontario Canada
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46
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Fluck RJ, Fouque D, Lockridge RS. Nephrologists' perspectives on dialysis treatment: results of an international survey. BMC Nephrol 2014; 15:16. [PMID: 24428875 PMCID: PMC3912927 DOI: 10.1186/1471-2369-15-16] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 01/03/2014] [Indexed: 02/02/2023] Open
Abstract
Background In-centre haemodialysis (ICHD) is the most common dialysis method used by patients worldwide. However, quality of life and clinical outcomes in patients treated via ICHD have not improved for some time. ‘High-dose’ haemodialysis (HD) regimens – which are longer and/or more frequent than conventional regimens and are particularly suitable to delivery in the home – may offer a route to improved outcomes and quality of life. This survey aimed to determine nephrologists’ views on the validity of alternatives to ICHD, particularly home HD and high-dose HD. Methods A total of 1,500 nephrologists from Europe, Canada and the United States were asked to respond to an online questionnaire that was designed following previous qualitative research. Certified nephrologists in practice for 2–35 years who managed >25 adult dialysis patients were eligible to take part. Results A total of 324 nephrologists completed the survey. ICHD was the most common type of dialysis used by respondents’ current patients (90%), followed by peritoneal dialysis (8%) and home HD (2%). The majority of respondents believed that: home HD provides better quality of life; increasing the frequency of dialysis beyond three times per week significantly improves clinical outcomes; and longer dialysis sessions performed nocturnally would result in significantly better clinical outcomes than traditional ICHD. Conclusions Survey results indicated that many nephrologists believe that home HD and high-dose HD are better for the patient. However, the majority of their patients were using ICHD. Education, training and support on alternative dialysis regimens are needed.
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Honkanen E, Hazel I, Zimmerman D. High-dose hemodialysis: Time for a change. Hemodial Int 2014; 18:3-6. [DOI: 10.1111/hdi.12069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Eero Honkanen
- Helsinki University Central Hospital; Helsinki Finland
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48
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Nadeau-Fredette AC, Tennankore KK, Kim SJ, Chan CT. Suboptimal initiation of home hemodialysis: determinants and clinical outcomes. Nephron Clin Pract 2013; 124:132-40. [PMID: 24281264 DOI: 10.1159/000356383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 10/14/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Suboptimal initiation of conventional hemodialysis is associated with poor clinical outcomes. In this study, we aimed to ascertain the determinants and adverse events associated with suboptimal starts in home hemodialysis (HHD). METHODS We conducted a retrospective cohort study including consecutive incident HHD patients from January 1996 to December 2011. All patients had HHD as their first renal replacement therapy or returned to HHD after kidney transplantation. A suboptimal start was defined by dialysis initiation as an inpatient or with a central venous catheter. The primary outcome was time to first hospitalization, technique failure or death. Secondary outcomes included hospitalization rate, hospital days and determinants of suboptimal starts. Suboptimal starts were further categorized as unavoidable as adjudicated by two independent observers with prespecified criteria. RESULTS Among 95 incident HHD patients, 44 (46%) and 51 (54%) had optimal and suboptimal starts, respectively. A suboptimal start was associated with a shorter time to the primary outcome (log-rank p < 0.001). In a multivariable Cox proportional hazards model, the hazard ratio for the composite outcome (comparing suboptimal to optimal starts) was 2.94 (95% confidence interval, CI, 1.49-5.78, p = 0.002). Transplantation clinic follow-up (OR 3.18, 95% CI 1.15-8.79) and the Charlson comorbidity index (OR 1.47, 95% CI 1.09-1.97) were associated with higher odds of suboptimal start. CONCLUSION Suboptimal initiation of HHD is associated with adverse clinical events including early hospitalization. Given the high proportion of suboptimal starts in patients returning from transplantation, better incorporation of dialysis planning and renal replacement therapy education is warranted.
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Golper TA, Mehrotra R, Schreiber MS. Is Dorothy correct? The role of patient education in promoting home dialysis. Semin Dial 2013; 26:138-42. [PMID: 23520987 DOI: 10.1111/sdi.12086] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The major payer of dialysis services in the United States, Medicare, has established incentives to encourage the use of home dialysis. However, this modality remains underutilized. We think that a major cause of this situation is ineffective education of the prospective dialysis population regarding the choices of kidney replacement modalities. We discuss the value of patient education and the consequences of failing to educate prospective dialysis patients. We then explore approaches to achieve patient education goals and the physician's and education team's roles in the development of an individual patient's life plan.
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Affiliation(s)
- Thomas A Golper
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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Affiliation(s)
- Thomas A Golper
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
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