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Sarafidis P, Faitatzidou D, Papagianni A. Benefits and risks of frequent or longer haemodialysis: weighing the evidence. Nephrol Dial Transplant 2020; 36:gfaa023. [PMID: 32073626 DOI: 10.1093/ndt/gfaa023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Indexed: 12/28/2022] Open
Abstract
Although the ability of individuals with end-stage renal disease to maintain body homoeostasis is equally impaired during all weekdays, conventional haemodialysis (HD) treatment is scheduled thrice weekly, containing two short and one long interdialytic interval. This intermittent nature of HD and the consequent fluctuations in volume, metabolic parameters and electrolytes have long been hypothesized to predispose to complications. Large observational studies link the first weekday with an increased risk of cardiovascular morbidity and mortality. Several schemes of frequent and/or longer, home or in-centre HD have been introduced, aiming to alleviate the above risks by both increasing total dialysis duration and reducing the duration of interdialytic intervals. Observational studies in this field have non-uniform results, showing that enhanced frequency in home (but not in-centre) HD is associated with reduced mortality. Evidence from the randomized Daily and Nocturnal Trials of the Frequent HD Network suggest the opposite, showing mortality benefits with in-centre daily but not with home nocturnal dialysis. Secondary analyses of these trials indicate that daily and nocturnal schedules do not have equal effects on intermediate outcomes. Alternative schemes, such as thrice weekly in-centre nocturnal HD or every-other-day HD, seem to also offer improvements in several intermediate endpoints, but need further testing with randomized trials. This review summarizes the effects of frequent and/or longer HD methods on hard and intermediate outcomes, attempting to provide a balanced overview of the field.
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Affiliation(s)
- Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Danai Faitatzidou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abdul Salim S, Cheungpasitporn W, Echols V, Monga D, Davidson J, Juncos LA, Fülöp T. Forty‐five years on home hemodialysis, a case of exceptional longevity. Hemodial Int 2019; 23:E120-E124. [DOI: 10.1111/hdi.12779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 08/10/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Sohail Abdul Salim
- Department of Internal Medicine, Division of NephrologyUniversity of Mississippi Medical Center Jackson Mississippi 52 USA
| | - Wisit Cheungpasitporn
- Department of Internal Medicine, Division of NephrologyUniversity of Mississippi Medical Center Jackson Mississippi 52 USA
| | - Vonda Echols
- Department of Internal Medicine, Division of NephrologyUniversity of Mississippi Medical Center Jackson Mississippi 52 USA
| | - Divya Monga
- Department of Internal Medicine, Division of NephrologyUniversity of Mississippi Medical Center Jackson Mississippi 52 USA
| | - Jamie Davidson
- Department of Internal Medicine, Division of NephrologyUniversity of Mississippi Medical Center Jackson Mississippi 52 USA
| | - Luis A. Juncos
- Division of NephrologyCentral Arkansas Veterans Healthcare System, John L. McClellan Memorial Veterans Hospital
- University of Arkansas for Medical Sciences College of Medicine Little Rock Arkansas USA
| | - Tibor Fülöp
- Department of Internal Medicine, Division of NephrologyMedical University of South Carolina Charleston South Carolina USA
- Ralph H. Johnson VA Medical Center Charleston South Carolina USA
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Kang SC, Lin CC, Chen YC, Wang WS. The Impact of Hemodialysis on Terminal Cancer Patients in Hospices: A Nationwide Retrospective Study in Taiwan. J Palliat Med 2019; 22:188-192. [PMID: 30601079 DOI: 10.1089/jpm.2018.0299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Hemodialysis (HD) is the most common renal replacement therapy for patients with end-stage renal disease in Taiwan. The use of HD in hospice care and its impact on terminal cancer patients remains unclear. METHODS Using claim data from the Taiwan National Health Insurance Research Database, all patients who died from cancer and claim data of their terminal admissions in hospice from 2007 to 2010. Those with a comorbid diagnosis of renal failure or who had health insurance claims data for HD were enrolled. RESULTS A total of 5482 subjects were identified, of whom 4484 received HD and 998 did not. The HD group was significantly correlated with a younger age and high costs of terminal hospice admission. After adjusting for age and gender, the HD group was positively associated with a long hospice stay, in-hospice death, bone/connective tissue/breast cancers, and secondary/metastatic cancers, but negatively associated with genitourinary cancer. Compared with Department of Health/municipal hospitals, patients at both national and private university-affiliated hospitals were less likely to undergo HD. CONCLUSIONS For terminal cancer patients under hospice care, HD was associated with a younger age, long terminal hospice stay, and high medical costs. Some types of cancers were associated with HD. University-affiliated hospitals played significant roles in non-HD renal supportive care. In-hospice HD is still common in Taiwan. Dialysis withdrawal and alternative care have space to promoting in hospice care.
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Affiliation(s)
- Shih-Chao Kang
- 1 Division of Family Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.,2 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Ching Lin
- 2 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,3 Department of Nephrology, Taipei Veterans Hospital, Taipei, Taiwan
| | - Yu-Chun Chen
- 2 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,4 Department of Family Medicine, Taipei Veterans Hospital, Taipei, Taiwan
| | - Wei-Shu Wang
- 2 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,5 Department of Medical Teaching and Research, National Yang-Ming University Hospital, Yilan, Taiwan
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Salim SA, Zsom L, Cheungpasitporn W, Fülöp T. Benefits, challenges, and opportunities using home hemodialysis with a focus on Mississippi, a rural southern state. Semin Dial 2018; 32:80-84. [DOI: 10.1111/sdi.12751] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sohail Abdul Salim
- Department of Medicine, Division of Nephrology; University of Mississippi Medical Center; Jackson Mississippi
- Central Nephrology Associates; Jackson Mississippi
| | - Lajos Zsom
- Hemodialysis Unit Cegléd; Fresenius Medical Care Hungary; Cegléd Hungary
| | - Wisit Cheungpasitporn
- Department of Medicine, Division of Nephrology; University of Mississippi Medical Center; Jackson Mississippi
| | - Tibor Fülöp
- Department Medicine, Division of Nephrology; Medical University of South Carolina; Charleston South Carolina
- Medical Services; Ralph H. Johnson VA Medical Center; Charleston South Carolina
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Cherukuri S, Bajo M, Colussi G, Corciulo R, Fessi H, Ficheux M, Slon M, Weinhandl E, Borman N. Home hemodialysis treatment and outcomes: retrospective analysis of the Knowledge to Improve Home Dialysis Network in Europe (KIHDNEy) cohort. BMC Nephrol 2018; 19:262. [PMID: 30314451 PMCID: PMC6186139 DOI: 10.1186/s12882-018-1059-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/26/2018] [Indexed: 02/06/2023] Open
Abstract
Background Utilization of home hemodialysis (HHD) is low in Europe. The Knowledge to Improve Home Dialysis Network in Europe (KIHDNEy) is a multi-center study of HHD patients who have used a transportable hemodialysis machine that employs a low volume of lactate-buffered, ultrapure dialysate per session. In this retrospective cohort analysis, we describe patient factors, HHD prescription factors, and biochemistry and medication use during the first 6 months of HHD and rates of clinical outcomes thereafter. Methods Using a standardized digital form, we recorded data from 7 centers in 4 Western European countries. We retained patients who completed ≥6 months of HHD. We summarized patient and HHD prescription factors with descriptive statistics and used mixed modeling to assess trends in biochemistry and medication use. We also estimated long-term rates of kidney transplant and death. Results We identified 129 HHD patients; 104 (81%) were followed for ≥6 months. Mean age was 49 years and 66% were male. Over 70% of patients were prescribed 6 sessions per week, and the mean treatment duration was 15.0 h per week. Median HHD training duration was 2.5 weeks. Mean standard Kt/Vurea was nearly 2.7 at months 3 and 6. Pre-dialysis biochemistry was generally stable. Between baseline and month 6, mean serum bicarbonate increased from 23.1 to 24.1 mmol/L (P = 0.01), mean serum albumin increased from 36.8 to 37.8 g/L (P = 0.03), mean serum C-reactive protein increased from 7.3 to 12.4 mg/L (P = 0.05), and mean serum potassium decreased from 4.80 to 4.59 mmol/L (P = 0.01). Regarding medication use, the mean number of antihypertensive medications fell from 1.46 agents per day at HHD initiation to 1.01 agents per day at 6 months (P < 0.001), but phosphate binder use and erythropoiesis-stimulating agent dose were stable. Long-term rates of kidney transplant and death were 15.3 and 5.4 events per 100 patient-years, respectively. Conclusions Intensive HHD with low-flow dialysate delivers adequate urea clearance and good biochemical outcomes in Western European patients. Intensive HHD coincided with a large decrease in antihypertensive medication use. With relatively rapid training, HHD should be considered in more patients.
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Affiliation(s)
| | - Maria Bajo
- Hospital Universitario La Paz, Servicio de Nefrologia, Madrid, Spain
| | - Giacomo Colussi
- Niguarda Hospital, Nefrologia - Centro Trapianti Rene, Milan, Italy
| | - Roberto Corciulo
- Policlinic University, Azienda Ospedaliero-Universitaria Consorziale Policlinico, Bari, Italy
| | - Hafedh Fessi
- Hôpital Tenon, Service de Néphrologie et Dialyses, Paris, France
| | - Maxence Ficheux
- CHR Clémenceau, Service Néphrologie-Hémodialyse-Transplantation, Caen, France
| | - Maria Slon
- Hospital de Navarra, Servicio de Nefrologia, Pamplona, Spain
| | - Eric Weinhandl
- NxStage Medical, Inc., 350 Merrimack Street, Lawrence, MA, 01843, USA. .,Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, MN, USA.
| | - Natalie Borman
- Queen Alexandra Hospital, Wessex Kidney Centre, Portsmouth, England
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Yu JZ, Rhee CM, Ferrey A, Li A, Jin A, Chang Y, Reddy U, Lau WL, Chou J, Inrig J, Kalantar-Zadeh K. There's no place like home: 35-year patient survival on home hemodialysis. Semin Dial 2017; 31:300-304. [PMID: 29265477 DOI: 10.1111/sdi.12660] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The vast majority of maintenance dialysis patients suffer from poor long-term survival rates and lower levels of health-related quality of life. However, home hemodialysis is a historically significant dialysis modality that has been associated with favorable outcomes as well as greater patient autonomy and control, yet only represents a small minority of the total dialysis performed in the United States. Some potential disadvantages of home hemodialysis include vascular access complications, infection-related hospitalizations, patient fatigue, and attrition. In addition, current barriers and challenges in expanding the utilization of this modality include limited patient and provider education and technical expertise. Here we report a 65-year old male with end-stage renal disease due to Alport's syndrome who has undergone 35 years of uninterrupted thrice-weekly home hemodialysis (ie, every Sunday, Tuesday, and Thursday evening, each session lasting 3 to 3¼ hours in length) using a conventional hemodialysis machine who has maintained a high functional status allowing him to work 6-8 hours per day. The patient has been able to liberalize his dietary and fluid intake while only requiring 3-4 liters of ultrafiltration per treatment, despite having absence of residual kidney function. Through this case of extraordinary longevity and outcomes after 35 years of dialysis and a review of the literature, we illustrate the history of home hemodialysis, its significant clinical and psychosocial advantages, as well as the barriers that hinder its widespread adaptation.
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Affiliation(s)
- Jerry Z Yu
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA, USA
| | - Connie M Rhee
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA, USA
| | | | - Alex Li
- Northwest Kidney Center, Snoqualmie, WA, USA
| | - Anna Jin
- Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, USA
| | - Yongen Chang
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA, USA
| | - Uttam Reddy
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA, USA
| | - Wei Ling Lau
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA, USA
| | - Jason Chou
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA, USA
| | - Jula Inrig
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA, USA.,St Joseph's Medical Center, Orange, CA, USA
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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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