1
|
Chen Y, Zhang M, Li Y, Xie Q, Dai S, Ge X, Hao CM, Zhu T. Retroperitoneal leakage as an important cause of acquired ultrafiltration decline in peritoneal dialysis: clinical characteristics and related risk factors. J Nephrol 2024:10.1007/s40620-024-02009-3. [PMID: 38997573 DOI: 10.1007/s40620-024-02009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/13/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Peritoneal dialysis (PD) is a widely-used renal replacement therapy while low ultrafiltration volume usually results in technique failure. Retroperitoneal leakage has been reported to be one of the causes of acquired decline in ultrafiltration. The present study investigated retroperitoneal leakage in PD patients and explored related risk factors. METHODS This study was designed as a prospective, observational study. A total of 420 PD patients regularly followed up at our center were enrolled from May 2011 to July 2021 and followed until December 2021. Retroperitoneal leakage was determined by magnetic resonance peritoneography and was used as the endpoint. Patients with retroperitoneal leakage were given intermittent PD or temporary hemodialysis (HD) as therapy. Cox regression models were used to identify risk factors for retroperitoneal leakage. RESULTS The cohort was followed up for up to 125.0 months (median: 46.4 months; interquartile range: 16.6 months). During the follow-up, 68 patients developed retroperitoneal leakage, with 31 (45.6%) cases occurring within the first year after PD initiation. A total of 62 (91.2%) patients recovered from retroperitoneal leakage and resumed their original PD regimen. Multivariate Cox regression analysis revealed that age and gender were independent predictors for retroperitoneal leakage. Younger males were more likely to develop retroperitoneal leakage. In females, waistline and body mass index (BMI) were found to be risk factors for retroperitoneal leakage. CONCLUSIONS Retroperitoneal leakage was common in PD patients with ultrafiltration insufficiency and was usually reversible after appropriate treatment. Age and gender were independent risk factors for retroperitoneal leakage.
Collapse
Affiliation(s)
- Yun Chen
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Min Zhang
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Yuan Li
- Division of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qionghong Xie
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Shuqi Dai
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Xiaolin Ge
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Chuan-Ming Hao
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Tongying Zhu
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
| |
Collapse
|
2
|
Gardezi AI, Yuan Z, Aziz F, Parajuli S, Mandelbrot D, Chan MR, Astor BC. Effect of End-Stage Renal Disease Prospective Payment System on Utilization of Peritoneal Dialysis in Patients with Kidney Allograft Failure. Am J Nephrol 2024:1-10. [PMID: 38754385 DOI: 10.1159/000539062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION The Center for Medicare and Medicaid Services introduced an End-Stage Renal Disease Prospective Payment System (PPS) in 2011 to increase the utilization of home dialysis modalities, including peritoneal dialysis (PD). Several studies have shown a significant increase in PD utilization after PPS implementation. However, its impact on patients with kidney allograft failure remains unknown. METHODS We conducted an interrupted time series analysis using data from the US Renal Data System (USRDS) that include all adult kidney transplant recipients with allograft failure who started dialysis between 2005 and 2019. We compared the PD utilization in the pre-PPS period (2005-2010) to the fully implemented post-PPS period (2014-2019) for early (within 90 days) and late (91-365 days) PD experience. RESULTS A total of 27,507 adult recipients with allograft failure started dialysis during the study period. There was no difference in early PD utilization between the pre-PPS and the post-PPS period in either immediate change (0.3% increase; 95% CI: -1.95%, 2.54%; p = 0.79) or rate of change over time (0.28% increase per year; 95% CI: -0.16%, 0.72%; p = 0.18). Subgroup analyses revealed a trend toward higher PD utilization post-PPS in for-profit and large-volume dialysis units. There was a significant increase in PD utilization in the post-PPS period in units with low PD experience in the pre-PPS period. Similar findings were seen for the late PD experience. CONCLUSION PPS did not significantly increase the overall utilization of PD in patients initiating dialysis after allograft failure.
Collapse
Affiliation(s)
- Ali I Gardezi
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Zhongyu Yuan
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Fahad Aziz
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sandesh Parajuli
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Didier Mandelbrot
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Micah R Chan
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Brad C Astor
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| |
Collapse
|
3
|
Rivara MB, Prince DK, Leuther KK, Hussein WF, Mehrotra R, Edwards T, Schiller B, Patrick DL. Evaluation and Measurement Properties of a Patient-Reported Experience Measure for Home Dialysis. Clin J Am Soc Nephrol 2024; 19:602-609. [PMID: 38261328 PMCID: PMC11108240 DOI: 10.2215/cjn.0000000000000429] [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: 08/16/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND No previously validated patient-reported experience measures exist for use among patients undergoing home dialysis. We tested the Home Dialysis Care Experience survey, a newly developed 26-item experience measure, among patients from 30 dialysis facilities in the United States. METHODS Using mail and telephone survey modalities, we approached 1372 patients treated with peritoneal dialysis or home hemodialysis for participation. Using the results from completed surveys, we evaluated item calibration by assessing item floor and ceiling effects. We tested three sets of composite scores and used factor analysis to assess model fit for each. We evaluated associations of composite scores with global ratings and separately with patient and dialysis facility characteristics. Finally, we measured test-retest reliability in patients who completed the survey at two separate time points. RESULTS Overall, 495 eligible patients completed at least one survey (response rate 36%). Of these, 49 completed the survey in Spanish and 61 completed a second survey within 30 days. We did not detect significant floor or ceiling effects, except for one item that demonstrated >90% responses at the top response option. Analyses supported one 12-item composite scale with high internal consistency reliability: Quality of Home Dialysis Care and Operations (Cronbach alpha=0.85). This scale strongly correlated with overall staff rating ( r =0.73) and overall center rating ( r =0.70). Patient demographic and dialysis facility characteristics were not consistently associated with composite scale scores or overall staff or center ratings. Intraclass correlation coefficients in the test-retest population were 0.74 for the Quality scale, 0.88 for overall staff rating, and 0.90 for overall center rating. CONCLUSIONS The Home Dialysis Care Experience survey is a 26-item measure that includes one composite scale and two global rating scores and is an informative tool to evaluate patient experience of care for home dialysis.
Collapse
Affiliation(s)
- Matthew B. Rivara
- Kidney Research Institute, University of Washington, Seattle, Washington
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - David K. Prince
- Kidney Research Institute, University of Washington, Seattle, Washington
| | | | - Wael F. Hussein
- Satellite Healthcare, Inc. San Jose, California
- Stanford University Department of Medicine, Palo Alto, California
| | - Rajnish Mehrotra
- Kidney Research Institute, University of Washington, Seattle, Washington
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Todd Edwards
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington
| | - Brigitte Schiller
- Satellite Healthcare, Inc. San Jose, California
- Stanford University Department of Medicine, Palo Alto, California
| | - Donald L. Patrick
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington
| |
Collapse
|
4
|
Rodriguez RA, Sparks MA, Conway PT, Gavhane A, Reddy S, Awdishu L, Waheed S, Davidson S, Adey DB, Lea JP, Lieske JC, McDonald FS. American Board of Internal Medicine Nephrology Procedure Requirements for Initial Certification: Time for a Change and Pursuing Consensus in the Nephrology Community. Am J Kidney Dis 2024:S0272-6386(24)00720-0. [PMID: 38640993 DOI: 10.1053/j.ajkd.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 04/21/2024]
Abstract
In 1988, the American Board of Internal Medicine (ABIM) defined essential procedural skills in nephrology, and candidates for ABIM certification were required to present evidence of possessing the skills necessary for placement of temporary dialysis vascular access, hemodialysis, peritoneal dialysis, and percutaneous renal biopsy. In 1996, continuous renal replacement therapy was added to the list of nephrology requirements. These procedure requirements have not been modified since 1996 while the practice of nephrology has changed dramatically. In March 2021, the ABIM Nephrology Board embarked on a policy journey to revise the procedure requirements for nephrology certification. With the guidance of nephrology diplomates, training program directors, professional and patient organizations, and other stakeholders, the ABIM Nephrology Board revised the procedure requirements to reflect current practice and national priorities. The approved changes include the Opportunity to Train standard for placement of temporary dialysis catheters, percutaneous kidney biopsies, and home hemodialysis, which better reflects the current state of training in most training programs, and the new requirements for home dialysis therapies training will align with the national priority to address the underuse of home dialysis therapies. This perspective details the ABIM process for considering changes to the certification procedure requirements and how ABIM collaborated with the larger nephrology community in considering revisions and additions to these requirements.
Collapse
Affiliation(s)
- Rudolph A Rodriguez
- Department of Medicine, University of Washington, Seattle, Washington; Hospital and Specialty Medicine, VA Puget Sound Health Care System, Seattle, Washington.
| | - Matthew A Sparks
- Division of Nephrology, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina; Renal Section, Durham VA Health Care System, Durham, North Carolina
| | - Paul T Conway
- American Association of Kidney Patients, Tampa, Florida
| | - Anamika Gavhane
- American Board of Internal Medicine, Philadelphia, Pennsylvania
| | - Siddharta Reddy
- American Board of Internal Medicine, Philadelphia, Pennsylvania
| | - Linda Awdishu
- Division of Clinical Pharmacy, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, California
| | - Sana Waheed
- Department of Medicine, Renal Division, School of Medicine, Emory University, Atlanta, Georgia
| | - Sandra Davidson
- American Board of Internal Medicine, Philadelphia, Pennsylvania
| | - Deborah B Adey
- Department of Medicine, Kidney Transplant Service, Division of Nephrology, University of California, San Francisco, California
| | - Janice P Lea
- Department of Medicine, Renal Division, School of Medicine, Emory University, Atlanta, Georgia
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Furman S McDonald
- American Board of Internal Medicine, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
5
|
Ng KH, Wong JHD, Leong SS. Shear wave elastography in chronic kidney disease - the physics and clinical application. Phys Eng Sci Med 2024; 47:17-29. [PMID: 38078996 DOI: 10.1007/s13246-023-01358-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: 12/16/2022] [Accepted: 11/15/2023] [Indexed: 03/26/2024]
Abstract
Chronic kidney disease is a leading public health problem worldwide. The global prevalence of chronic kidney disease is nearly five hundred million people, with almost one million deaths worldwide. Estimated glomerular filtration rate, imaging such as conventional ultrasound, and histopathological findings are necessary as each technique provides specific information which, when taken together, may help to detect and arrest the development of chronic kidney disease, besides managing its adverse outcomes. However, estimated glomerular filtration rate measurements are hampered by substantial error margins while conventional ultrasound involves subjective assessment. Although histopathological assessment is the best tool for evaluating the severity of the renal pathology, it may lead to renal insufficiency and haemorrhage if complications occurred. Ultrasound shear wave elastography, an emerging imaging that quantifies tissue stiffness non-invasively has gained interest recently. This method applies acoustic force pulses to generate shear wave within the tissue that propagate perpendicular to the main ultrasound beam. By measuring the speed of shear wave propagation, the tissue stiffness is estimated. This paper reviews the literature and presents our combined experience and knowledge in renal shear wave elastography research. It discusses and highlights the confounding factors on shear wave elastography, current and future possibilities in ultrasound renal imaging and is not limited to new sophisticated techniques.
Collapse
Affiliation(s)
- Kwan Hoong Ng
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Faculty of Medicine and Health Sciences, UCSI University, Port Dickson, Negeri Sembilan, Malaysia
| | - Jeannie Hsiu Ding Wong
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sook Sam Leong
- Centre for Medical Imaging Studies, Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Selangor, Malaysia.
| |
Collapse
|
6
|
Rivara MB, Himmelfarb J. From Home to Wearable Hemodialysis: Barriers, Progress, and Opportunities. Clin J Am Soc Nephrol 2024:01277230-990000000-00334. [PMID: 38190138 DOI: 10.2215/cjn.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/26/2023] [Indexed: 01/09/2024]
Abstract
Although the past two decades have seen substantial proportional growth of home hemodialysis in the United States, the absolute number of patients treated with home hemodialysis remains small. Currently available stationary hemodialysis devices for use in the home have inherent limitations that represent barriers for more widespread adoption by a larger proportion of individuals with kidney failure. These limitations include device weight and bulk, ergonomics considerations, technical complexity, vascular access challenges, and limited remote patient monitoring. Recent years have witnessed a resurgence in research and development of prototype wearable kidney replacement devices incorporating innovations in miniaturization, new biomaterials, and new methods for toxin clearance and dialysate regeneration. Recent work has built on five decades of incremental innovation in wearable dialysis concepts and prototypes, starting from the work by Kolff in the 1970s. Wearable dialysis devices that successfully overcome key persistent barriers to successful development and adoption of these technologies will radically reshape the landscape of kidney replacement therapies and have the potential to dramatically improve the lives of individuals living with kidney failure.
Collapse
Affiliation(s)
- Matthew B Rivara
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | | |
Collapse
|
7
|
Doernberg SN, Soled DR, Truog RD. Ethical Issues in the Transition to ECMO as a Destination Therapy. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:18-20. [PMID: 37220369 DOI: 10.1080/15265161.2023.2201193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
| | - Derek R Soled
- Brigham and Women's Hospital
- Harvard Medical School
- Boston Children's Hospital
- Boston Medical Center
| | | |
Collapse
|
8
|
Wilson L, Dohan D, Garibaldi M, Szeto D, Timmerman M, Matheny J. Prosthesis preferences for those with upper limb loss: Discrete choice study of PULLTY® for use in regulatory decisions. J Rehabil Assist Technol Eng 2023; 10:20556683231152418. [PMID: 36698551 PMCID: PMC9869218 DOI: 10.1177/20556683231152418] [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] [Indexed: 01/21/2023] Open
Abstract
Introduction The patient's voice in shared decision-making has progressed from physician's office to regulatory decision-making for medical devices with FDA's Patient Preference Initiative. A discrete-choice preference measure for upper limb prosthetic devices was developed to investigate patient's risk/benefit preference choices for regulatory decision making. Methods Rapid ethnographic procedures were used to design a discrete-choice measure describing risk and benefits of osseointegration with myoelectric control and test in a pilot preference study in adults with upper limb loss. Primary outcome is utility of each choice based conjoint (CBC) attribute using mixed-effects regression. Utilities with and without video, and between genders were compared. Results Strongest negative preference was for avoiding infection risk (B = -1.77, p < 0.001) and chance of daily pain (B = -1.22, p, 0.001). Strongest positive preference was for attaining complete independence when cooking dinner (B = 1.62, p < 0.001) and smooth grip patterns at all levels (B = 1.62, B = 1.28, B = 1.26, p < 0.001). Trade-offs showed a 1% increase in risk of serious/treatable infection resulted in a 1.77 decrease in relative preference. There were gender differences, and where video was used, preferences were stronger. Conclusions Strongest preferences were for attributes of functionality and independence versus connectedness and sensation but showed willingness to make risk-benefit trade-offs. Findings provide valuable information for regulatory benefit-risk decisions for prosthetic device innovations. Trial Registration This study is not a clinical trial reporting results of a health care intervention so is not registered.
Collapse
Affiliation(s)
- Leslie Wilson
- Department of Cllinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA, USA,Leslie Wilson, Department of Cllinical Pharmacy, University of California San Francisco School of Pharmacy, 480 16th street Office 32f, Box 0613, San Francisco, CA 94143-3402, USA.
| | - Dan Dohan
- Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Matthew Garibaldi
- Director, Orthotics Prosthetics, University of California San Francisco, San Francisco, CA, USA
| | - David Szeto
- Department of Cllinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA, USA
| | - Molly Timmerman
- General Physical Medicine & Rehabilitation, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Johnny Matheny
- Department of Cllinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA, USA
| |
Collapse
|
9
|
Emrani Z, Amiresmaili M, Daroudi R, Najafi MT, Akbari Sari A. Payment systems for dialysis and their effects: a scoping review. BMC Health Serv Res 2023; 23:45. [PMID: 36650516 PMCID: PMC9847119 DOI: 10.1186/s12913-022-08974-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/15/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND End stage renal disease (ESRD) is a major health concern and a large drain on healthcare resources. A wide range of payment methods are used for management of ESRD. The main aim of this study is to identify current payment methods for dialysis and their effects. METHOD In this scoping review Pubmed, Scopus, and Google Scholar were searched from 2000 until 2021 using appropriate search strategies. Retrieved articles were screened according to predefined inclusion criteria. Data about the study characteristics and study results were extracted by a pre-structured data extraction form; and were analyzed by a thematic analysis approach. RESULTS Fifty-nine articles were included, the majority of them were published after 2011 (66%); all of them were from high and upper middle-income countries, especially USA (64% of papers). Fee for services, global budget, capitation (bundled) payments, and pay for performance (P4P) were the main reimbursement methods for dialysis centers; and FFS, salary, and capitation were the main methods to reimburse the nephrologists. Countries have usually used a combination of methods depending on their situations; and their methods have been further developed over time specially from the retrospective payment systems (RPS) towards the prospective payment systems (PPS) and pay for performance methods. The main effects of the RPS were undertreatment of unpaid and inexpensive services, and over treatment of payable services. The main effects of the PPS were cost saving, shifting the service cost outside the bundle, change in quality of care, risk of provider, and modality choice. CONCLUSION This study provides useful insights about the current payment systems for dialysis and the effects of each payment system; that might be helpful for improving the quality and efficiency of healthcare.
Collapse
Affiliation(s)
- Zahra Emrani
- grid.411705.60000 0001 0166 0922Department of Health Policy, Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Amiresmaili
- grid.412105.30000 0001 2092 9755Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Rajabali Daroudi
- grid.411705.60000 0001 0166 0922Department of Health Policy, Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Najafi
- grid.411705.60000 0001 0166 0922Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran ,Center of Excellence in Nephrology, Tehran, Iran
| | - Ali Akbari Sari
- grid.411705.60000 0001 0166 0922Department of Health Policy, Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Verger C, Fabre E. Evolution de la dialyse péritonéale en France depuis 2018 et durant les « années COVID » Rapport RDPLF. BULLETIN DE LA DIALYSE À DOMICILE 2022. [DOI: 10.25796/bdd.v5i3.67903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
La quasi-totalité (99 %) des patients traités par dialyse péritonéale en France est enregistrée dans la base de données du RDPLF. En dehors de toute analyse statistique visant à interpréter les chiffres, ce travail est un rapport des données brutes observées dans la population d’insuffisants rénaux Stade V traités par dialyse péritonéale depuis le début de l’épidémie COVID-19 et dans les deux années qui ont précédé. Depuis le début de l’épidémie ces données semblent montrer une diminution de l’incidence des traitements par dialyse péritonéale et une augmentation des transferts en hémodialyse en centre. On observe par ailleurs une diminution des inscriptions sur liste d’attente de transplantation et une diminution du nombre de transplantations. Si la baisse temporaire de l’activité de transplantation peut s’expliquer par la désorganisation qu’a provoquée l’épidémie dans les hôpitaux, une baisse des indications de mise à domicile mérite probablement une réflexion plus approfondie sur ses causes, d’autant plus que ce résultat est en opposition avec les tendances d’autres pays. Ce rapport a pour but d’encourager des études plus précises sur l’intérêt de la dialyse à domicile en période épidémique.
Collapse
|
11
|
Rivara M. Assessment of Patient Experience of Care in Home Dialysis Around the World: Enhancing the Patient’s Voice in Home Dialysis Care and Research. BULLETIN DE LA DIALYSE À DOMICILE 2021. [DOI: 10.25796/bdd.v4i3.62803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
With the global growth in the use of home dialysis modalities, there is a need to better understand patients’ experiences with their home dialysis care. Patient-reported experience measures or PREMs, are standardized survey questionnaires that allow patients to provide input on processes and experiences of care in a confidential and validated manner. Until recently, no validated PREM has been available for assessment of patient-reported experience of care for home dialysis modalities, including peritoneal dialysis or home hemodialysis. The Home Dialysis Care Experience instrument (Home-DCE) is a newly developed and content-valid PREM for use among patients treated with home dialysis modalities. The survey instrument includes 26 core survey questions and 20 demographic questions, and is now available in English, Spanish, and French. Domains of care assessed in the Home-DCE include staff education and patient-centered communication, care coordination, patient safety, concern and helpfulness of the care team, and staff care proficiency. Worldwide use of the Home-DCE will allow incorporation of patients’ experiences and preferences in initiatives to enhance quality of care for home dialysis patients globally. Translation and deployment of a PREM in additional languages should be done using established cultural adaptation methods, the gold standard for which is termed linguistic validation. Translation and linguistic validation are hurdles to global use of the Home-DCE, but challenges that should be met to enhance home dialysis patients’ voice in clinical kidney care.
Collapse
|
12
|
Mendu ML, Divino-Filho JC, Vanholder R, Mitra S, Davies SJ, Jha V, Damron KC, Gallego D, Seger M. Expanding Utilization of Home Dialysis: An Action Agenda From the First International Home Dialysis Roundtable. Kidney Med 2021; 3:635-643. [PMID: 34401729 PMCID: PMC8350829 DOI: 10.1016/j.xkme.2021.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
In a groundbreaking meeting, leading global kidney disease organizations came together in the fall of 2020 as an International Home Dialysis Roundtable (IHDR) to address strategies to increase access to and uptake of home dialysis, both peritoneal dialysis and home hemodialysis. This challenge has become urgent in the wake of the coronavirus disease 2019 (COVID-19) pandemic, during which patients with advanced kidney disease, who are more susceptible to viral infections and severe complications, must be able to safely physically distance at home. To boost access to home dialysis on a global scale, IHDR members committed to collaborate, through the COVID-19 public health emergency and beyond, to promote uptake of home dialysis on a broad scale. Their commitments included increasing the reach and influence of key stakeholders with policy makers, building a cooperative of advocates and champions for home dialysis, working together to increase patient engagement and empowerment, and sharing intelligence about policy, education, and other programs so that such efforts can be operationalized globally. In the spirit of international cooperation, IHDR members agreed to document, amplify, and replicate established efforts shown to improve access to home dialysis and support new policies that facilitate access through procedures, innovation, and reimbursement.
Collapse
Affiliation(s)
- Mallika L. Mendu
- Division of Renal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of the Chief Medical Officer, Brigham and Women’s Hospital, Boston, MA
| | - José Carolino Divino-Filho
- Division of Renal Medicine, CLINTEC, Karolinska Institute, Campus Flemingsberg, Stockholm, Sweden
- Latin America Chapter (LAC-DD)-International Society for Peritoneal Dialysis
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent
- European Kidney Health Alliance (EKHA), Brussels, Belgium
| | - Sandip Mitra
- Department of Renal Medicine, Manchester University NHS Foundation Trust, Manchester
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester
- National Institute of Health Research MedTech and In-vitro Diagnostics Co-operative, Devices for Dignity, Sheffield
| | - Simon J. Davies
- Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, United Kingdom
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | | | | | | | - International Home Dialysis Roundtable Steering Committee
- Division of Renal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of the Chief Medical Officer, Brigham and Women’s Hospital, Boston, MA
- Division of Renal Medicine, CLINTEC, Karolinska Institute, Campus Flemingsberg, Stockholm, Sweden
- Latin America Chapter (LAC-DD)-International Society for Peritoneal Dialysis
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent
- European Kidney Health Alliance (EKHA), Brussels, Belgium
- Department of Renal Medicine, Manchester University NHS Foundation Trust, Manchester
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester
- National Institute of Health Research MedTech and In-vitro Diagnostics Co-operative, Devices for Dignity, Sheffield
- Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, United Kingdom
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- National Kidney Foundation, New York, NY
- European Kidney Patients Federation, Vienna, Austria
- Venn Strategies, Washington, DC
| |
Collapse
|
13
|
Shettigar R, Samaranayaka A, Schollum JBW, Wyeth EH, Derrett S, Walker RJ. Predictors of Health Deterioration Among Older New Zealanders Undergoing Dialysis: A Three-Year Accelerated Longitudinal Cohort Study. Can J Kidney Health Dis 2021; 8:20543581211022207. [PMID: 34178361 PMCID: PMC8207284 DOI: 10.1177/20543581211022207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Patient involvement in dialysis decision-making is crucial, yet little is known about patient-reported outcomes over time on dialysis. Objective: To examine health-related outcomes over 24 and 36 months in an older cohort of dialysis patients. Design: The “Dialysis outcomes in those aged ≥65 years study” is a prospective longitudinal cohort study of New Zealanders with kidney failure. Setting: Three New Zealand nephrology units. Patients: Kidney failure (dialysis and predialysis) patients aged 65 or above. We have previously described outcomes after 12 months of dialysis therapy relative to baseline. Measurements: Patient-reported social and health factors using the SF-36, EQ-5D, and Kidney Symptom Score questionnaires. Methods: This article describes and compares characteristics of 120 older kidney failure patients according to whether they report “Same/better” or “Worse” health 24 and 36 months later, and identifies predictors of “worse health.” Modified Poisson regression modeling estimated relative risks (RR) of worse health. Results: Of 120 patients at 12 months, 47.5% had worse health or had died by 24 months. Of those surviving at 24 months (n = 80), 40% had “Worse health” or had died at 36 months. Variables independently associated with reduced risk of “Worse health” (24 months) were as follows: Māori ethnicity (RR = 0.44; 95% CI = 0.26-0.75), Pacific ethnicity (RR = 0.39; 95% CI = 0.33-0.46); greater social satisfaction (RR = 0.57; 95% CI = 0.46-0.7). Variables associated with an increased risk of “Worse health” were as follows: problems with usual activities (RR = 1.32; 95% CI = 1.04-1.37); pain or discomfort (RR = 1.48; 95% CI = 1.34, 1.63). At 36 months, lack of sense of community (RR = 1.41; 95% CI = 1.18-1.69), 2 or more comorbidities (RR = 1.21; 95% CI = 1.13-1.29), and problems with poor health (RR = 1.47; 95% CI = 1.41-1.54) were associated with “Worse health.” Limitations: Participant numbers restricted the number of variables able to be included in the multivariable model, and hence there may have been insufficient power to detect certain associations. Conclusions: In this study, the majority of older dialyzing patients report “Same/better health” at 24 and 36 months. Māori and Pacific people report better outcomes on dialysis. Social and/or clinical interventions aimed at improving social satisfaction, sense of community, and help with usual activities may impact favorably on the experiences for older dialysis patients. Trial registration: Australian and New Zealand clinical trials registry: ACTRN12611000024943.
Collapse
Affiliation(s)
- Reshma Shettigar
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Ari Samaranayaka
- Biostatistics Centre, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - John B W Schollum
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Emma H Wyeth
- Department of Preventive and Social Medicine, Ngāi Tahu Māori Health Research Unit, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Department of Preventive Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Robert J Walker
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| |
Collapse
|
14
|
Shah S, Nicolau DP, McManus D, Topal JE. A Novel Dosing Strategy of Ceftolozane/Tazobactam in a Patient Receiving Intermittent Hemodialysis. Open Forum Infect Dis 2021; 8:ofab238. [PMID: 34141819 PMCID: PMC8204874 DOI: 10.1093/ofid/ofab238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
We describe the case of a 54-year-old male receiving intermittent hemodialysis (iHD) who was found to have Pseudomonas aeruginosa bacteremia secondary to osteomyelitis of the calcaneus bone. The patient was clinically cured without recurrence using a ceftolozane/tazobactam (CTZ) dosing strategy of 100/50 mg every 8 hours (standard dosing) and 1000/500 mg thrice weekly following iHD. Utilizing a susceptibility breakpoint of ≤4 µg/mL for P. aeruginosa, the T > MIC for standard dosing and the 1000/500-mg thrice-weekly following iHD regimen were calculated to be 92.7% and 94.1%, respectively. Ceftolozane total body clearance for the standard q 8 h dosing and the 1000/500-mg thrice-weekly following iHD regimen were calculated to be 0.196 L/h and 0.199 L/h, respectively. To our knowledge, this is the first report to illustrate the administration of CTZ at a dose of 1000/500 mg thrice weekly following iHD.
Collapse
Affiliation(s)
- Sunish Shah
- Department of Pharmacy Services, Yale New Haven Health System, New Haven, Connecticut, USA.,Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David P Nicolau
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut, USA
| | - Dayna McManus
- Department of Pharmacy Services, Yale New Haven Health System, New Haven, Connecticut, USA
| | - Jeffrey E Topal
- Department of Pharmacy Services, Yale New Haven Health System, New Haven, Connecticut, USA.,Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
15
|
Rivara MB, Edwards T, Patrick D, Anderson L, Himmelfarb J, Mehrotra R. Development and Content Validity of a Patient-Reported Experience Measure for Home Dialysis. Clin J Am Soc Nephrol 2021; 16:588-598. [PMID: 33785497 PMCID: PMC8092066 DOI: 10.2215/cjn.15570920] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/22/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The population of patients with kidney failure in the United States using home dialysis modalities is growing rapidly. Unlike for in-center hemodialysis, there is no patient-reported experience measure for assessment of patient experience of care for peritoneal dialysis or home hemodialysis. We sought to develop and establish content validity of a patient-reported experience measure for patients undergoing home dialysis using a mixed methods multiple stakeholder approach. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a structured literature review, followed by concept elicitation focus groups and interviews among 65 participants, including 21 patients on home dialysis, 33 home dialysis nurses, three patient care partners, and eight nephrologists. We generated a list of candidate items for possible measure inclusion and conducted a national prioritization exercise among 91 patients on home dialysis and 39 providers using a web-based platform. We drafted the Home Dialysis Care Experience instrument and conducted cognitive debriefing interviews to evaluate item interpretability, order, and structure. We iteratively refined the measure on the basis of interview findings. RESULTS The literature review and concept elicitation phases supported 15 domains of home dialysis care experience in six areas: communication and education of patients, concern and helpfulness of the care team, proficiency of the care team, patient-centered care, care coordination, and amenities and environment. Focus groups results showed that domains of highest importance for measure inclusion were patient education and communication, care coordination, and personalization of care. Prioritization exercise results confirmed focus group findings. Cognitive debriefing indicated that the final measure was easily understood and supported content validity. CONCLUSIONS The Home Dialysis Care Experience instrument is a 26-item patient-reported experience measure for use in peritoneal dialysis and home hemodialysis. The Home Dialysis Care Experience instrument represents the first rigorously developed and content-valid English-language instrument for assessment of patient-reported experience of care in home dialysis.
Collapse
Affiliation(s)
- Matthew B. Rivara
- Kidney Research Institute, University of Washington, Seattle, Washington,Division of Nephrology, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Todd Edwards
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Donald Patrick
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Lisa Anderson
- Kidney Research Institute, University of Washington, Seattle, Washington
| | - Jonathan Himmelfarb
- Kidney Research Institute, University of Washington, Seattle, Washington,Division of Nephrology, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Rajnish Mehrotra
- Kidney Research Institute, University of Washington, Seattle, Washington,Division of Nephrology, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington
| |
Collapse
|
16
|
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.
Collapse
|
17
|
Li L, Pei H, Liu Z, Zhang J. Analysis of risk factors and construction of prediction model of drop out from peritoneal dialysis. Medicine (Baltimore) 2021; 100:e24195. [PMID: 33546035 PMCID: PMC7837897 DOI: 10.1097/md.0000000000024195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 12/15/2020] [Indexed: 12/05/2022] Open
Abstract
This study is to investigate the risk factors for the drop out from peritoneal dialysis.We retrospectively analyzed patients who underwent catheterization between January 1, 2009 and September 30, 2019. The follow-up period ended on November 30, 2019. End point events were the cessation of peritoneal dialysis, including death, conversion to hemodialysis, and kidney transplantation. Kaplan-Meier method was used to analyze peritoneal dialysis curve. Significant factors were included in the multivariate Cox proportional hazards model. Calibration curve was plotted.A total of 377 patients were included in this study. The dropout rate of peritoneal dialysis was 41.38%. The main drop out reason was conversion to hemodialysis, accounting for 41.67% of the total number of drop out, followed by kidney transplantation (28.21%) and death (25%). According to multivariable Cox proportional hazards model analysis, the medium education level (hazard ratio (HR): 2.53, 95% confidence interval (CI): 1.08-5.91, P = .03), high education level (HR: 2.47, 95% CI: 1.03-5.93, P = .04), diabetes (HR: 1.87, 95% CI: 1.24-2.83, P < .03), hypertension (HR: 2.40, 95% CI: 1.64-3.51, P < .01), repeated peritonitis (HR: 5.18, 95% CI: 3.04-8.80, P < .01), and repeated chest complications (HR: 4.98, 95% CI: 2.79-8.89, P < .01) were independent risk factors for dropping out from peritoneal dialysis, while the number of hospitalizations after catheterization (HR: 0.94, 95% CI: 0.89-0.98, P = .01) was protective factor for maintenance of peritoneal dialysis. The C index of the prediction model was 0.74.Higher education level, diabetes, hypertension, repeated peritonitis, and repeated chest complications were the risk factors of dropping out from peritoneal dialysis, while higher number of hospitalizations after catheterization was a protective factor for the maintenance of peritoneal dialysis. The nomogram could predict the probability of dropping out from peritoneal dialysis.
Collapse
Affiliation(s)
- Li Li
- Department of Nephrology
- Department of Urological Surgery, First Affiliated Hospital of Xinjiang Medical University
| | - Hualian Pei
- RICU of First Affiliated Hospital of Xinjiang Medical University
| | - Zhenhui Liu
- Department of Microrepair and Reconstruction, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | | |
Collapse
|
18
|
Promoting Peritoneal Dialysis Retention in Underserved Communities. Am J Med Sci 2021; 361:1-2. [PMID: 33422190 DOI: 10.1016/j.amjms.2020.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/23/2020] [Indexed: 11/22/2022]
|
19
|
Prasad B, Jafari M, Shah S, McNaught C, Diebel L. Barriers to Peritoneal Dialysis in Saskatchewan Canada: Results From a Province-Wide Survey. Can J Kidney Health Dis 2020; 7:2054358120975545. [PMID: 33403116 PMCID: PMC7747106 DOI: 10.1177/2054358120975545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/29/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Peritoneal dialysis (PD) is an underutilized, therapeutic option to in-center hemodialysis (HD), given its similar survival and clinical efficacy but provides lifestyle benefits and cost savings. Despite these advantages, PD prevalence rates remains below 20% in many Canadian jurisdictions. Objectives: The primary objective of this study was to identify and assess patient-perceived barriers to PD implementation in Saskatchewan. The secondary objectives were to examine variations in patient-perceived barriers to PD by dialysis units (main dialysis units vs satellite dialysis units) and specific challenges faced by First Nation patients residing on reserves. Design: A cross-sectional observational survey study. Setting: Two major centers (Regina and Saskatoon) and 5 associated satellite units attached to each center across the province of Saskatchewan. Patients: We approached all prevalent in-center HD patients across Saskatchewan, 366 (49%) agreed to participate in the study. Measurements: Self-reported barriers to PD were assessed using a 26-question survey which was created after engagement of our multidisciplinary team. Methods: We conducted a cross-sectional survey of 740 prevalent in-center HD patients within the province of Saskatchewan, Canada, from June 2018 to January 2019. Around 366 (49%) patients agreed to participate in the study. The questionnaire was designed to capture patients’ perceived barriers to PD. Descriptive statistics were used to present the data. Chi-square and Mann-Whitney U-test were used to compare the patients’ responses (main dialysis units vs satellite dialysis units, and First Nation reserves vs nonreserves). Results: Of the 366 patients who completed the survey, 284 met the eligibility criteria and were included in the analysis. Patient-reported satisfaction with current in-center HD care was the most common barrier to PD uptake (92%), followed by proximity to their HD unit (61%). A lack of understanding of the benefits/risks of PD, fear of family burden (54% each), and unwillingness to dialyze daily and to learn a new technique (51% each) were additional factors. Patients residing on reserves compared to nonreserve residents felt PD had a higher risk of infection compared to HD (54% vs 34%, P = .005), and felt PD led to suboptimal care (47% vs 31%, P = .021). Limitations: We used a nonstandardized locally derived questionnaire to quantify barriers, and this prevents inclusion of additional barriers than individual patients may consider important. Cross-sectional data can only be used as a snapshot. Only 366 patients agreed to participate, and the results cannot be generalized to 740 prevalent HD patients. We did not capture data on demographics (age, income, and literacy level), comorbidities, and dialysis vintage, which would have been helpful in interpretation of the results. We did not involve patients, carers, or patients of First Nations heritage, in the design of the survey and the study. Conclusions: The results of our survey indicate that the major patient-reported barrier to PD uptake in our province is clinical inertia in patients defaulted to in-center HD at the onset of dialysis. Lack of patient awareness and knowledge of PD as a viable treatment modality also figured prominently, as did fears/concerns surrounding the safety, efficacy, and perceived family burden with PD compared with in-center HD. Trial Registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.
Collapse
Affiliation(s)
- Bhanu Prasad
- Section of Nephrology, Department of Medicine, Regina General Hospital, Saskatchewan Health Authority, Regina, Canada
| | - Maryam Jafari
- Dr. T. Bhanu Prasad Medical Prof Corp, Regina, SK, Canada
| | - Sachin Shah
- Section of Nephrology, Department of Medicine, St. Paul's Hospital, Saskatoon, SK, Canada
| | - Connie McNaught
- Hemodialysis, Regina General Hospital, Saskatchewan Health Authority, Regina, Canada
| | - Lucas Diebel
- College of Medicine, University of Saskatchewan, Regina, Canada
| |
Collapse
|
20
|
Rastogi A, Bhatt N, Rossetti S, Beto J. Management of Hyperphosphatemia in End-Stage Renal Disease: A New Paradigm. J Ren Nutr 2020; 31:21-34. [PMID: 32386937 DOI: 10.1053/j.jrn.2020.02.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/27/2020] [Accepted: 02/08/2020] [Indexed: 12/12/2022] Open
Abstract
Bone and mineral metabolism becomes dysregulated with progression of chronic kidney disease (CKD), and increasing levels of parathyroid hormone serve as an adaptive response to maintain normal phosphorus and calcium levels. In end-stage renal disease, this response becomes maladaptive and high levels of phosphorus may occur. We summarize strategies to control hyperphosphatemia based on a systematic literature review of clinical trial and real-world observational data on phosphorus control in hemodialysis patients with CKD-mineral bone disorder (CKD-MBD). These studies suggest that current management options (diet and lifestyle changes; regular dialysis treatment; and use of phosphate binders, vitamin D, calcimimetics) have their own benefits and limitations with variable clinical outcomes. A more integrated approach to phosphorus control in dialysis patients may be necessary, incorporating measurement of multiple biomarkers of CKD-MBD pathophysiology (calcium, phosphorus, and parathyroid hormone) and correlation between diet adjustments and CKD-MBD drugs, which may facilitate improved patient management.
Collapse
Affiliation(s)
- Anjay Rastogi
- David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Nisha Bhatt
- Division of Nephrology, Department of Medical Affairs, Amgen Inc., Thousand Oaks, California
| | - Sandro Rossetti
- Division of Nephrology, Department of Medical Affairs, Amgen Inc., Thousand Oaks, California
| | - Judith Beto
- Division of Nephrology and Hypertension, Loyola University Chicago, Maywood, Illinois
| |
Collapse
|
21
|
Cartwright EJ, Zs Goh Z, Foo M, Chan CM, Htay H, Griva K. eHealth interventions to support patients in delivering and managing peritoneal dialysis at home: A systematic review. Perit Dial Int 2020; 41:32-41. [PMID: 32301380 DOI: 10.1177/0896860820918135] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Peritoneal dialysis (PD) requires patients to develop a variety of self-management skills in order to effectively deliver and manage their dialysis at home. eHealth interventions may provide patients with accessible information to develop the skills and knowledge they require to manage their treatment. This review aims to identify and evaluate 'active' eHealth interventions in supporting patients on PD. Six databases were included within the review using the terms Peritoneal Dialysis, eHealth, telemedicine and remote consultation. Studies which explored patients who were delivering PD, an intervention where the main component involved a digital device and required active engagement from patients were included. The primary outcomes examined were identified using the core outcomes recommended by the Standardised Outcomes in Nephrology in Peritoneal Dialysis initiative (PD infection, cardiovascular disease, mortality, PD failure and life participation). Hospitalisation rates were also considered as a primary outcome. Secondary outcomes included quality of life, patient skills, patient knowledge and satisfaction. Using the inclusion criteria, 15 studies (1334 participants) were included in the study. The effectiveness of eHealth interventions was mixed. Due to high heterogeneity, a meta-analysis was not possible, and quality of evidence was low. Risk of bias across the randomised studies was unclear but bias across non-randomised studies was identified as critical. There were no reported adverse effects of eHealth interventions within the included studies. Despite the high interest of eHealth interventions in PD, good quality evidence is needed to explore their effectiveness before a wider application of eHealth interventions.
Collapse
Affiliation(s)
- Emma J Cartwright
- Lee Kong Chian School of Medicine, 54761Nanyang Technological University, Singapore
| | - Zack Zs Goh
- Lee Kong Chian School of Medicine, 54761Nanyang Technological University, Singapore
| | | | | | - Htay Htay
- 37581Singapore General Hospital, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, 54761Nanyang Technological University, Singapore
| |
Collapse
|
22
|
Kaiser P, Pipitone O, Franklin A, Jackson DR, Moore EA, Dubuque CR, Peralta CA, De Mory AC. A Virtual Multidisciplinary Care Program for Management of Advanced Chronic Kidney Disease: Matched Cohort Study. J Med Internet Res 2020; 22:e17194. [PMID: 32049061 PMCID: PMC7055849 DOI: 10.2196/17194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 02/06/2023] Open
Abstract
Background It is not well established whether a virtual multidisciplinary care program for persons with advanced chronic kidney disease (CKD) can improve their knowledge about their disease, increase their interest in home dialysis therapies, and result in more planned outpatient (versus inpatient) dialysis starts. Objective We aimed to evaluate the feasibility and preliminary associations of program participation with disease knowledge, home dialysis modality preference, and outpatient dialysis initiation among persons with advanced CKD in a community-based nephrology practice. Methods In a matched prospective cohort, we enrolled adults aged 18 to 85 years with at least two estimated glomerular filtration rates (eGFRs) of less than 30 mL/min/1.73 m2 into the Cricket Health program and compared them with controls receiving care at the same clinic, matched on age, gender, eGFR, and presence of heart failure and diabetes. The intervention included online education materials, a virtual multidisciplinary team (nurse, pharmacist, social worker, dietician), and patient mentors. Prespecified follow-up time was nine months with extended follow-up to allow adequate time to determine the dialysis start setting. CKD knowledge and dialysis modality choice were evaluated in a pre-post survey among intervention participants. Results Thirty-seven participants were matched to 61 controls by age (mean 67.2, SD 10.4 versus mean 68.8, SD 9.5), prevalence of diabetes (54%, 20/37 versus 57%, 35/61), congestive heart failure (22%, 8/37 versus 25%, 15/61), and baseline eGFR (mean 19, SD 6 versus mean 21, SD 5 mL/min/1.73 m2), respectively. At nine-month follow-up, five patients in each group started dialysis (P=.62). Among program participants, 80% (4/5) started dialysis as an outpatient compared with 20% (1/5) of controls (OR 6.28, 95% CI 0.69-57.22). In extended follow-up (median 15.7, range 11.7 to 18.1 months), 19 of 98 patients started dialysis; 80% (8/10) of the intervention group patients started dialysis in the outpatient setting versus 22% (2/9) of control patients (hazard ratio 6.89, 95% CI 1.46-32.66). Compared to before participation, patients who completed the program had higher disease knowledge levels (mean 52%, SD 29% versus mean 94%, SD 14% of questions correct on knowledge-based survey, P<.001) and were more likely to choose a home modality as their first dialysis choice (36%, 7/22 versus 68%, 15/22, P=.047) after program completion. Conclusions The Cricket Health program can improve patient knowledge about CKD and increase interest in home dialysis modalities, and may increase the proportion of dialysis starts in the outpatient setting.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Carmen A Peralta
- Cricket Health, San Francisco, CA, United States.,Kidney Health Research Collaborative at the University of California San Francisco, San Francisco, CA, United States
| | | |
Collapse
|
23
|
Greenberg KI, Jaar BG. Urgent start peritoneal dialysis: are we there yet? BMC Nephrol 2020; 21:39. [PMID: 32005195 PMCID: PMC6995122 DOI: 10.1186/s12882-020-1706-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/28/2020] [Indexed: 11/10/2022] Open
Abstract
The use of peritoneal dialysis (PD) has increased substantially in the United States (US) in the past decade. This was likely spurred in large part by the implementation of the expanded prospective payment system for the Medicare End Stage Renal Disease (ESRD) program in 2011. Over the same period, there has also been growing interest in urgent start PD, which is commonly defined as initiation of PD within 14 days of catheter insertion. Ye and colleagues recently reported their experience with urgent start PD in 2059 Chinese ESRD patients over a 9-year period. Rates of complications, including peri-catheter leaks and peritonitis, were very low despite initiation of PD immediately after open catheter placement via open laparotomy in nearly all patients. Long term technique survival was good, with only 75 patients developing catheter failure. This study provides further evidence to suggest that urgent start PD is feasible and effective, although the generalizability of these results to Western populations is unclear. Recent proposed changes to the payment models in the Medicare ESRD program, designed to incentivize use of kidney transplantation and home dialysis, are likely to further propel growth of PD and urgent start PD in the US. Further studies are needed to optimize use of urgent PD and patient outcomes.
Collapse
Affiliation(s)
- Keiko I Greenberg
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bernard G Jaar
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA. .,Nephrology Center of Maryland, 5601 Loch Raven Boulevard, Suite 3 North, Baltimore, MD, 21239, USA.
| |
Collapse
|
24
|
Auguste BL, Girsberger M, Kennedy C, Srithongkul T, McGrath-Chong M, Bargman J, Chan CT. Are adverse events in newly trained home dialysis patients related to learning styles? A single-centre retrospective study from Toronto, Canada. BMJ Open 2020; 10:e033315. [PMID: 31964671 PMCID: PMC7045245 DOI: 10.1136/bmjopen-2019-033315] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Home haemodialysis (HD) and peritoneal dialysis (PD) have seen growth in utilisation around the globe over the last few years. However, home dialysis, with its attendant technical complexity and risk of adverse events continues to pose challenges for wider adoption. We examined whether differences in patients' learning styles are associated with differing risk of adverse events in both home HD and PD patients. DESIGN Retrospective cohort study. SETTING Tertiary care hospital in Toronto, Ontario, Canada. PARTICIPANTS One hundred and eighteen prevalent adult (≥18 years) home dialysis patients (40 PD and 78 home HD) were enrolled. Patients on home dialysis for less than 6 months or receiving home nursing assistance for dialysis were excluded from the study. INTERVENTIONS Enrolled patients completed (VARK) Visual, Aural, Reading-writing and Kinesthetic questionnaires to determine learning styles. PRIMARY AND SECONDARY OUTCOME MEASURES Home HD and PD adverse events were identified within 6 months of completing home dialysis training. Event rates were then stratified and compared according to learning styles. RESULTS Thirty patients had a total of 53 adverse events. We used logistic regression analysis to determine unadjusted and adjusted ORs for a single adverse event. Non-visual learners were 4.35 times more likely to have an adverse event (p=0.001). After adjusting for age, gender, dialysis modality, training duration, dialysis vintage, prior renal replacement therapy, visual impairment, education and literacy, an adverse event was still four times more likely among non-visual learners compared to visual learners (p=0.008). A subgroup analysis of home HD patients showed adverse events were more likely among non-visual learners (OR 11.1; p=0.003), whereas PD patients showed a trend for more adverse events in non-visual learners (OR: 1.60; p=0.694). CONCLUSIONS Different learning styles in home dialysis patients exist. Visual learning styles are associated with fewer adverse events in home dialysis patients within the first 6 months of completing training. Individualisation of home dialysis training by learning style is warranted.
Collapse
Affiliation(s)
- Bourne Lewis Auguste
- Medicine; Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Medicine; Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Michael Girsberger
- Medicine; Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Claire Kennedy
- Medicine; Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | | | | | - Joanne Bargman
- Medicine; Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
- Medicine; Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Christopher T Chan
- Medicine; Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Wu J, Huang Q, Li P, Wang Y, Zheng C, Lei X, Li S, Gong W, Yin B, Luo C, Xiao J, Zhou W, Xu Z, Chen Y, Peng F, Long H. MicroRNA-145 promotes the epithelial-mesenchymal transition in peritoneal dialysis-associated fibrosis by suppressing fibroblast growth factor 10. J Biol Chem 2019; 294:15052-15067. [PMID: 31431501 PMCID: PMC6791318 DOI: 10.1074/jbc.ra119.007404] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 08/14/2019] [Indexed: 12/11/2022] Open
Abstract
Peritoneal fibrosis is a common complication of long-term peritoneal dialysis (PD) and the principal cause of ultrafiltration failure during PD. The initial and reversible step in PD-associated peritoneal fibrosis is the epithelial-mesenchymal transition (EMT). Although the mechanisms in the EMT have been the focus of many studies, only limited information is currently available concerning microRNA (miRNA) regulation in peritoneal fibrosis. In this study, we aimed to characterize the roles of microRNA-145 (miR-145) and fibroblast growth factor 10 (FGF10) in peritoneal fibrosis. After inducing EMT with transforming growth factor-β1 (TGF-β1) in vitro, we found that miR-145 is significantly up-regulated, whereas FGF10 is markedly down-regulated, suggesting a close link between miR-145 and FGF10 in peritoneal fibrosis, further confirmed in luciferase reporter experiments. Furthermore, in human peritoneal mesothelial cells (i.e. HMrSV5 cells), miR-145 mimics induced EMT, whereas miR-145 inhibition suppressed EMT, and we also observed that miR-145 suppressed FGF10 expression. In vivo, we found that the exogenous delivery of an miR-145 expression plasmid both blocked FGF10 and intensified the EMT, whereas miR-145 inhibition promoted the expression of FGF10 and reversed the EMT. In conclusion, miR-145 promotes the EMT during the development of peritoneal fibrosis by suppressing FGF10 activity, suggesting that miR-145 represents a potential therapeutic target for managing peritoneal fibrosis.
Collapse
Affiliation(s)
- Jiayu Wu
- Department of Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Qianyin Huang
- Department of Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Peilin Li
- Department of Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Yuxian Wang
- Department of Gerontology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Chenghao Zheng
- Second Clinical Medical School, Southern Medical University, Guangzhou 510280, China
| | - Xianghong Lei
- Department of Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Shuting Li
- Department of Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Wangqiu Gong
- Department of Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Bohui Yin
- Department of Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Congwei Luo
- Department of Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Jing Xiao
- Department of Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Weidong Zhou
- Department of Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Zhaozhong Xu
- Department of Emergency, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Yihua Chen
- Department of Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Fenfen Peng
- Department of Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Haibo Long
- Department of Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| |
Collapse
|
26
|
Rivara MB, Ravel V, Streja E, Obi Y, Soohoo M, Cheung AK, Himmelfarb J, Kalantar-Zadeh K, Mehrotra R. Weekly Standard Kt/V urea and Clinical Outcomes in Home and In-Center Hemodialysis. Clin J Am Soc Nephrol 2018; 13:445-455. [PMID: 29326306 PMCID: PMC5967669 DOI: 10.2215/cjn.05680517] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 11/30/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients undergoing hemodialysis with a frequency other than thrice weekly are not included in current clinical performance metrics for dialysis adequacy. The weekly standard Kt/Vurea incorporates treatment frequency, but there are limited data on its association with clinical outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We used multivariable regression to examine the association of dialysis standard Kt/Vurea with BP and metabolic control (serum potassium, calcium, bicarbonate, and phosphorus) in patients incidental to dialysis treated with home (n=2373) or in-center hemodialysis (n=109,273). We further used Cox survival models to examine the association of dialysis standard Kt/Vurea with mortality, hospitalization, and among patients on home hemodialysis, transfer to in-center hemodialysis. RESULTS After adjustment for potential confounders, patients with dialysis standard Kt/Vurea <2.1 had higher BPs compared with patients with standard Kt/Vurea 2.1 to <2.3 (3.4 mm Hg higher [P<0.001] for home hemodialysis and 0.9 mm Hg higher [P<0.001] for in-center hemodialysis). There were no clinically meaningful associations between dialysis standard Kt/Vurea and markers of metabolic control, irrespective of dialysis modality. There was no association between dialysis standard Kt/Vurea and risk for mortality, hospitalization, or transfer to in-center hemodialysis among patients undergoing home hemodialysis. Among patients on in-center hemodialysis, dialysis standard Kt/Vurea <2.1 was associated with higher risk (adjusted hazard ratio, 1.11; 95% confidence interval, 1.07 to 1.14) and standard Kt/Vurea ≥2.3 was associated with lower risk (adjusted hazard ratio, 0.97; 95% confidence interval, 0.94 to 0.99) for death compared with standard Kt/Vurea 2.1 to <2.3. Additional analyses limited to patients with available data on residual kidney function showed similar relationships of dialysis and total (dialysis plus kidney) standard Kt/Vurea with outcomes. CONCLUSIONS Current targets for standard Kt/Vurea have limited utility in identifying individuals at increased risk for adverse clinical outcomes for those undergoing home hemodialysis but may enhance risk stratification for in-center hemodialysis.
Collapse
Affiliation(s)
- Matthew B. Rivara
- Kidney Research Institute, Harborview Medical Center, Division of Nephrology, University of Washington, Seattle, Washington
| | - Vanessa Ravel
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Irvine, California; and
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Irvine, California; and
| | - Yoshitsugu Obi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Irvine, California; and
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Irvine, California; and
| | - Alfred K. Cheung
- Division of Nephrology & Hypertension, University of Utah, Salt Lake City, Utah
| | - Jonathan Himmelfarb
- Kidney Research Institute, Harborview Medical Center, Division of Nephrology, 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; and
| | - Rajnish Mehrotra
- Kidney Research Institute, Harborview Medical Center, Division of Nephrology, University of Washington, Seattle, Washington
| |
Collapse
|
27
|
Abstract
Although varying widely among different countries and geographic regions, the development of peritoneal dialysis invariably requires a well-established program. Key ingredients for the successful delivery of this therapy include adequate chronic kidney disease education, governmental or nongovernmental reimbursement, qualified physicians and nurses trained in the principles and practice of peritoneal dialysis, clinical management that incorporates an excellent and well-trained peritoneal dialysis team, a feasible and well-designed program for catheter insertion, a sound patient training and follow-up scheme, and continuous quality improvement. Some programs are enhanced by an active clinical research portfolio and other appropriate supportive systems. All of these factors are interlinked and inseparable from one another in ensuring a high-quality peritoneal dialysis program.
Collapse
|
28
|
Abstract
Peritoneal dialysis is the most common modality for home dialysis and to ensure patients have access to dialysis at home, training programs have to ensure that the fellows attain clinical competency in the care of such patients. The limited data available however are sobering; about 10 years ago, 44% of nephrologists reported that they did not feel competent in the care of patients undergoing peritoneal dialysis. There are recognizable challenges in ensuring clinical competency of trainees that may need creative solutions. It is important for training program directors to evaluate the state of training at their institution, identify their unique barriers, and work to overcome them in the interest of ensuring that fellows are trained in all aspects of nephrology.
Collapse
Affiliation(s)
- Rajnish Mehrotra
- Harborview Medical Center and Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
29
|
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.
Collapse
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
| | | | | |
Collapse
|
30
|
Race but not Hepatitis C co-infection affects survival of HIV + individuals on dialysis in contemporary practice. Kidney Int 2017; 93:706-715. [PMID: 29107361 DOI: 10.1016/j.kint.2017.08.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/08/2017] [Accepted: 08/17/2017] [Indexed: 12/29/2022]
Abstract
Individuals with HIV infection are at elevated risk of developing end-stage renal disease. However, their outcomes after starting chronic dialysis in the contemporary era of widespread antiretroviral therapy are not well described. Using detailed data from a national dialysis provider, we determined HIV status by administrative codes and antiretroviral medication prescriptions, with hepatitis C virus (HCV) co-infection status provided by routinely measured serology. The survival on dialysis among 5348 individuals in the HIV+ group and 1863 HIV+/HCV+ individuals to a HIV-/HCV- reference cohort was compared. Race significantly modified the effect of HIV and HIV/HCV infection on mortality. In a multivariable model, HIV infection was not associated with an increased risk of death among Caucasians (hazard ratio 1.03, 95% confidence interval 0.91-1.16) but HIV/HCV co-infection (1.48, 1.18-1.87) was. In the same model for non-Caucasians, both HIV infection (1.44, 1.37-1.52) and HIV/HCV co-infection (1.71, 1.60-1.84) were significantly associated with higher mortality. A secondary analysis using propensity scores yielded similar results. Median follow-up for the reference group was 645 days (interquartile range 230-1323), 772 days (276-1623) for the HIV+ group and 777 days (334-1665) for the co-infected group. Thus, in the contemporary era of widespread antiretroviral use, HIV infection remains associated with a significant reduction in dialysis survival for non-Caucasians while HIV/HCV co-infection is associated with impaired survival regardless of race or ethnicity. Hence, interventions to improve the care for these vulnerable populations are needed.
Collapse
|
31
|
Lin E, Cheng XS, Chin KK, Zubair T, Chertow GM, Bendavid E, Bhattacharya J. Home Dialysis in the Prospective Payment System Era. J Am Soc Nephrol 2017; 28:2993-3004. [PMID: 28490435 DOI: 10.1681/asn.2017010041] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/05/2017] [Indexed: 01/23/2023] Open
Abstract
The ESRD Prospective Payment System introduced two incentives to increase home dialysis use: bundling injectable medications into a single payment for treatment and paying for home dialysis training. We evaluated the effects of the ESRD Prospective Payment System on home dialysis use by patients starting dialysis in the United States from January 1, 2006 to August 31, 2013. We analyzed data on dialysis modality, insurance type, and comorbidities from the United States Renal Data System. We estimated the effect of the policy on home dialysis use with multivariable logistic regression and compared the effect on Medicare Parts A/B beneficiaries with the effect on patients with other types of insurance. The ESRD Prospective Payment System associated with a 5.0% (95% confidence interval [95% CI], 4.0% to 6.0%) increase in home dialysis use by the end of the study period. Home dialysis use increased by 5.8% (95% CI, 4.3% to 6.9%) among Medicare beneficiaries and 4.1% (95% CI, 2.3% to 5.4%) among patients covered by other forms of health insurance. The difference between these groups was not statistically significant (1.8%; 95% CI, -0.2% to 3.8%). Conversely, in both populations, the training add-on did not associate with increases in home dialysis use beyond the effect of the policy. The ESRD Prospective Payment System bundling, but not the training add-on, associated with substantial increases in home dialysis, which were identical for both Medicare and non-Medicare patients. These spill-over effects suggest that major payment changes in Medicare can affect all patients with ESRD.
Collapse
Affiliation(s)
- Eugene Lin
- Department of Medicine, Division of Nephrology, and .,Center for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California
| | | | - Kuo-Kai Chin
- Stanford University School of Medicine, Stanford, California; and
| | - Talhah Zubair
- Stanford University School of Medicine, Stanford, California; and
| | | | - Eran Bendavid
- Center for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California
| | - Jayanta Bhattacharya
- Center for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
32
|
Agrawal V, Jhaveri KD, Shah HH. Enhancing outpatient nephrology experience for internal medicine residents. Clin Kidney J 2017; 10:429-436. [PMID: 29479427 PMCID: PMC5815570 DOI: 10.1093/ckj/sfx019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/24/2017] [Indexed: 11/12/2022] Open
Abstract
Interest in nephrology careers continues to remain low in the USA. Educational innovations that enhance interest in nephrology among medical trainees are being actively studied. While internal medicine (IM) residency programs commonly offer the inpatient nephrology elective to the resident, outpatient nephrology experience is lacking. Understanding the provision of care in outpatient and home dialysis and management of patients with glomerular diseases, chronic kidney disease and kidney transplantation are vital components of an outpatient nephrology rotation. In this review article, we share our experiences in incorporating outpatient nephrology to the IM resident's elective time. We also present the structure of the nephrology rotations at our programs and suggest several learning opportunities in outpatient nephrology that the training community can provide to medical residents. Strategies to effectively set up an outpatient nephrology rotation are also described. While more educational research on the impact of outpatient nephrology on resident learning and career choices are needed, we encourage a collaborative effort between faculty members in nephrology and the medicine residency programs to provide this unique learning opportunity to IM residents.
Collapse
Affiliation(s)
- Varun Agrawal
- Division of Nephrology and Hypertension, University of Vermont, Burlington, VT, USA
| | - Kenar D Jhaveri
- Division of Kidney Diseases and Hypertension, North Shore University Hospital and Long Island Jewish Medical Center, Hofstra Northwell School of Medicine, Great Neck, NY, USA
| | - Hitesh H Shah
- Division of Kidney Diseases and Hypertension, North Shore University Hospital and Long Island Jewish Medical Center, Hofstra Northwell School of Medicine, Great Neck, NY, USA
| |
Collapse
|
33
|
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: 55] [Impact Index Per Article: 7.9] [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.
Collapse
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
| |
Collapse
|
34
|
Schreiber MJ. Changing Landscape for Peritoneal Dialysis: Optimizing Utilization. Semin Dial 2017; 30:149-157. [PMID: 28144977 DOI: 10.1111/sdi.12576] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The future growth of peritoneal dialysis (PD) will be directly linked to the shift in US healthcare to a value-based payment model due to PD's lower yearly cost, early survival advantage over in-center hemodialysis, and improved quality of life for patients treating their kidney disease in the home. Under this model, nephrology practices will need an increased focus on managing the transition from chronic kidney disease to end-stage renal disease (ESRD), providing patient education with the aim of accomplishing modality selection and access placement ahead of dialysis initiation. Physicians must expand their knowledge base in home therapies and work toward increased technique survival through implementation of specific practice initiatives that highlight PD catheter placement success, preservation of residual renal function, consideration of incremental PD, and competence in urgent start PD. Avoidance of both early and late PD technique failures is also critical to PD program growth. Large dialysis organizations must continue to measure and improve quality metrics for PD, expand their focus beyond the sole provision of PD to holistic patient care, and initiate programs to reduce PD hospitalization rates and encourage physicians to consider the benefits of PD as an initial modality for appropriate patients. New and innovative strategies are needed to address the main reasons for PD technique failure, improve the connectivity of the patient in the home, leverage home biometric data to improve overall outcomes, and develop PD cycler devices that lower patient treatment burden and reduce both treatment fatigue and treatment-dependent complications.
Collapse
Affiliation(s)
- Martin J Schreiber
- Clinical Affairs, Home Modalities, DaVita Kidney Care, DaVita Inc, Denver, Colorado
| |
Collapse
|
35
|
Perl J, McArthur E, Bell C, Garg AX, Bargman JM, Chan CT, Harel S, Li L, Jain AK, Nash DM, Harel Z. Dialysis Modality and Readmission Following Hospital Discharge: A Population-Based Cohort Study. Am J Kidney Dis 2017; 70:11-20. [PMID: 28069285 DOI: 10.1053/j.ajkd.2016.10.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/08/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Readmissions following hospital discharge among maintenance dialysis patients are common, potentially modifiable, and costly. Compared with patients receiving in-center hemodialysis (HD), patients receiving peritoneal dialysis (PD) have fewer routine dialysis clinic encounters and as a result may be more susceptible to a hospital readmission following discharge. STUDY DESIGN Population-based retrospective-cohort observational study. SETTINGS & PARTICIPANTS Patients treated with maintenance dialysis who were discharged following an acute-care hospitalization during January 1, 2003, to December 31, 2013, across 164 acute-care hospitals in Ontario, Canada. For those with multiple hospitalizations, we randomly selected a single hospitalization as the index hospitalization. PREDICTOR Dialysis modality PD or in-center HD. Propensity scores were used to match each patient on PD therapy to 2 patients on in-center HD therapy to ensure that baseline indicators of health were similar between the 2 groups. OUTCOME All-cause 30-day readmission following the index hospital discharge. RESULTS 28,026 dialysis patients were included in the study. 4,013 PD patients were matched to 8,026 in-center HD patients. Among the matched cohort, 30-day readmission rates were 7.1 (95% CI, 6.6-7.6) per 1,000 person-days for patients on PD therapy and 6.0 (95% CI, 5.7-6.3) per 1,000 person-days for patients on in-center HD therapy. The risk for a 30-day readmission among patients on PD therapy was higher compared with those on in-center HD therapy (adjusted HR, 1.19; 95% CI, 1.08-1.31). The primary results were consistent across several key prespecified subgroups. LIMITATIONS Lack of information for the frequency of nephrology physician encounters following discharge from the hospital in both the PD and in-center HD cohorts. Limited validation of International Classification of Diseases, Tenth Revision codes. CONCLUSIONS The risk for 30-day readmission is higher for patients on home-based PD compared to in-center HD therapy. Interventions to improve transitions in care between the inpatient and outpatient settings are needed, particularly for patients on PD therapy.
Collapse
Affiliation(s)
- Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Chaim Bell
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Amit X Garg
- Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Joanne M Bargman
- Division of Nephrology, University Health Network, University of Toronto, Ontario, Canada
| | - Christopher T Chan
- Division of Nephrology, University Health Network, University of Toronto, Ontario, Canada
| | - Shai Harel
- Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Lihua Li
- Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Arsh K Jain
- Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Danielle M Nash
- Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Ziv Harel
- Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
36
|
Castledine C. Racial Disparity in Access to Home Therapies—We Have the Power to Change. Perit Dial Int 2017; 37:4-5. [DOI: 10.3747/pdi.2016.00182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
37
|
Li PKT, Chow KM, Van de Luijtgaarden MWM, Johnson DW, Jager KJ, Mehrotra R, Naicker S, Pecoits-Filho R, Yu XQ, Lameire N. Changes in the worldwide epidemiology of peritoneal dialysis. Nat Rev Nephrol 2016; 13:90-103. [PMID: 28029154 DOI: 10.1038/nrneph.2016.181] [Citation(s) in RCA: 334] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
As the global burden of chronic kidney disease continues to increase, so does the need for a cost-effective renal replacement therapy. In many countries, patient outcomes with peritoneal dialysis are comparable to or better than those with haemodialysis, and peritoneal dialysis is also more cost-effective. These benefits have not, however, always led to increased utilization of peritoneal dialysis. Use of this therapy is increasing in some countries, including China, the USA and Thailand, but has proportionally decreased in parts of Europe and in Japan. The variable trends in peritoneal dialysis use reflect the multiple challenges in prescribing this therapy to patients. Key strategies for facilitating peritoneal dialysis utilization include implementation of policies and incentives that favour this modality, enabling the appropriate production and supply of peritoneal dialysis fluid at a low cost, and appropriate training for nephrologists to enable increased utilization of the therapy and to ensure that rates of technique failure continue to decline. Further growth in peritoneal dialysis use is required to enable this modality to become an integral part of renal replacement therapy programmes worldwide.
Collapse
Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol &Richard Yu PD Research Centre, Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
| | - Kai Ming Chow
- Department of Medicine and Therapeutics, Carol &Richard Yu PD Research Centre, Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
| | - Moniek W M Van de Luijtgaarden
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, PO Box 22700, Amsterdam 1100 DE, Netherlands
| | - David W Johnson
- Department of Nephrology, Division of Medicine, ARTS Building, University of Queensland at Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, PO Box 22700, Amsterdam 1100 DE, Netherlands
| | - Rajnish Mehrotra
- Kidney Research Institute and Harborview Medical Center, Division of Nephrology, University of Washington, 325 9th Avenue, BOX 359606, Seattle, Washington 98104, USA
| | - Sarala Naicker
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | | | - Xue Qing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Norbert Lameire
- University Hospital Gent, 185, De Pintelaan, BE-9000 Gent, Belgium
| |
Collapse
|
38
|
Erickson KF, Winkelmayer WC, Chertow GM, Bhattacharya J. Effects of physician payment reform on provision of home dialysis. THE AMERICAN JOURNAL OF MANAGED CARE 2016; 22:e215-23. [PMID: 27355909 PMCID: PMC5055389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Patients with end-stage renal disease can receive dialysis at home or in-center. In 2004, CMS reformed physician payment for in-center hemodialysis care from a capitated to a tiered fee-for-service model, augmenting physician payment for frequent in-center visits. We evaluated whether payment reform influenced dialysis modality assignment. STUDY DESIGN Cohort study of patients starting dialysis in the United States in the 3 years before and the 3 years after payment reform. METHODS We conducted difference-in-difference analyses comparing patients with traditional Medicare coverage (who were affected by the policy) to others with Medicare Advantage (who were unaffected by the policy). We also examined whether the policy had a more pronounced influence on dialysis modality assignment in areas with lower costs of traveling to dialysis facilities. RESULTS Patients with traditional Medicare coverage experienced a 0.7% (95% CI, 0.2%-1.1%; P = .003) reduction in the absolute probability of home dialysis use following payment reform compared with patients with Medicare Advantage. Patients living in areas with larger dialysis facilities (where payment reform made in-center hemodialysis comparatively more lucrative for physicians) experienced a 0.9% (95% CI, 0.5%-1.4%; P < .001) reduction in home dialysis use following payment reform compared with patients living in areas with smaller facilities (where payment reform made in-center hemodialysis comparatively less lucrative for physicians). CONCLUSIONS The transition from a capitated to a tiered fee-for-service payment model for in-center hemodialysis care resulted in fewer patients receiving home dialysis. This area of policy failure highlights the importance of considering unintended consequences of future physician payment reform efforts.
Collapse
Affiliation(s)
- Kevin F Erickson
- Center for Innovations in Quality, Effectiveness, and Safety, Baylor College of Medicine, 2002 Holcombe Blvd, Mail Code 152, Houston, TX 77030. E-mail:
| | | | | | | |
Collapse
|
39
|
Rivara MB, Mehrotra R. New-Onset Diabetes in Peritoneal Dialysis Patients - Which Predictors Really Matter? Perit Dial Int 2016; 36:243-6. [PMID: 27230599 DOI: 10.3747/pdi.2015.00251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Matthew B Rivara
- Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, WA
| | - Rajnish Mehrotra
- Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, WA
| |
Collapse
|
40
|
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.
Collapse
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
| |
Collapse
|
41
|
Mehrotra R, Soohoo M, Rivara MB, Himmelfarb J, Cheung AK, Arah OA, Nissenson AR, Ravel V, Streja E, Kuttykrishnan S, Katz R, Molnar MZ, Kalantar-Zadeh K. Racial and Ethnic Disparities in Use of and Outcomes with Home Dialysis in the United States. J Am Soc Nephrol 2015; 27:2123-34. [PMID: 26657565 DOI: 10.1681/asn.2015050472] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 09/22/2015] [Indexed: 12/20/2022] Open
Abstract
Home dialysis, which comprises peritoneal dialysis (PD) or home hemodialysis (home HD), offers patients with ESRD greater flexibility and independence. Although ESRD disproportionately affects racial/ethnic minorities, data on disparities in use and outcomes with home dialysis are sparse. We analyzed data of patients who initiated maintenance dialysis between 2007 and 2011 and were admitted to any of 2217 dialysis facilities in 43 states operated by a single large dialysis organization, with follow-up through December 31, 2011 (n =: 162,050, of which 17,791 underwent PD and 2536 underwent home HD for ≥91 days). Every racial/ethnic minority group was significantly less likely to be treated with home dialysis than whites. Among individuals treated with in-center HD or PD, racial/ethnic minorities had a lower risk for death than whites; among individuals undergoing home HD, only blacks had a significantly lower death risk than whites. Blacks undergoing PD or home HD had a higher risk for transfer to in-center HD than their white counterparts, whereas Asians or others undergoing PD had a lower risk than whites undergoing PD. Blacks irrespective of dialysis modality, Hispanics undergoing PD or in-center HD, and Asians and other racial groups undergoing in-center HD were significantly less likely than white counterparts to receive a kidney transplant. In conclusion, there are racial/ethnic disparities in use of and outcomes with home dialysis in the United States. Disparities in kidney transplantation evident for blacks and Hispanics undergoing home dialysis are similar to those with in-center HD. Future studies should identify modifiable causes for these disparities.
Collapse
Affiliation(s)
- Rajnish Mehrotra
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington;
| | - Melissa Soohoo
- Division of Nephrology, Department of Medicine, University of California, Irvine, Orange, California
| | - Matthew B Rivara
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Jonathan Himmelfarb
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | | | - Onyebuchi A Arah
- Department of Medicine, University of California, Los Angeles, California
| | - Allen R Nissenson
- Department of Medicine, University of California, Los Angeles, California; DaVita Health Partners, El Segundo, California; and Division of Nephrology, Department of Medicine, University of Tennessee, Memphis, Tennessee
| | - Vanessa Ravel
- Division of Nephrology, Department of Medicine, University of California, Irvine, Orange, California
| | - Elani Streja
- Division of Nephrology, Department of Medicine, University of California, Irvine, Orange, California
| | - Sooraj Kuttykrishnan
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Ronit Katz
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Miklos Z Molnar
- DaVita Health Partners, El Segundo, California; and Division of Nephrology, Department of Medicine, University of Tennessee, Memphis, Tennessee
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Department of Medicine, University of California, Irvine, Orange, California
| |
Collapse
|
42
|
Gould AL, Chahla E, Hachem C. Peritonitis following Endoscopy in a Patient on Peritoneal Dialysis with a Discussion of Current Recommendations on Antibiotic Prophylaxis. Case Rep Gastroenterol 2015; 9:302-6. [PMID: 26483616 PMCID: PMC4608652 DOI: 10.1159/000437291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Patients on peritoneal dialysis (PD) are at increased risk for peritonitis. We report a case of a patient with end-stage renal disease on continuous ambulatory PD (CAPD) who developed peritonitis within 24 h of upper endoscopy with biopsy and colonoscopy with polypectomy. He had a previous history of peritonitis unrelated to invasive procedures and eventually was transitioned to hemodialysis because of his recurrent peritonitis. The International Society for Peritoneal Dialysis (ISPD) and newly revised American Society for Gastrointestinal Endoscopy (ASGE) guidelines recommend prophylactic antibiotics for CAPD patients undergoing endoscopic procedures. Other guidelines do not address this issue, and there has been limited evidence to support recommendations.
Collapse
Affiliation(s)
- Amy L Gould
- Saint Louis University School of Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Elie Chahla
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Christine Hachem
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Mo., USA
| |
Collapse
|
43
|
Nadeau-Fredette AC, Hawley CM, Pascoe EM, Chan CT, Clayton PA, Polkinghorne KR, Boudville N, Leblanc M, Johnson DW. An Incident Cohort Study Comparing Survival on Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry). Clin J Am Soc Nephrol 2015; 10:1397-407. [PMID: 26068181 PMCID: PMC4527016 DOI: 10.2215/cjn.00840115] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 04/20/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Home dialysis is often recognized as a first-choice therapy for patients initiating dialysis. However, studies comparing clinical outcomes between peritoneal dialysis and home hemodialysis have been very limited. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This Australia and New Zealand Dialysis and Transplantation Registry study assessed all Australian and New Zealand adult patients receiving home dialysis on day 90 after initiation of RRT between 2000 and 2012. The primary outcome was overall survival. The secondary outcomes were on-treatment survival, patient and technique survival, and death-censored technique survival. All results were adjusted with three prespecified models: multivariable Cox proportional hazards model (main model), propensity score quintile-stratified model, and propensity score-matched model. RESULTS The study included 10,710 patients on incident peritoneal dialysis and 706 patients on incident home hemodialysis. Treatment with home hemodialysis was associated with better patient survival than treatment with peritoneal dialysis (5-year survival: 85% versus 44%, respectively; log-rank P<0.001). Using multivariable Cox proportional hazards analysis, home hemodialysis was associated with superior patient survival (hazard ratio for overall death, 0.47; 95% confidence interval, 0.38 to 0.59) as well as better on-treatment survival (hazard ratio for on-treatment death, 0.34; 95% confidence interval, 0.26 to 0.45), composite patient and technique survival (hazard ratio for death or technique failure, 0.34; 95% confidence interval, 0.29 to 0.40), and death-censored technique survival (hazard ratio for technique failure, 0.34; 95% confidence interval, 0.28 to 0.41). Similar results were obtained with the propensity score models as well as sensitivity analyses using competing risks models and different definitions for technique failure and lag period after modality switch, during which events were attributed to the initial modality. CONCLUSIONS Home hemodialysis was associated with superior patient and technique survival compared with peritoneal dialysis.
Collapse
Affiliation(s)
- Annie-Claire Nadeau-Fredette
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Medicine, Université de Montreal, Montreal, Canada
| | - Carmel M Hawley
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Elaine M Pascoe
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Christopher T Chan
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kevan R Polkinghorne
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Department of Nephrology, Monash Medical Centre, Monash Health, Clayton, Australia; Departments of Medicine, Epidemiology, and Preventative Medicine, Monash University, Melbourne, Australia; and
| | - Neil Boudville
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Martine Leblanc
- Department of Medicine, Université de Montreal, Montreal, Canada
| | - David W Johnson
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia;
| |
Collapse
|
44
|
Causes for Withdrawal in an Urban Peritoneal Dialysis Program. Int J Nephrol 2015; 2015:652953. [PMID: 26064683 PMCID: PMC4430635 DOI: 10.1155/2015/652953] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 03/31/2015] [Accepted: 04/08/2015] [Indexed: 02/08/2023] Open
Abstract
Background. Peritoneal dialysis (PD) is an underutilized dialysis modality in the United States, especially in urban areas with diverse patient populations. Technique retention is a major concern of dialysis providers and might influence their approach to patients ready to begin dialysis therapy. Methods. Records from January 2009 to March 2014 were abstracted for demographic information, technique duration, and the reasons for withdrawal. Results. The median technique survival of the 128 incident patients during the study window was 781 days (2.1 years). The principle reasons for PD withdrawal were repeated peritonitis (30%); catheter dysfunction (18%); ultrafiltration failure (16%); patient choice or lack of support (16%); or hernia, leak, or other surgical complications (6%); and a total of 6 patients died during this period. Of the patients who did not expire and were not transplanted, most transferred to in-center hemodialysis and 8% transitioned to home-hemodialysis. Conclusions. Our findings suggest measures to ensure proper catheter placement and limiting infectious complications should be primary areas of focus in order to promote technique retention. Lastly, more focused education about home-hemodialysis as an option may allow those on PD who are beginning to demonstrate signs of technique failure to stay on home therapy.
Collapse
|