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Yoon HE, Chung S, Chung HW, Shin MJ, Lee SJ, Kim YS, Kim HW, Song HC, Yang CW, Jin DC, Kim YS, Kim SY, Choi EJ, Chang YS, Kim YO. Status of initiating pattern of hemodialysis: a multi-center study. J Korean Med Sci 2009; 24 Suppl:S102-8. [PMID: 19194537 PMCID: PMC2633201 DOI: 10.3346/jkms.2009.24.s1.s102] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Accepted: 11/21/2008] [Indexed: 11/20/2022] Open
Abstract
This study was to evaluate the status of initiating pattern of hemodialysis (HD). Five hundred-three patients in 8 University Hospitals were included. Presentation mode (planned vs. unplanned), and access type (central venous catheters [CVC] vs. permanent access) at initiation of HD were evaluated, and the influence of predialysis care on determining the mode of HD and access type was also assessed. Most patients started unplanned HD (81.9%) and the most common initial access type was CVC (86.3%). The main reason for unplanned HD and high rate of CVC use was patient-related factors such as refusal of permanent access creation and failure to attend scheduled clinic appointments. Predialysis care was performed in 57.9% of patients and only 24.1% of these patients started planned HD and 18.9% used permanent accesses initially. Only a minority of patients initiated planned HD with permanent accesses in spite of predialysis care. To overcome this, efforts to improve the quality of predialysis care are needed.
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Affiliation(s)
- Hye Eun Yoon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sungjin Chung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Wha Chung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi Jung Shin
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Ju Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Soo Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Wook Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Cheol Song
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Woo Yang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Chan Jin
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Soo Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Suk Young Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Euy Jin Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Sik Chang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Ok Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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52
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Lobbedez T, Cousin M, Hurault de Ligny B, Ficheux M, El Haggan W, Ryckelynck JP. [Failed transplant patients: dialysis initiation and short-term outcome]. Nephrol Ther 2008; 5:188-92. [PMID: 19071082 DOI: 10.1016/j.nephro.2008.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 10/09/2008] [Accepted: 10/10/2008] [Indexed: 11/18/2022]
Abstract
UNLABELLED This study was carried out to evaluate dialysis initiation of failed transplant patient and the short-term outcome of these patients on dialysis. PATIENTS AND METHOD We conducted a retrospective study of transplanted patients from one centre returning in dialysis after allograft failure. Those patients were transplanted between 31st October 1986 and 3rd March 2004. Patients who experienced allograft failure after 6 months on transplantation were included in the study. RESULTS Among 600 transplanted patients, 92 patients restarted dialysis after allograft failure. Of the 92 failed transplant patients, 69 had a graft survival of more than 6 months. The mean glomerular filtration rate at dialysis initiation was 13+/-5mL per minute. At time of dialysis initiation, patients had mean haemoglobin level at 80.7+/-10.7g/L, and mean serum albumin level at 34+/-6g/L. Urgent dialysis was needed for 39 over 57 patients. Fourteen over 58 patients had no vascular access or peritoneal catheter at dialysis initiation. Fifty-six over 69 patients were treated by haemodialysis. Of the 13 patients treated by peritoneal dialysis 7 were on PD before transplantation whereas 49 over 57 haemodialysis patients were treated by haemodialysis before transplant failure (p<0.05). Immunosuppressive therapy was stopped during the first year following transplantation failure in 52 over 69 patients and 36 over 69 patients underwent transplantectomy. Thirteen over 56 patients presented a least one cardiovascular events after transplantation failure. CONCLUSION Unplanned dialysis initiation is frequent in failed transplant patients, in whom an early dialysis start is probably mandatory.
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Affiliation(s)
- Thierry Lobbedez
- Service de néphrologie, dialyse et transplantation, CHU Clémenceau, avenue Georges-Clémenceau, 14033 Caen cedex, France.
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Motiwala SS, McFarlane PA. Standardized Preplanned Patient Education to Encourage Transfer from Hospital Hemodialysis to Home Dialysis. Perit Dial Int 2008. [DOI: 10.1177/089686080802800416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Philip A. McFarlane
- Diabetes Comprehensive Care Program University of Toronto Toronto, Ontario, Canada
- St. Michael's Hospital Faculty of Medicine University of Toronto Toronto, Ontario, Canada
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54
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Just PM, de Charro FT, Tschosik EA, Noe LL, Bhattacharyya SK, Riella MC. Reimbursement and economic factors influencing dialysis modality choice around the world. Nephrol Dial Transplant 2008; 23:2365-73. [PMID: 18234844 PMCID: PMC2441769 DOI: 10.1093/ndt/gfm939] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Accepted: 12/18/2007] [Indexed: 11/21/2022] Open
Abstract
The worldwide incidence of kidney failure is on the rise and treatment is costly; thus, the global burden of illness is growing. Kidney failure patients require either a kidney transplant or dialysis to maintain life. This review focuses on the economics of dialysis. Alternative dialysis modalities are haemodialysis (HD) and peritoneal dialysis (PD). Important economic factors influencing dialysis modality selection include financing, reimbursement and resource availability. In general, where there is little or no facility or physician reimbursement or payment for PD, the share of PD is very low. Regarding resource availability, when centre HD capacity is high, there is an incentive to use that capacity rather than place patients on home dialysis. In certain countries, there is interest in revising the reimbursement structure to favour home-based therapies, including PD and home HD. Modality selection is influenced by employment status, with an association between being employed and PD as the modality choice. Cost drivers differ for PD and HD. PD is driven mainly by variable costs such as solutions and tubing, while HD is driven mainly by fixed costs of facility space and staff. Many cost comparisons of dialysis modalities have been conducted. A key factor to consider in reviewing cost comparisons is the perspective of the analysis because different costs are relevant for different perspectives. In developed countries, HD is generally more expensive than PD to the payer. Additional research is needed in the developing world before conclusive statements may be made regarding the relative costs of HD and PD.
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Affiliation(s)
- Paul M Just
- Baxter Healthcare Corporation, 1620 Waukegan Road, MPGR-A2E, McGaw Park, IL 60085, USA.
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55
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Lee A, Gudex C, Povlsen JV, Bonnevie B, Nielsen CP. Patients' views regarding choice of dialysis modality. Nephrol Dial Transplant 2008; 23:3953-9. [PMID: 18586764 DOI: 10.1093/ndt/gfn365] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Increasing patient numbers have resulted in pressure on dialysis centres and a need to reorganize dialysis treatment. This study explored patients' experiences with different dialysis modalities and investigated issues related to the patient's choice of modality, especially 'out-of-centre' dialysis (i.e. modalities other than CHD). METHODS Six focus group interviews were conducted with 24 dialysis patients, 3 pre-dialysis patients and 18 relatives. Each focus group comprised patients on one type of dialysis, i.e. CHD, self-care CHD, HHD, CAPD/APD, aAPD or pre-dialysis patients. Based on a semi-structured interview guide, the group discussions centred on advantages and disadvantages of dialysis modalities, problems experienced and their (possible) solutions and patient involvement in choice of modality. RESULTS The focus groups participants considered that each dialysis modality has its advantages and disadvantages. Flexibility, independence and feelings of security were key factors in determining choice of modality, with maintenance of a normal life being a major goal. Patients and their relatives want to participate in choice of modality, but a genuine offer of out-of-centre dialysis including professional support and appropriate and timely education is needed to encourage a greater use of modalities other than CHD. CONCLUSIONS No single dialysis modality emerged as offering the best solution for patients with end-stage renal disease. In the absence of absolute clinical contraindications, the treatment of choice should be the modality that best accommodates the patients' preferences for their daily activities and lifestyle. A move towards more patients on out-of-centre dialysis requires a greater focus on pre-dialysis patients and closer consideration of patients' preferences and current lifestyle.
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Affiliation(s)
- Anne Lee
- Centre for Applied Health Services Research and Technology Assessment (CAST), University of Southern Denmark, Odense C, Denmark.
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56
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Lobbedez T, Lecouf A, Ficheux M, Henri P, de Ligny BH, Ryckelynck JP. Is rapid initiation of peritoneal dialysis feasible in unplanned dialysis patients? A single-centre experience. Nephrol Dial Transplant 2008; 23:3290-4. [DOI: 10.1093/ndt/gfn213] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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57
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Waterman A, Barrett A, Stanley S. Optimal transplant education for recipients to increase pursuit of living donation. Prog Transplant 2008. [DOI: 10.7182/prtr.18.1.d4r0564645ut6074] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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58
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Waterman AD, Barrett AC, Stanley SL. Optimal Transplant Education for Recipients to Increase Pursuit of Living Donation. Prog Transplant 2008; 18:55-62. [DOI: 10.1177/152692480801800111] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context Inadequate transplant education may stop kidney patients from beginning or completing evaluation or limit recipients from considering living donation. Objective To learn about recipients' decision making about living donation and preferred transplant education resources. Design Retrospective, cross-sectional survey. Patients—304 kidney recipients. Main Outcome Measures Living donation comfort, concerns, education preferences. Results Recipients spent 10 median hours learning about transplant, primarily by speaking to medical staff (2–3 hours) and reading transplant brochures (0–1 hour). Twelve percent had not received any education before coming to the transplant center. At least 75% wanted education discussing the evaluation, surgery, and medical tests required of recipients and donors, as well as common transplant-related fears. Recipients who received living donor transplants were more interested in information about donors' evaluation ( P< .001), surgery ( P< .001), medical tests ( P< .001), and donation concerns ( P= .004) than were other recipients. Recipients who had living donors evaluated were more comfortable accepting family members or friends who volunteered rather than asking potential donors because of concerns about pressuring donors (85%), harming their health (83%), or causing them pain or inconvenience (76%). Besides providing accurate medical information, education that addresses recipients' fears about transplantation, explains living donors' donation experiences, and teaches patients how to pursue living donation may increase recipients' pursuit of living donation.
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Affiliation(s)
- Amy D. Waterman
- Washington University School of Medicine, St Louis, Missouri
| | - Ann C. Barrett
- Washington University School of Medicine, St Louis, Missouri
| | - Sara L. Stanley
- Washington University School of Medicine, St Louis, Missouri
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Lavaud S, Yelmo V, Paris B, Flatet S, Canivet E, Grandmaitre G, Tenet M, Rieu P. Information prédialyse Préparation au traitement de suppléance : l’information, du point de vue du médecin et de l’infirmier. Nephrol Ther 2007. [DOI: 10.1016/s1769-7255(07)78750-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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60
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Abstract
Patient education approaches are currently derived from a biomedical 'acute' model characterized by the sequence of health, disease, and recovery resulting from our professional intervention. Unfortunately, this model proves to be totally inadequate when applied to a chronic disease such as kidney failure. Our patients never fully regain their health and may continue to worsen under our care, even after many state-of-the-art treatments. The solution is represented in acquiring a new professional identity, shifting from the 'biomedical' acute model to a 'bio-psycho-social-educational model'. Within this model, a Therapeutic Education approach in predialysis has been proven to provide both short- and long-term positive results for renal patients. There is a tremendous difference between the learning processes in children and adults and two different sciences have already been described. 'Pedagogy' deals with child learning and 'Andragogy' with adult learning. Nevertheless, when the learner is a patient with a chronic disease, we believe that new considerations must be taken into account. We propose to create a novel science and to call it 'Nosogogy', derived from the ancient Greek word (see text), meaning 'disease'. Nosogogy could be defined as the science of teaching adults affected by chronic disease. The new educator is someone deeply involved in renal care who knows and understands the characteristic conflicts and dynamics that arise in the renal patient, and possesses adequate communication skills to deal with him. In our experience, we prefer to have educational sessions run by nephrologists and nurses who have great experience in the field.
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61
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McCormick BB, Brown PA, Knoll G, Yelle JD, Page D, Biyani M, Lavoie S. Use of the embedded peritoneal dialysis catheter: Experience and results from a North American Center. Kidney Int 2006:S38-43. [PMID: 17080110 DOI: 10.1038/sj.ki.5001914] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since 2000, the Ottawa Hospital Home Dialysis Program has used a variation on the embedded peritoneal dialysis catheter technique described by Moncrief et al. In this paper, we describe our approach to placement of peritoneal access and report our experience with 304 embedded catheters placed between January 2000 and December 2003. We review the advantages and disadvantages of this technique and describe factors that have been important to the success of our program.
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Affiliation(s)
- B B McCormick
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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62
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Diaz-Buxo JA, Crawford-Bonadio TL, St Pierre D, Ingram KM. Establishing a successful home dialysis program. Blood Purif 2006; 24:22-7. [PMID: 16361836 DOI: 10.1159/000089432] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The renewed interest in home dialysis therapies makes it pertinent to address the essentials of establishing and running a successful home dialysis program. The success of a home program depends on a clear understanding of the structure of the home program team, the physical plant, educational tool requirements, reimbursement sources and a business plan. A good command of the technical and economic aspects is important, but the primary drivers for the creation and growth of a home dialysis program are the confidence and commitment of the nephrological team.
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