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Platnich JM, Pauly RP. Patient Training and Patient Safety in Home Hemodialysis. Clin J Am Soc Nephrol 2024; 19:1045-1050. [PMID: 38190130 PMCID: PMC11321743 DOI: 10.2215/cjn.0000000000000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
The success of a home hemodialysis program depends largely on a patient safety framework and the risk tolerance of a home dialysis program. Dialysis treatments require operators to perform dozens of steps repeatedly and reliably in a complex procedure. For home hemodialysis, those operators are patients themselves or their care partners, so attention to safety and risk mitigation is front of mind. While newer, smaller, and more user-friendly dialysis machines designed explicitly for home use are slowly entering the marketplace, teaching patients to perform their own treatments in an unsupervised setting hundreds of times remains a foundational programmatic obligation regardless of machine. Just how safe is home hemodialysis? How does patient training affect this safety? There is a surprising lack of literature surrounding these questions. No consensus exists among home hemodialysis programs regarding optimized training schedules or methods, with each program adopting its own approach on the basis of local experience. Furthermore, there are little available data on the safety of home hemodialysis as compared with conventional in-center hemodialysis. This review will outline considerations for training patients on home hemodialysis, discuss the safety of home hemodialysis with an emphasis on the risk of serious and life-threatening adverse effects, and address the methods by which adverse events are monitored and prevented.
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Affiliation(s)
- Jaye M Platnich
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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2
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Desbiens LC, Bargman JM, Chan CT, Nadeau-Fredette AC. Integrated home dialysis model: facilitating home-to-home transition. Clin Kidney J 2024; 17:i21-i33. [PMID: 38846416 PMCID: PMC11151120 DOI: 10.1093/ckj/sfae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Indexed: 06/09/2024] Open
Abstract
Peritoneal dialysis (PD) and home hemodialysis (HHD) are the two home dialysis modalities offered to patients. They promote patient autonomy, enhance independence, and are generally associated with better quality of life compared to facility hemodialysis. PD offers some advantages (enhanced flexibility, ability to travel, preservation of residual kidney function, and vascular access sites) but few patients remain on PD indefinitely due to peritonitis and other complications. By contrast, HHD incurs longer and more intensive training combined with increased upfront health costs compared to PD, but is easier to sustain in the long term. As a result, the integrated home dialysis model was proposed to combine the advantages of both home-based dialysis modalities. In this paradigm, patients are encouraged to initiate dialysis on PD and transfer to HHD after PD termination. Available evidence demonstrates the feasibility and safety of this approach and some observational studies have shown that patients who undergo the PD-to-HHD transition have clinical outcomes comparable to patients who initiate dialysis directly on HHD. Nevertheless, the prevalence of PD-to-HHD transfers remains low, reflecting the multiple barriers that prevent the full uptake of home-to-home transitions, notably a lack of awareness about the model, home-care "burnout," clinical inertia after a transfer to facility HD, suboptimal integration of PD and HHD centers, and insufficient funding for home dialysis programs. In this review, we will examine the conceptual advantages and disadvantages of integrated home dialysis, present the evidence that underlies it, identify challenges that prevent its success and finally, propose solutions to increase its adoption.
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Affiliation(s)
- Louis-Charles Desbiens
- Department of Medicine, Université de Montréal, Montreal, Canada
- Department of Medicine, Hôpital Maisonneuve-Rosemont, Montreal, Canada
| | - Joanne M Bargman
- Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Christopher T Chan
- Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Annie-Claire Nadeau-Fredette
- Department of Medicine, Université de Montréal, Montreal, Canada
- Department of Medicine, Hôpital Maisonneuve-Rosemont, Montreal, Canada
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3
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Tran E, Karadjian O, Chan CT, Trinh E. Home hemodialysis technique survival: insights and challenges. BMC Nephrol 2023; 24:205. [PMID: 37434110 PMCID: PMC10337160 DOI: 10.1186/s12882-023-03264-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 07/06/2023] [Indexed: 07/13/2023] Open
Abstract
Home hemodialysis (HHD) offers several clinical, quality of life and cost-saving benefits for patients with end-stage kidney disease. While uptake of this modality has increased in recent years, its prevalence remains low and high rates of discontinuation remain a challenge. This comprehensive narrative review aims to better understand what is currently known about technique survival in HHD patients, elucidate the clinical factors that contribute to attrition and expand on possible strategies to prevent discontinuation. With increasing efforts to encourage home modalities, it is imperative to better understand technique survival and find strategies to help maintain patients on the home therapy of their choosing. It is crucial to better target high-risk patients, examine ideal training practices and identify practices that are potentially modifiable to improve technique survival.
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Affiliation(s)
- Estelle Tran
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Oliver Karadjian
- Division of Nephrology, Department of Medicine, McGill University Health Center, 1650 Av Cedar, L4-510, Montreal, QC, H3G 1A4, Canada
| | | | - Emilie Trinh
- Division of Nephrology, Department of Medicine, McGill University Health Center, 1650 Av Cedar, L4-510, Montreal, QC, H3G 1A4, Canada.
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Main Barriers to the Introduction of a Home Haemodialysis Programme in Poland: A Review of the Challenges for Implementation and Criteria for a Successful Programme. J Clin Med 2022; 11:jcm11144166. [PMID: 35887931 PMCID: PMC9321469 DOI: 10.3390/jcm11144166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Home dialysis in Poland is restricted to the peritoneal dialysis (PD) modality, with the majority of dialysis patients treated using in-centre haemodialysis (ICHD). Home haemodialysis (HHD) is an additional home therapy to PD and provides an attractive alternative to ICHD that combines dialysis with social distancing; eliminates transportation needs; and offers clinical, economic, and quality of life benefits. However, HHD is not currently provided in Poland. This review was performed to provide an overview of the main barriers to the introduction of a HHD programme in Poland. Main findings: The main high-level barrier to introducing HHD in Poland is the absence of specific health legislation required for clinician prescribing of HHD. Other barriers to overcome include clear definition of reimbursement, patient training and education (including infrastructure and experienced personnel), organisation of logistics, and management of complications. Partnering with a large care network for HHD represents an alternative option to payers for the provision of a new HHD service. This may reduce some of the barriers which need to be overcome when compared with the creation of a new HHD service and its supporting network due to the pre-existing infrastructure, processes, and staff of a large care network. Conclusions: Provision of HHD is not solely about the provision of home treatment, but also the organisation and definition of a range of support services that are required to deliver the service. HHD should be viewed as an additional, complementary option to existing dialysis modalities which enables choice of modality best suited to a patient’s needs.
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5
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McIsaac M, Chan CT, Auguste BL. The need for individualizing teaching and assurance of knowledge transmission to patients training for home dialysis. Nephrology (Carlton) 2022; 27:733-738. [PMID: 35315965 DOI: 10.1111/nep.14040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/07/2022] [Accepted: 03/13/2022] [Indexed: 11/28/2022]
Abstract
Patients have varied learning styles and this has implications for home haemodialysis (HHD). Assessment tools directed toward understanding these styles remains understudied. As a consequence, this may lead to substandard retention rates or adverse events in HHD programs. As part of a continuous quality improvement initiative we have aimed to improve our understanding of patient learning styles and consequently tailor home dialysis training to individuals. To objectively determine knowledge translation and comprehension, irrespective of learning styles, we have introduced an objective structured clinical examination (OSCE). This assessment tool allows for further refinement of educational priorities by highlighting both deficiencies and strengths. Thereafter, an exit OSCE ensures patients attain an acceptable standard to complete home haemodialysis independently. We hope this tool will help shape future training criteria for HHD programs and consequently reduce adverse event rates.
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Affiliation(s)
- Mark McIsaac
- University Health Network, University of Toronto, Toronto, Canada
| | | | - Bourne L Auguste
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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Morin C, Gionest I, Laurin LP, Goupil R, Nadeau-Fredette AC. Risk of hospitalization, technique failure, and death with increased training duration in 3-days-a-week home hemodialysis. Hemodial Int 2021; 25:457-464. [PMID: 34169633 DOI: 10.1111/hdi.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Quality training is a core component of successful home hemodialysis (HHD) and training duration varies significantly between dialysis centers as well as at the patient level. This study aimed to assess the adverse outcomes associated with HHD training duration. METHODS All HHD patients successfully trained in a single dialysis center between January 2005 and July 2017 were included. A multivariable multiple-events (Andersen-Gill) survival model was built to evaluate the association between training time and main adverse events, including hospitalizations, technique failure, and death on HHD. Potential confounding factors were defined a priori (age, diabetes, coronary artery disease, and year of training start). Adjusted risk of vascular interventions (arteriovenous fistula angioplasties and central venous catheter replacements) was assessed as the secondary outcome in a negative binomial regression. FINDINGS Forty-eight patients were included in the study. Median HHD training duration was 86 (67-108) days, using a thrice weekly training schedule. Over a follow-up median time of 2.0 (0.7-3.3) years, three patients died while on HHD, 10 had a definitive transfer to HD, and 18 experienced a least 1 hospitalization (38 hospitalizations in total). Training duration was associated with a higher risk of hospitalization, technique failure, and death in unadjusted (hazard ratio [HR] 1.16 per month, 95% confidence interval [CI] 1.08-1.24) and adjusted multiple events model (HR 1.21, 95% CI 1.04-1.43). Risk of vascular access intervention was also significantly higher with increased training time (adjusted incidence rate ratio 1.31, 95% CI 1.03-1.64, per training month). DISCUSSION In this single-center observational study, HHD training duration was associated with a higher risk of adverse events including, death, technique failure, hospitalizations, and vascular access intervention. Enhanced clinical follow-up and home support should be offered to these more vulnerable patients to mitigate this heightened risk.
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Affiliation(s)
- Catherine Morin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Isabelle Gionest
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.,Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Rémi Goupil
- Hospital and Research Center, Sacré-Coeur de Montreal Hospital, Montreal, Quebec, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.,Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
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Paterson B, Fox DE, Lee CH, Riehl-Tonn V, Qirzaji E, Quinn R, Ward D, MacRae JM. Understanding Home Hemodialysis Patient Attrition: A Cohort Study. Can J Kidney Health Dis 2021; 8:20543581211022195. [PMID: 34178360 PMCID: PMC8207266 DOI: 10.1177/20543581211022195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/01/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Home hemodialysis (HHD) offers a flexible, patient-centered modality for patients with kidney failure. Growth in HHD is achieved by increasing the number of patients starting HHD and reducing attrition with strategies to prevent the modifiable reasons for loss. Objective: Our primary objective was to describe a Canadian HHD population in terms of technique failure and time to exit from HHD in order to understand reasons for exit. Our secondary objectives include the following: (1) determining reasons for training failure, (2) reasons for early exit from HHD, and (3) timing of program exit. Design: A retrospective cohort study of incident adult HHD patients between January 1, 2013—June 30, 2020. Setting: Alberta Kidney Care South, AKC-S HHD program. Participants: Patients who started training for HHD in AKC-S. Methods: A retrospective, cohort study of incident adult HHD patients with primary outcome time on home hemodialysis, secondary outcomes include reason for train failure, time to and reasons for technique failure. Cox-proportional hazard model to determine associations between patient characteristics and technique failure. The cumulative probability of technique failure over time was reported using a competing risks model. Results: A total of 167 patients entered HHD. Training failure occurred in 20 (12%), at 3.1 [2.0, 5.5] weeks; these patients were older (P < .001) and had 2 or more comorbidities (P < .001). Reasons for HHD exit after training included transplant (35; 21%), death (8; 4.8%), and technique failure (24; 14.4%). Overall, the median time to HHD exit, was 23 months [11, 41] and the median time of technique failure was 17 months [8.9, 36]. Reasons for technique failure included: psychosocial reasons (37%) at a median time 8.9 months [7.7, 13], safety (12.5%) at 19 months [19, 36], and medical (37.5%) at 26 months [11, 50]. Limitations: Small patient population with quality of data limited by the electronic-based medical record and non-standardized definitions of reasons for exit. Conclusions: Training failure is a particularly important source of patient loss. Reasons for exit differ according to duration on HHD. Early interventions aimed at reducing train failure and increasing psychosocial supports may help program growth.
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Affiliation(s)
- Bailey Paterson
- Cumming School of Medicine, University of Calgary, AB, Canada
| | - Danielle E Fox
- Department of Community Health Sciences, University of Calgary, AB, Canada
| | - Chel Hee Lee
- Department of Mathematics and Statistics, University of Calgary, AB, Canada
| | - Victoria Riehl-Tonn
- Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Elena Qirzaji
- Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Rob Quinn
- Department of Community Health Sciences, University of Calgary, AB, Canada.,Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada
| | - David Ward
- Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Jennifer M MacRae
- Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada.,Department of Cardiac Sciences, University of Calgary, AB, Canada
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8
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Pérez-Alba A, Catalán Navarrete S, Renau Ortells E, García Peris B, Agustina Trilles A, Cerrillo García V, Calvo Gordo C. Nursing program to support home hemodialysis. Experience of a center. Nefrologia 2021; 41:360-362. [PMID: 36166254 DOI: 10.1016/j.nefroe.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/04/2020] [Indexed: 06/16/2023] Open
Affiliation(s)
| | | | - Elena Renau Ortells
- Unidad de Enfermería-Diálisis, Hospital General de Castellón, Castellón, Spain
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9
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Lavoie-Cardinal M, Nadeau-Fredette AC. Physical Infrastructure and Integrated Governance Structure for Home Hemodialysis. Adv Chronic Kidney Dis 2021; 28:149-156. [PMID: 34717861 DOI: 10.1053/j.ackd.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 02/11/2021] [Accepted: 02/25/2021] [Indexed: 01/17/2023]
Abstract
In view of the growing enthusiasm for home dialysis use, new dialysis centers may build or expend their home hemodialysis program in the next few years. This review will discuss the main challenges faced by small and large home hemodialysis programs in terms of physical spaces, human resource, training considerations, and overall governance. We will elaborate on the inclusion of home hemodialysis in the kidney replacement therapy care continuum, with a specific interest for collaboration and transition between peritoneal dialysis and home hemodialysis programs.
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10
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Gupta A, Zimmerman D. Complications and challenges of home hemodialysis: A historical review. Semin Dial 2021; 34:269-274. [PMID: 33609415 DOI: 10.1111/sdi.12960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Home hemodialysis (HHD) has evolved as a preferred and safe kidney replacement modality over the past six decades. Despite advances in technological aspects of HHD, potential complications still pose a challenge to health care givers, patients, and their families. In this narrative review, we describe vascular access and cannulation, anticoagulation, nutritional, residual kidney function, psychosocial, technique failure, and machine/procedural-related complications. Addressing these problems is essential for favorable patient outcomes.
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Affiliation(s)
- Ankur Gupta
- Department of Medicine, Whakatane Hospital, Whakatane, New Zealand
| | - Deborah Zimmerman
- Division of Nephrology, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
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11
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Schachter ME, Saunders MJ, Akbari A, Caryk JM, Bugeja A, Clark EG, Tennankore KK, Martinusen DJ. Technique Survival and Determinants of Technique Failure in In-Center Nocturnal Hemodialysis: A Retrospective Observational Study. Can J Kidney Health Dis 2020; 7:2054358120975305. [PMID: 33335741 PMCID: PMC7724416 DOI: 10.1177/2054358120975305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022] Open
Abstract
Background Long-duration (7-8 hours) hemodialysis provides benefits compared with conventional thrice-weekly, 4-hour sessions. Nurse-administered, in-center nocturnal hemodialysis (INHD) may expand the population to whom an intensive dialysis schedule can be offered. Objective The primary objective of this study was to determine predictors of INHD technique failure, disruptions, and technique survival. Design This study used retrospective chart and database review methodology. Setting This study was conducted at a single Canadian INHD program operating in Victoria, British Columbia, within a tertiary care hospital. Our program serves a catchment population of approximately 450 000 people. Patients/Sample/Participants Forty-three consecutive incident INHD patients took part in the INHD program of whom 42 provided informed consent to participate in this study. Methods We conducted a retrospective observational study including incident INHD patients from 2015 to 2017. The primary outcome was technique failure ≤6 months (TF ≤6). Secondary outcomes included technique survival and reasons for/predictors of INHD discontinuation or temporary disruption. Predictors of each outcome included demographics, comorbidities, and Clinical Frailty Scale (CFS) scoring. Results Among 42 patients, mean (SD) age, dialysis vintage, CFS score, and follow-up were 63 (16) years, 46 (55) months, 4 (1), and 11 (9) months, respectively. 52% were aged ≥65 years. TF ≤6 occurred in 12 (29%) patients. One-year technique survival censored for transplants and home dialysis transitions was 60%. Discontinuation related to insomnia (32%), medical status change (27%), and vascular access (23%). In unadjusted Cox survival analysis, 1-point increases in CFS score associated with a higher risk of technique failure (hazard ratio: 2.04, 95% confidence interval [CI]: 1.26-3.31). In an adjusted analysis, higher frailty severity also associated with temporary INHD disruptions (incidence rate ratio: 2.64, 95% CI: 1.55-4.50, comparing CFS of ≥4 to 1-3). Limitations The retrospective, observational design of this study resulted in limited ability to control for confounding factors. In addition, the relatively small number of events observed owing to a small sample size diminished statistical power to inform study conclusions. Use of a single physician to determine the clinical frailty score is another limitation. Finally, the use of a single center for this study limits generalizability to other programs and clinic settings. Conclusions INHD is a sustainable modality, even among older patients. Higher frailty associates with INHD technique failure and greater missed treatments. Inclusion of a CFS threshold of ≤4 into INHD inclusion criteria may help to identify individuals most likely to realize the long-term benefits of INHD. Trial Registration Due to the retrospective and observational design of this study, trial registration was not necessary.
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Affiliation(s)
- Michael E Schachter
- Division of Nephrology, Vancouver Island Health Authority, Victoria, BC, Canada
| | - Marc J Saunders
- Master of Biomedical Technology Program, University of Calgary, AB, Canada
| | - Ayub Akbari
- Division of Nephrology, The Ottawa Hospital and University of Ottawa, ON, Canada
| | - Julia M Caryk
- Division of Nephrology, Vancouver Island Health Authority, Victoria, BC, Canada
| | - Ann Bugeja
- Division of Nephrology, The Ottawa Hospital and University of Ottawa, ON, Canada
| | - Edward G Clark
- Division of Nephrology, The Ottawa Hospital and University of Ottawa, ON, Canada
| | | | - Dan J Martinusen
- Division of Nephrology, Vancouver Island Health Authority, Victoria, BC, Canada
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12
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Nadeau-Fredette AC, Tennankore KK, Perl J, Bargman JM, Johnson DW, Chan CT. Home Hemodialysis and Peritoneal Dialysis Patient and Technique Survival in Canada. Kidney Int Rep 2020; 5:1965-1973. [PMID: 33163717 PMCID: PMC7609902 DOI: 10.1016/j.ekir.2020.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/13/2020] [Accepted: 08/18/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION As interest for home dialysis is growing, knowledge of comparative clinical outcomes between peritoneal dialysis (PD) and home hemodialysis (HHD) would help to better inform shared decision making with patients and caregivers during modality discussion. This study aimed to assess differences in risk of mortality and technique failure in an incident home dialysis cohort and, specifically, to assess change in this association through eras. METHODS All adults patients initiating PD or HHD, in Canada (excluding Quebec), within 365 days after kidney replacement therapy (KRT) initiation between 2000 and 2013 were included (administrative censoring 31 December 2014). Mortality and treatment failure (transfer to another modality for >90 days or death) were assessed in a multivariable Cox proportional hazard model, with prespecified stratification based on the year of KRT initiation. RESULTS The study included 959 HHD and 15,469 PD patients. Compared with incident PD, incident HHD was associated with a lower risk of mortality (adjusted hazard ratio [aHR] = 0.64, 95% confidence interval [CI] = 0.53-0.78), and treatment failure (aHR = 0.52, 95% CI = 0.45-0.60). These lower risks of mortality with HHD were more pronounced for older cohorts (2000-2005: aHR = 0.47, 95% CI = 0.31-0.70; 2006-2010: aHR = 0.70, 95% CI = 0.54-0.89) and not significantly different in the most recent era (2011-2013: aHR = 0.86, 95% CI = 0.51-1.47). CONCLUSION In Canadian incident KRT patients, HHD was associated with appreciably lower risks of mortality and treatment failure compared to PD, although this association appeared to be attenuated in the most contemporary era.
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Affiliation(s)
- Annie-Claire Nadeau-Fredette
- Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | | | - Jeffrey Perl
- St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Joanne M. Bargman
- University Health Network/Toronto General Hospital, Toronto, Ontario, Canada
| | - David W. Johnson
- Division of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Christopher T. Chan
- University Health Network/Toronto General Hospital, Toronto, Ontario, Canada
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13
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[Nursing program to support home hemodialysis. Experience of a center]. Nefrologia 2020; 41:360-362. [PMID: 32807579 DOI: 10.1016/j.nefro.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/04/2020] [Indexed: 11/21/2022] Open
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14
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Kennedy C, Auguste BL, Girsberger M, Srithongkul T, Faratro R, Arustei D, d'Gama C, Magtoto E, Wong E, McGrath-Chong M, Chan CT. The need for outpatient back-up for home hemodialysis patients: Implications for resource utilization. Hemodial Int 2020; 24:454-459. [PMID: 32770636 DOI: 10.1111/hdi.12856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The provision of sufficient support contributes to home hemodialysis (HHD) technique survival. The need for back-up treatment in incident and prevalent patients on HHD has not been well described previously, and is important from both technique survival and resource allocation. We aimed to quantify the amount of back-up treatment given to patients in our HHD unit, and hypothesized that the provision of back-up HD facilitated technique survival. METHODS This was a retrospective, single-center cohort study quantifying the provision of back-up HD between January and December 2018. Electronic and paper medical records were accessed for data collection. FINDINGS One hundred and nineteen patients dialyzed independently at home during the study period (96 patient years of HHD). Seventy-eight (66%) patients required a total of 292 back-up HD sessions in the HHD unit, representing an average of three back-up HD runs per patient year of HHD. Fifty-three percent of back-up HD runs were required for vascular access related issues. The most common clinical issue requiring assessment and back-up HD was extracellular fluid volume management. An equal proportion (95%) of those that utilized back-up HD and those that did not utilize back-up HD maintained a positive disposition (transplant or ongoing HHD) in relation to technique survival in the short term. CONCLUSIONS From a resource viewpoint, this program of approximately 100 HHD patients required the availability of one to two staffed HD stations each weekday for back-up HD. The provision of back-up HD was not a harbinger of HHD discontinuation.
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Affiliation(s)
- Claire Kennedy
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bourne L Auguste
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael Girsberger
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thatsaphan Srithongkul
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rose Faratro
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Daniela Arustei
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Celine d'Gama
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Eduardo Magtoto
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Elizabeth Wong
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | | | - Christopher T Chan
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Torres H, Naljayan M, Frontini M, Aguilar E, Barry S, Reisin E. Evaluating Factors Contributing to Dropout in a Large Peritoneal Dialysis Program. Am J Med Sci 2020; 361:30-35. [PMID: 32732078 DOI: 10.1016/j.amjms.2020.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/30/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The low prevalence of peritoneal dialysis (PD) (9%) vs. hemodialysis (HD) (88.2%) is partly due to patient dropout from therapy. METHODS This retrospective study identified patients who withdrew from PD between 2016 and 2018 in our program. We evaluated all other factors as controllable losses. Analysis included time on therapy at dropout (very early, early or late) and method of initiation (HD to PD conversion, unplanned PD, or planned start). RESULTS Eighty-three patients enrolled into our PD program. 27 dropped out; 24 were due to controllable factors, 3 due to death, with a median age at dropout of 52 years old. We determined psychosocial factors (PF) to be the largest controllable factor influencing dropout; contributing a 63% rate among all controllable factors. When considering time until dropout, 100% of very early dropout patients and 50% of late dropout patients did so due to PF. Among early dropout patients 67% dropped out due to other medical reasons. The mean time to dropout for PF, other, and infection (INF) were 13, 26, and 33 months, respectively. When considering type of initiation, we found PF to be the largest attributable factor with 50% of unplanned, 100% of planned, and 50% of conversions stopping therapy. CONCLUSIONS Our study indicates that the primary reason for controllable loss from therapy was secondary to PF regardless of the time on therapy or the method of initiation to therapy.
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Affiliation(s)
- Hayden Torres
- Louisiana State University Health Sciences Center in New Orleans - Section of Nephrology and Hypertension, School of Medicine, New Orleans, Louisiana
| | - Mihran Naljayan
- Louisiana State University Health Sciences Center in New Orleans - Section of Nephrology and Hypertension, School of Medicine, New Orleans, Louisiana
| | - Maria Frontini
- Louisiana State University Health Sciences Center in New Orleans - Section of Infectious Diseases, School of Medicine, New Orleans, Louisiana
| | - Erwin Aguilar
- Louisiana State University Health Sciences Center in New Orleans - Section of Nephrology and Hypertension, School of Medicine, New Orleans, Louisiana
| | - Sean Barry
- Louisiana State University Health Sciences Center in New Orleans - Section of Nephrology and Hypertension, School of Medicine, New Orleans, Louisiana
| | - Efrain Reisin
- Louisiana State University Health Sciences Center in New Orleans - Section of Nephrology and Hypertension, School of Medicine, New Orleans, Louisiana.
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Beaumier M, Béchade C, Dejardin O, Lassalle M, Vigneau C, Longlune N, Launay L, Couchoud C, Ficheux M, Lobbedez T, Châtelet V. Is self-care dialysis associated with social deprivation in a universal health care system? A cohort study with data from the Renal Epidemiology and Information Network Registry. Nephrol Dial Transplant 2020; 35:861-869. [PMID: 31821495 DOI: 10.1093/ndt/gfz245] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/25/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Socioeconomic status is associated with dialysis modality in developed countries. The main objective of this study was to investigate whether social deprivation, estimated by the European Deprivation Index (EDI), was associated with self-care dialysis in France. METHODS The EDI was calculated for patients who started dialysis in 2017. The event of interest was self-care dialysis 3 months after dialysis initiation [self-care peritoneal dialysis (PD) or satellite haemodialysis (HD)]. A logistic model was used for the statistical analysis, and a counterfactual approach was used for the causal mediation analysis. RESULTS Among the 9588 patients included, 2894 (30%) were in the most deprived quintile of the EDI. A total of 1402 patients were treated with self-care dialysis. In the multivariable analysis with the EDI in quintiles, there was no association between social deprivation and self-care dialysis. Compared with the other EDI quintiles, patients from Quintile 5 (most deprived quintile) were less likely to be on self-care dialysis (odds ratio 0.81, 95% confidence interval 0.71-0.93). Age, sex, emergency start, cardiovascular disease, chronic respiratory disease, cancer, severe disability, serum albumin and registration on the waiting list were associated with self-care dialysis. The EDI was not associated with self-care dialysis in either the HD or in the PD subgroups. CONCLUSIONS In France, social deprivation estimated by the EDI is associated with self-care dialysis in end-stage renal disease patients undergoing replacement therapy.
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Affiliation(s)
- Mathilde Beaumier
- Centre Universitaire des maladies rénales, CHU de Caen, Caen, France
| | - Clémence Béchade
- Centre Universitaire des maladies rénales, CHU de Caen, Caen, France
| | - Olivier Dejardin
- U1086 Inserm, «ANTICIPE », Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | | | - Cécile Vigneau
- Centre Hospitalier Universitaire Pontchaillou, Service de Néphrologie, Rennes, France
| | - Nathalie Longlune
- Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Ludivine Launay
- U1086 Inserm, «ANTICIPE », Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Cécile Couchoud
- REIN Registry, Biomedecine Agency, Saint-Denis-La-Plaine, France
| | - Maxence Ficheux
- Centre Universitaire des maladies rénales, CHU de Caen, Caen, France
| | - Thierry Lobbedez
- Centre Universitaire des maladies rénales, CHU de Caen, Caen, France
| | - Valérie Châtelet
- Centre Universitaire des maladies rénales, CHU de Caen, Caen, France
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Jacquet S, Trinh E. The Potential Burden of Home Dialysis on Patients and Caregivers: A Narrative Review. Can J Kidney Health Dis 2019; 6:2054358119893335. [PMID: 31897304 PMCID: PMC6920584 DOI: 10.1177/2054358119893335] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/12/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose of review: Home dialysis modalities offer several benefits for patients with end-stage
kidney disease when compared with facility-based thrice-weekly hemodialysis.
To increase uptake of home dialysis, many centers are encouraging a
“home-first” approach. However, it is important to appreciate that “one size
may not fit all” and that dialysis modality selection is a complex decision
that needs to be individualized. The purpose of this review was to explore
aspects associated with home dialysis that may be associated with burden for
patients and their caregivers and to discuss strategies to alleviate these
concerns. Sources of information: Original research articles were identified from PubMed using search terms
“peritoneal dialysis,” “home hemodialysis,” “home dialysis,” “barriers,”
“quality of life” and “burden.” Methods: We performed a focused narrative review examining potential sources of burden
with home dialysis therapies after conducting a critical appraisal of the
literature and identifying the major recurring themes. Key findings: Home dialysis is associated with burden for certain patients. Indeed, some
patients may experience ongoing concerns regarding the risks of adverse
events and of inadequately performing dialysis on their own. Psychosocial
issues affecting quality of life may also arise and include fear of social
isolation, sleep disturbances, perceived financial burden, anxiety, and
fatigue. Patients who depend on a caregiver may worry about creating a
stressful home environment for their close ones. Furthermore, the demands
associated with being a caregiver may lead to psychosocial distress in the
caregivers themselves. All these factors may lead to burnout and
consequently, therapy discontinuation necessitating an unplanned transition
to in-center hemodialysis leading to adverse outcomes. However, certain
strategies may help alleviate burden especially if concerns are identified
early on. Limitations: As we did not apply any formal tool to assess the quality of the studies
included, selection bias may have occurred. Nonetheless, we have attempted
to provide a comprehensive review on the topic using numerous diverse
studies and extensive review of the literature. Implications: Future studies should focus on better identifying patient priorities and
strategies to facilitate dialysis modality selection and improve quality of
life.
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Affiliation(s)
- Sabriella Jacquet
- Division of Nephrology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Emilie Trinh
- Division of Nephrology, McGill University Health Centre, McGill University, Montreal, QC, Canada
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Abstract
There is a resurgence in clinical adoption of home hemodialysis globally driven by several demonstrated clinical and economic advantages. Yet, the overall adoption of home hemodialysis remains under-represented in most countries. The practicality of managing ESKD with home hemodialysis is a common concern among practicing nephrologists in the United States. The primary objective of this invited feature is to deliver a practical guide to managing ESKD with home hemodialysis. We have included common clinical scenarios, clinical and infrastructure management problems, and approaches to the day-to-day management of patients undergoing home hemodialysis.
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Affiliation(s)
- Ali Ibrahim
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Christopher T Chan
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
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Trinh E, Hanley JA, Nadeau-Fredette AC, Perl J, Chan CT. A comparison of technique survival in Canadian peritoneal dialysis and home hemodialysis patients. Nephrol Dial Transplant 2019; 34:1941-1949. [DOI: 10.1093/ndt/gfz075] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/21/2019] [Indexed: 11/14/2022] Open
Abstract
AbstractBackgroundHigh discontinuation rates remain a challenge for home hemodialysis (HHD) and peritoneal dialysis (PD). We compared technique failure risks among Canadian patients receiving HHD and PD.MethodsUsing the Canadian Organ Replacement Register, we studied adult patients who initiated HHD or PD within 1 year of beginning dialysis between 2000 and 2012, with follow-up until 31 December 2013. Technique failure was defined as a transfer to any alternative modality for a period of ≥60 days. Technique survival between HHD and PD was compared using a Fine and Gray competing risk model. We also examined the time dependence of technique survival, the association of patient characteristics with technique failure and causes of technique failure.ResultsBetween 2000 and 2012, 15 314 patients were treated with a home dialysis modality within 1 year of dialysis initiation: 14 461 on PD and 853 on HHD. Crude technique failure rates were highest during the first year of therapy for both home modalities. During the entire period of follow-up, technique failure was lower with HHD compared with PD (adjusted hazard ratio = 0.79; 95% confidence interval 0.69–0.90). However, the relative technique failure risk was not proportional over time and the beneficial association with HHD was only apparent after the first year of dialysis. Comparisons also varied among subgroups and the superior technique survival associated with HHD relative to PD was less pronounced in more recent years and among older patients. Predictors of technique failure also differed between modalities. While obesity, smoking and small facility size were associated with higher technique failure in both PD and HHD, the association with age and gender differed. Furthermore, the majority of discontinuation occurred for medical reasons in PD (38%), while the majority of HHD patients experienced technique failure due to social reasons or inadequate resources (50%).ConclusionsIn this Canadian study of home dialysis patients, HHD was associated with better technique survival compared with PD. However, patterns of technique failure differed significantly among these modalities. Strategies to improve patient retention across all home dialysis modalities are needed.
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Affiliation(s)
- Emilie Trinh
- Division of Nephrology, Department of Medicine, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - James A Hanley
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montreal, Montreal, Quebec, Canada
| | - Jeffrey Perl
- Division of Nephrology, Department of Medicine, St Michael’s Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Christopher T Chan
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
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20
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Seshasai RK, Wong T, Glickman JD, Shea JA, Dember LM. The home hemodialysis patient experience: A qualitative assessment of modality use and discontinuation. Hemodial Int 2019; 23:139-150. [DOI: 10.1111/hdi.12713] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/19/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Rebecca Kurnik Seshasai
- Department of Medicine, Renal, Electrolyte and Hypertension DivisionPerelman School of Medicine Philadelphia Pennsylvania USA
| | - Tiffany Wong
- Department of Medicine, Renal, Electrolyte and Hypertension DivisionPerelman School of Medicine Philadelphia Pennsylvania USA
| | - Joel D. Glickman
- Department of Medicine, Renal, Electrolyte and Hypertension DivisionPerelman School of Medicine Philadelphia Pennsylvania USA
| | - Judy A. Shea
- Department of Medicine, Division of General Internal MedicinePerelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
| | - Laura M. Dember
- Department of Medicine, Renal, Electrolyte and Hypertension DivisionPerelman School of Medicine Philadelphia Pennsylvania USA
- Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and BiostatisticsPerelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
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21
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Beig JY, Semple DJ. Changing ethnic and clinical trends and factors associated with successful home haemodialysis at Auckland District Health Board. Intern Med J 2019; 49:1425-1435. [PMID: 30719826 DOI: 10.1111/imj.14240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/16/2019] [Accepted: 01/31/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The health and diversity of the population in New Zealand (NZ) is changing under the influence of many socio-economic factors. This may have shifted the landscape of home haemodialysis (HHD). AIMS To examine the demographic and clinical changes, determinants of HHD training and technique outcome and mortality between 2008 and 2015 at Auckland District Health Board, NZ. METHODS We compared three incident cohorts of HHD patients between 2008 and 2015. Relevant factors, including demographic and clinical characteristics, training failure, technique failure and mortality were recorded. Factors associated with training and technique failure were examined by multivariate logistic regression. RESULTS Of 152 patients, 133 completed training, 13 (10%) experienced technique failure and 15 (11%) died. Significant changes in ethnicity (increased: Māori 1.7-fold, Asian 1.7-fold and Pasifika 1.4-fold; decreased: NZ European 2.7-fold, P = 0.001), and major comorbidities, ≥2 major comorbidities (1.8-fold increase, P = 0.03), diabetes (2.1-fold increase, P = 0.013) and heart failure (P = 0.04) were seen. HHD as first renal replacement therapy modality increased 15-fold (P = 0.0001) and training time increased by 4.5 weeks (P = 0.004). Death and technique failure were unchanged over time. Shorter training time, employment and lower C-reactive protein were associated with 'Successful HHD'. 'Unsuccessful HHD' patient characteristics differed by ethnicity. CONCLUSIONS The HHD population has become more representative of the NZ population, but significantly more comorbid over time. Patient training time has increased, but mortality and technique failure remain stable. 'Successful HHD' is predicted by social and clinical factors, and 'unsuccessful HHD' may have different mechanisms in different patient groups.
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Affiliation(s)
- Junaid Y Beig
- Department of Renal Medicine, Auckland District Health Board, Auckland, New Zealand
| | - David J Semple
- Department of Renal Medicine, Auckland District Health Board, Auckland, New Zealand
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22
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Pauly RP, Rosychuk RJ, Usman I, Reintjes F, Muneer M, Chan CT, Copland M, Lindsay R, MacRae J, Nesrallah G, Pierratos A, Zimmerman DL, Komenda P. Technique Failure in a Multicenter Canadian Home Hemodialysis Cohort. Am J Kidney Dis 2019; 73:230-239. [DOI: 10.1053/j.ajkd.2018.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 08/26/2018] [Indexed: 12/18/2022]
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23
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Chan CT, Wallace E, Golper TA, Rosner MH, Seshasai RK, Glickman JD, Schreiber M, Gee P, Rocco MV. Exploring Barriers and Potential Solutions in Home Dialysis: An NKF-KDOQI Conference Outcomes Report. Am J Kidney Dis 2018; 73:363-371. [PMID: 30545707 DOI: 10.1053/j.ajkd.2018.09.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/27/2018] [Indexed: 11/11/2022]
Abstract
Home dialysis therapy, including home hemodialysis and peritoneal dialysis, is underused as a modality for the treatment of chronic kidney failure. The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative sponsored a home dialysis conference in late 2017 that was designed to identify the barriers to starting and maintaining patients on home dialysis therapy. Clinical, operational, policy, and societal barriers were identified that need to be overcome to ensure that dialysis patients have the freedom to choose their treatment modality. Education of patients and patient partners, as well as health care providers, about home dialysis therapy, if offered at all, is often provided in a cursory manner. Lack of exposure to home dialysis therapies perpetuates a lack of familiarity and thus a hesitancy to refer patients to home dialysis therapies. Patient and care partner support, both psychosocial and financial, is also critical to minimize the risk for burnout leading to dropout from a home dialysis modality. Thus, the facilitation of home dialysis therapy will require a systematic change in chronic kidney disease education and the approach to dialysis therapy initiation, the creation of additional incentives for performing home dialysis, and breakthroughs to simplify the performance of home dialysis modalities. The home dialysis work group plans to develop strategies to overcome these barriers to home dialysis therapy, which will be presented at a follow-up home dialysis conference.
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Affiliation(s)
| | - Eric Wallace
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | - Joel D Glickman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Patrick Gee
- Quality Insights Renal Network 5, Mid-Atlantic Renal Coalition, North Chesterfield, VA
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24
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Weinhandl ED, Collins AJ. Relative risk of home hemodialysis attrition in patients using a telehealth platform. Hemodial Int 2017; 22:318-327. [PMID: 29210164 DOI: 10.1111/hdi.12621] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Home hemodialysis (HHD) facilitates increased treatment frequency, which may improve patient outcomes. However, attrition due to technique failure limits the clinical effectiveness of the modality. Nx2me Connected Health is a telehealth platform that enables ongoing assessment of HHD patients using NxStage equipment, and that may reduce patient burden. We aimed to assess whether use of Nx2me was associated with risk of HHD attrition. METHODS We compared risks of all-cause attrition, dialysis cessation (i.e., death or transplant), and technique failure in Nx2me users and matched control patients, using a retrospective cohort study. We also compared the likelihood of HHD training graduation in patients who initiated use of Nx2me during training with the likelihood in matched control patients. Matching factors included date of HHD initiation, NxStage treatment duration at initiation of follow-up, and prescribed treatment frequency. We used stratified Fine-Gray and Cox regression to compare risks, with adjustment for demographic factors and vascular access modality, and stratification by matched cluster. FINDINGS We identified 606 Nx2me users; 49.5% initiated use of Nx2me in <3 months after initiation of HHD with NxStage equipment. Adjusted hazard ratios (AHRs) of all-cause attrition, dialysis cessation, and technique failure were 0.80 (95% confidence interval, 0.68-0.95), 1.10 (0.86-1.41), and 0.71 (0.57-0.87), respectively, for Nx2me users vs. matched controls. AHRs were similar in patients who initiated use of Nx2me in <3 months after initiation of HHD. The AHR of HHD training graduation was 1.61 (1.10-2.36) in patients who initiated use of Nx2me within 2 weeks of training initiation vs. matched controls. DISCUSSION Use of Nx2me was associated with lower risk of all-cause attrition, lower risk of technique failure, and higher likelihood of HHD training graduation. Further studies are needed to identify the mechanisms by which use of a telehealth platform may improve clinical outcomes and reduce patient burden.
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Affiliation(s)
- Eric D Weinhandl
- NxStage Medical, Inc., Lawrence, Massachusetts, USA.,Department of Pharmaceutical Care and Health Systems
| | - Allan J Collins
- NxStage Medical, Inc., Lawrence, Massachusetts, USA.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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25
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Trinh E, Na Y, Sood MM, Chan CT, Perl J. Racial Differences in Home Dialysis Utilization and Outcomes in Canada. Clin J Am Soc Nephrol 2017; 12:1841-1851. [PMID: 28835369 PMCID: PMC5672971 DOI: 10.2215/cjn.03820417] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/17/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Data on racial disparities in home dialysis utilization and outcomes are lacking in Canada, where health care is universally available. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We studied patients starting maintenance dialysis between 1996 and 2012 in the Canadian Organ Replacement Register, stratified by race: white, Asian, black, Aboriginal, Indian subcontinent, and other. The association between race and treatment with home dialysis was examined using generalized linear models. Secondary outcomes assessed racial differences in all-cause mortality and technique failure using a Fine and Gray competing risk model. RESULTS 66,600 patients initiated chronic dialysis between 1996 and 2012. Compared with whites (n=46,092), treatment with home dialysis was lower among Aboriginals (n=3866; adjusted relative risk, RR, 0.71; 95% confidence interval, CI, 0.66 to 0.76) and higher in Asians (n=4157; adjusted RR, 1.28; 95% CI, 1.22 to 1.35) and others (n=2170; adjusted RR, 1.12; 95% CI, 1.04 to 1.20) but similar in blacks (n=2143) and subcontinent Indians (n=2809). Black (adjusted hazard ratio, HR, 1.31; 95% CI, 1.16 to 1.48) and Aboriginal (adjusted HR, 1.19; 95% CI, 1.06 to 1.33) patients treated with peritoneal dialysis had a significantly higher adjusted risk of technique failure compared with whites, whereas Asians had a lower risk (adjusted HR, 0.89; 95% CI, 0.82 to 0.99). In patients on peritoneal dialysis, the risk of death was significantly lower in Asians (adjusted HR, 0.83; 95% CI, 0.75 to 0.92), blacks (adjusted HR, 0.71; 95% CI, 0.59 to 0.85), and others (adjusted HR, 0.79; 95% CI, 0.68 to 0.92) but higher in Aboriginals (adjusted HR, 1.16; 95% CI, 1.02 to 1.32) compared with whites. Among patients on home hemodialysis, no significant racial differences in patient and technique survival were observed, which may be limited by the low number of events among each subgroups. CONCLUSIONS With the exception of Aboriginals, all racial minority groups in Canada were as likely to be treated with home dialysis compared with whites. However, significant racial differences exist in outcomes.
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Affiliation(s)
- Emilie Trinh
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Yingbo Na
- Division of Nephrology, St. Michael’s Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada; and
| | - Manish M. Sood
- Division of Nephrology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Jeffrey Perl
- Division of Nephrology, St. Michael’s Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada; and
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Shah N, Reintjes F, Courtney M, Klarenbach SW, Ye F, Schick-Makaroff K, Jindal K, Pauly RP. Quality Assurance Audit of Technique Failure and 90-Day Mortality after Program Discharge in a Canadian Home Hemodialysis Program. Clin J Am Soc Nephrol 2017; 12:1259-1264. [PMID: 28739573 PMCID: PMC5544501 DOI: 10.2215/cjn.00140117] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/25/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Little is known about patients exiting home hemodialysis. We sought to characterize the reasons, clinical characteristics, and pre-exit health care team interactions of patients on home hemodialysis who died or underwent modality conversion (negative disposition) compared with prevalent patients and those who were transplanted (positive disposition). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted an audit of all consecutive patients incident to home hemodialysis from January of 2010 to December of 2014 as part of ongoing quality assurance. Records were reviewed for the 6 months before exit, and vital statistics were assessed up to 90 days postexit. RESULTS Ninety-four patients completed training; 25 (27%) received a transplant, 11 (12%) died, and 23 (25%) were transferred to in-center hemodialysis. Compared with the positive disposition group, patients in the negative disposition group had a longer mean dialysis vintage (3.15 [SD=4.98] versus 1.06 [SD=1.16] years; P=0.003) and were performing conventional versus a more intensive hemodialysis prescription (23 of 34 versus 23 of 60; P<0.01). In the 6 months before exit, the negative disposition group had significantly more in-center respite dialysis sessions, had more and longer hospitalizations, and required more on-call care team support in terms of phone calls and drop-in visits (each P<0.05). The most common reason for modality conversion was medical instability in 15 of 23 (65%) followed by caregiver or care partner burnout in three of 23 (13%) each. The 90-day mortality among patients undergoing modality conversion was 26%. CONCLUSIONS Over a 6-year period, approximately one third of patients exited the program due to death or modality conversion. Patients who die or transfer to another modality have significantly higher health care resource utilization (e.g., hospitalization, respite treatments, nursing time, etc.).
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Affiliation(s)
- Nikhil Shah
- Division of Nephrology, Department of Medicine and
| | - Frances Reintjes
- Northern Alberta Renal Program, Alberta Health Services, Edmonton, Alberta, Canada; and
| | - Mark Courtney
- Division of Nephrology, Department of Medicine and
- Northern Alberta Renal Program, Alberta Health Services, Edmonton, Alberta, Canada; and
| | - Scott W. Klarenbach
- Division of Nephrology, Department of Medicine and
- Northern Alberta Renal Program, Alberta Health Services, Edmonton, Alberta, Canada; and
| | - Feng Ye
- Division of Nephrology, Department of Medicine and
- Alberta Kidney Disease Network, Edmonton, Alberta, Canada
| | | | - Kailash Jindal
- Division of Nephrology, Department of Medicine and
- Northern Alberta Renal Program, Alberta Health Services, Edmonton, Alberta, Canada; and
| | - Robert P. Pauly
- Division of Nephrology, Department of Medicine and
- Northern Alberta Renal Program, Alberta Health Services, Edmonton, Alberta, Canada; and
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27
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Rioux JP, Marshall MR, Faratro R, Hakim R, Simmonds R, Chan CT. Patient selection and training for home hemodialysis. Hemodial Int 2016; 19 Suppl 1:S71-9. [PMID: 25925826 DOI: 10.1111/hdi.12254] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patient selection and training is arguably the most important step toward building a successful home hemodialysis (HD) program. We present a step-by-step account of home HD training to guide providers who are developing home HD programs. Although home HD training is an important step in allowing patients to undergo dialysis in the home, there is a surprising lack of systematic research in this field. Innovations and research in this area will be pivotal in further promoting a higher acceptance rate of home HD as the renal replacement therapy of choice.
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28
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Seshasai RK, Mitra N, Chaknos CM, Li J, Wirtalla C, Negoianu D, Glickman JD, Dember LM. Factors Associated With Discontinuation of Home Hemodialysis. Am J Kidney Dis 2015; 67:629-37. [PMID: 26709066 DOI: 10.1053/j.ajkd.2015.11.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/07/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Home hemodialysis (HHD) is associated with improved clinical and quality-of-life outcomes compared to in-center hemodialysis, but remains an underused modality in the United States. Discontinuation from HHD therapy may be an important contributor to the low use of this modality. This study aimed to describe the rate and timing of HHD therapy discontinuation, or technique failure, and identify contributing factors. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Using data from a large dialysis provider, we identified a nationally representative cohort of patients who initiated HHD therapy from 2007 to 2009 (N=2,840). FACTORS Demographics, end-stage renal disease duration, kidney transplant listing status, comorbid conditions, level of urbanization or rurality based on residence zip code, socioeconomic status based on residence zip code, and dialysis facility factors. OUTCOMES Discontinuation from HHD therapy, defined as 60 or more days with no HHD treatments. MEASUREMENTS Competing-risk models were used to produce cumulative incidence plots and identify sociodemographic and clinical variables associated with HHD therapy discontinuation. Transplantation and death were treated as competing risks for HHD therapy discontinuation. RESULTS The 1-year incidence of discontinuation was 24.9%, and the 1-year mortality estimate was 7.6%. Median end-stage renal disease duration prior to initiating HHD therapy was 2.1 years. Diabetes and smoking/alcohol/drug use were associated with increased risk for HHD discontinuation (HRs of 1.34 [95% CI, 1.07-1.68] and 1.34 [95% CI, 1.01-1.78], respectively). Listing for kidney transplantation and rural residence (rural-urban commuting area ≥ 7) were associated with decreased risk for HHD therapy discontinuation (HRs of 0.73 [95% CI, 0.61-0.87] and 0.78 [95% CI, 0.59-1.02], respectively). LIMITATIONS Limited to variables available within the DaVita dialysis and US Renal Data System data sets. CONCLUSIONS A substantial proportion of patients discontinue HHD therapy within the first 12 months of use of the modality. Patients with diabetes, substance use, nonlisting for kidney transplantation, and urban residence are at greater risk for discontinuation. Targeting high-risk patients for increased support from clinical teams is a potential strategy for reducing HHD therapy discontinuation and increasing technique survival.
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Affiliation(s)
- Rebecca Kurnik Seshasai
- Division of Nephrology and Hypertension. Department of Medicine, Drexel University College of Medicine, Philadelphia, PA.
| | - Nandita Mitra
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - C Michael Chaknos
- Renal, Electrolyte and Hypertension Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jiaqi Li
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Christopher Wirtalla
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dan Negoianu
- Renal, Electrolyte and Hypertension Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Joel D Glickman
- Renal, Electrolyte and Hypertension Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Laura M Dember
- Renal, Electrolyte and Hypertension Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
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29
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Nadeau-Fredette AC, Hawley C, Pascoe E, Chan CT, Leblanc M, Clayton PA, Polkinghorne KR, Boudville N, Johnson DW. Predictors of Transfer to Home Hemodialysis after Peritoneal Dialysis Completion. Perit Dial Int 2015; 36:547-54. [PMID: 26526050 DOI: 10.3747/pdi.2015.00121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/09/2015] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND The aim of the present study was to evaluate the predictors of transfer to home hemodialysis (HHD) after peritoneal dialysis (PD) completion. ♦ METHODS All Australian and New Zealand patients treated with PD on day 90 after initiation of renal replacement therapy between 2000 and 2012 were included. Completion of PD was defined by death, transplantation, or hemodialysis (HD) for 180 days or more. Patients were categorized as "transferred to HHD" if they initiated HHD fewer than 180 days after PD had ended. Multivariable logistic regression was used to evaluate predictors of transfer to HHD in a restricted cohort experiencing PD technique failure; a competing-risks analysis was used in the unrestricted cohort. ♦ RESULTS Of 10 710 incident PD patients, 3752 died, 1549 underwent transplantation, and 2915 transferred to HD, among whom 156 (5.4%) started HHD. The positive predictors of transfer to HHD in the restricted cohort were male sex [odds ratio (OR): 2.81], obesity (OR: 2.20), and PD therapy duration (OR: 1.10 per year). Negative predictors included age (OR: 0.95 per year), infectious cause of technique failure (OR: 0.48), underweight (OR: 0.50), kidney disease resulting from hypertension (OR: 0.38) or diabetes (OR: 0.32), race being Maori (OR: 0.65) or Aboriginal and Torres Strait Islander (OR: 0.30). Comparable results were obtained with a competing-risks model. ♦ CONCLUSIONS Transfer to HHD after completion of PD is rare and predicted by patient characteristics at baseline and at the time of PD end. Transition to HHD should be considered more often in patients using PD, especially when they fulfill the identified characteristics.
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Affiliation(s)
- Annie-Claire Nadeau-Fredette
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Université de Montreal, Montreal, Quebec, Canada
| | - Carmel Hawley
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, University of Queensland, Brisbane, Australia
| | - Elaine Pascoe
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Christopher T Chan
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Sydney Medical School, University of Sydney, Sydney
| | - Kevan R Polkinghorne
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, Monash Medical Centre Monash Health, Clayton Department of Medicine and of Epidemiology and Preventive Medicine, Monash University, Melbourne
| | - Neil Boudville
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - David W Johnson
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, University of Queensland, Brisbane, Australia
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30
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Rousseau-Gagnon M, Faratro R, D'Gama C, Fung S, Wong E, Chan CT. The use of vascular access audit and infections in home hemodialysis. Hemodial Int 2015; 20:298-305. [PMID: 26467170 DOI: 10.1111/hdi.12372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vascular access-related infection is an important adverse event in home hemodialysis (HHD). We hypothesize that errors in self-cannulation or manipulation of dialysis vascular access are associated with increased incidence of access-related infection. We conducted a retrospective cohort study of all prevalent HHD patients at the University Health Network. All vascular access-related infections were recorded from 2006 to 2013. Errors in dialysis access were ascertained by nurse-administered vascular access checklist. Ninety-two patients had completed at least one vascular access audit. Median HHD vintage was 2.3 (0.9-5.0) years in patients with appropriate vascular access technique and 5.8 (1.5-9.4) years in patients with erroneous vascular access technique. The overall rate of infection between patients with and without appropriate vascular access technique was similar (0.27 and 0.28 infections per year, P = 0.166). Among patients who were identified with errors in dialysis access manipulation, patients with five or more errors were associated with higher rate of access-related infection (mean of 0.47 vs. 0.16 infection per patient-year, P < 0.001). The use of vascular access audit is a feasible strategy, which can identify errors in vascular access technique. Patients with a longer median HHD vintage are associated with higher risk of inappropriate vascular access technique. Patients with multiple errors in vascular access technique are associated with a higher risk of dialysis access-related infection. Prospective evaluation of the impact of vascular access audit on adverse vascular access events is warranted.
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Affiliation(s)
| | - Rose Faratro
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Celine D'Gama
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Stella Fung
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Elizabeth Wong
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Christopher T Chan
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
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31
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Marshall MR, Young BA, Fox SJ, Cleland CJ, Walker RJ, Masakane I, Herold AM. The home hemodialysis hub: physical infrastructure and integrated governance structure. Hemodial Int 2015; 19 Suppl 1:S8-S22. [PMID: 25925827 DOI: 10.1111/hdi.12273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An effective home hemodialysis program critically depends on adequate hub facilities and support functions and on transparent and accountable organizational processes. The likelihood of optimal service delivery and patient care will be enhanced by fit-for-purpose facilities and implementation of a well-considered governance structure. In this article, we describe the required accommodation and infrastructure for a home hemodialysis program and a generic organizational structure that will support both patient-facing clinical activities and business processes.
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Affiliation(s)
- Mark R Marshall
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Renal Medicine, Counties Manukau District Health Board, Auckland, New Zealand
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32
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Naso A, Scaparrotta G, Naso E, Calò LA. Intensive Home Hemodialysis: An Eye at the Past Looking for the Hemodialysis of the Future. Artif Organs 2015; 39:736-40. [DOI: 10.1111/aor.12458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Agostino Naso
- Department of Medicine, Nephrology; University of Padova-Azienda Ospedaliera di Padova; Padova Italy
| | - Giuseppe Scaparrotta
- Department of Medicine, Nephrology; University of Padova-Azienda Ospedaliera di Padova; Padova Italy
| | - Elena Naso
- Department of Medicine, Nephrology; University of Padova-Azienda Ospedaliera di Padova; Padova Italy
| | - Lorenzo A. Calò
- Department of Medicine, Nephrology; University of Padova-Azienda Ospedaliera di Padova; Padova Italy
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33
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Ferguson TW, Tangri N, Rigatto C, Komenda P. Cost-effective treatment modalities for reducing morbidity associated with chronic kidney disease. Expert Rev Pharmacoecon Outcomes Res 2015; 15:243-52. [DOI: 10.1586/14737167.2015.1012069] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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34
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Cornelis T, Tennankore KK, Goffin E, Rauta V, Honkanen E, Őzyilmaz A, Thanaraj V, Jayanti A, Mitra S, van der Sande FM, Kooman JP, Chan CT. An international feasibility study of home haemodialysis in older patients. Nephrol Dial Transplant 2014; 29:2327-33. [DOI: 10.1093/ndt/gfu260] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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35
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Welch JL, Thomas-Hawkins C, Bakas T, McLennon SM, Byers DM, Monetti CJ, Decker BS. Needs, Concerns, Strategies, and Advice of Daily Home Hemodialysis Caregivers. Clin Nurs Res 2013; 23:644-63. [DOI: 10.1177/1054773813495407] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Improved patient outcomes have led to increased international interest in daily home hemodialysis as a kidney replacement therapy. Daily home hemodialysis often requires the assistance of a caregiver during and between treatments. Understanding the needs and concerns of caregivers of persons on daily home hemodialysis will inform the design of supportive interventions to improve caregiver retention and maintain their health and well-being. Using a descriptive qualitative design, the purpose of this study was to identify and describe the needs, concerns, strategies, and advice of family caregivers. Twenty-one caregivers were interviewed; five of these individuals were former caregivers of patients who had returned to outpatient hemodialysis. Data were collected via audio-recorded telephone interviews following a semistructured interview guide with five open-ended questions. A content analysis approach was used to code and analyze the data. Caregivers described needs, concerns, and strategies and offered advice in five predetermined major categories. Major findings included a need for respite services and a need for interventions to manage the emotional responses to caregiving. This study provides valuable information about relevant areas to consider when developing an intervention program for daily home hemodialysis caregivers.
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Affiliation(s)
- Janet L. Welch
- Indiana University School of Nursing, Indianapolis, IN, USA
| | | | - Tamilyn Bakas
- Indiana University School of Nursing, Indianapolis, IN, USA
| | | | - Doris M. Byers
- Indiana University School of Nursing, Indianapolis, IN, USA
| | | | - Brian S. Decker
- Indiana University School of Medicine, Indianapolis, IN, USA
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