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Quiroga B, Giorgi M, Barril G. During COVID-19 stay at home even if you are a hemodialysis patient. Ther Apher Dial 2020; 25:705-706. [PMID: 33340228 DOI: 10.1111/1744-9987.13615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Borja Quiroga
- Nephrology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Martín Giorgi
- Nephrology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Guillermina Barril
- Nephrology Department, Hospital Universitario de La Princesa, Madrid, Spain
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Diebel L, Jafari M, Shah S, Day C, McNaught C, Prasad B. Barriers to Home Hemodialysis Across Saskatchewan, Canada: A Cross-Sectional Survey of In-Center Dialysis Patients. Can J Kidney Health Dis 2020; 7:2054358120948293. [PMID: 32843987 PMCID: PMC7418229 DOI: 10.1177/2054358120948293] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/24/2020] [Indexed: 01/28/2023] Open
Abstract
Background Despite clinical and lifestyle advantages of home hemodialysis (HHD) compared with in-center hemodialysis (ICHD), it remains underutilized in our province. The aim of the study was to explore the patients' perception and to identify the barriers to use of HHD in Saskatchewan, Canada. Objectives The primary objective of the study was to evaluate and explore patient perceptions of HHD and to identify the obstacles for adoption of HHD in Saskatchewan. The secondary objective was to examine variations in the patients' perceptions and barriers to HHD by center (main dialysis units vs satellite dialysis units). Design This is a cross-sectional observational survey study. Setting Two major centers (Regina and Saskatoon) and 5 associated satellite units attached to each center across the province of Saskatchewan. Patients We approached all prevalent ICHD patients across Saskatchewan, 398 agreed to participate in the study. Measurements Self-reported barriers to HHD were assessed using a questionnaire. Methods A questionnaire was designed to determine the patients' perceived barriers to HHD. Descriptive statistics was used to present the data. Chi-square and Mann-Whitney U test were used to compare the patients' responses between main and satellite units. Results Satisfaction with current dialysis care (91%), increase in utility bills (65%), fear of catastrophic events at home (59%), medicalization of one's home (54%), and knowledge deficits toward treatment modalities (54%) were the main barriers to HHD uptake. Compared with patients dialyzing in our main units, satellite patients chose not to pursue HHD more frequently because they had greater satisfaction with their current dialysis unit care (97% vs 87%, P < .001), felt more comfortable dialyzing under the supervision of medical staff (95% vs 86%, P < .007), could not afford additional utility costs (92% vs 45%, P < .001), were unaware of the risks and benefits of HHD (83% vs 33%, P < .001), had concerns over time commitments for training to HHD (69% vs 32%, P < .001), and had concern for family burnout (60.8% vs 40.6%, P < .001). Limitations We used questionnaires to quantify known barriers, and this prevents inclusion of additional barriers that individual patients may consider important. Cross-sectional data can only be used as a snapshot. Only 398 patients agreed to participate, and the results cannot be generalized to 740 prevalent HD patients. We did not capture data on demographics (age, income, and literacy level), comorbidities, and dialysis vintage, which would have been helpful in interpretation of the results. Conclusions Satisfaction with in-center care, lack of awareness and education, specifically in the satellite population, concerns with family burnout, expenses associated with utilities, and training time will need to be addressed to increase the uptake of HHD. Trial Registration The study was not registered on a publicly accessible registry as it did not involve any health care intervention on human participants.
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Affiliation(s)
- Lucas Diebel
- College of Medicine, University of Saskatchewan, Regina, Canada
| | - Maryam Jafari
- Dr. T. Bhanu Prasad Medical Professional Corporation, Regina, SK, Canada
| | - Sachin Shah
- Section of Nephrology, Department of Medicine, St. Paul's Hospital, Saskatoon, SK, Canada
| | - Christine Day
- Peritoneal Dialysis, Regina General Hospital, Saskatchewan Health Authority, Regina, Canada
| | - Connie McNaught
- Hemodialysis, Regina General Hospital, Saskatchewan Health Authority, Regina, Canada
| | - Bhanu Prasad
- Section of Nephrology, Department of Medicine, Regina General Hospital, Saskatchewan Health Authority, Regina, 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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Vaartio-Rajalin H, Fagerström L. Professional care at home: Patient-centredness, interprofessionality and effectivity? A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e270-e288. [PMID: 30843316 DOI: 10.1111/hsc.12731] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/07/2019] [Accepted: 02/09/2019] [Indexed: 06/09/2023]
Abstract
The aim of this scoping review was to describe the state of knowledge on professional care at home with regard to different perspectives on patient-centredness, content of care, interprofessional collaboration, competence framework and effectivity. A scoping review, n = 35 papers, from four databases (EBSCO, CINAHL, Medline, Swemed) were reviewed between May and August 2018 using the terms: hospital-at-home, hospital-in-the-home, advanced home healthcare, hospital-based home care or patient-centered medical home. Criteria for inclusion in this review included full text papers, published between 2001 and 2018, in English, Swedish or Finnish. A descriptive content analysis was conducted. Patient-centredness appears to be one aim of professional care at home, but clarity is lacking regarding patient recruitment and the planning and evaluation of care. Content depends, to a certain degree, on the type of care at home and how it is organised: the more non-acute care needs, the more nurse-coordinated care and family involvement and the less interprofessionality. The competence framework presupposed for care at home was extensive yet not explicit, varying from maturity, clinical experience, collaboration skills, ongoing clinical assessment education to Master's studies or degree. The effectivity of care at home services was discussed in terms of experiential, clinical and economic aspects. Patients and their family caregivers were satisfied with care at home, but there was no consensus on clinical or economic outcomes compared with inpatient care. In the context of professional care at home, there is still a lot to do regarding patient-centredness, patient recruitment, patient and care staff education, the organisation of interprofessional collaboration and the analysis of effectivity.
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Affiliation(s)
- Heli Vaartio-Rajalin
- Department of Caring Science, Åbo Akademi University, Vasa, Finland
- Nursing Program, Novia University of Applied Sciences, Åbo, Finland
| | - Lisbeth Fagerström
- Department of Caring Science, Åbo Akademi University, Vasa, Finland
- University of South-Eastern Norway, Kongsberg, Norway
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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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de Maar JS, de Groot MAJ, Luik PT, Mui KW, Hagen EC. GUIDE, a structured pre-dialysis programme that increases the use of home dialysis. Clin Kidney J 2016; 9:826-832. [PMID: 27994863 PMCID: PMC5162404 DOI: 10.1093/ckj/sfw037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/30/2016] [Indexed: 11/14/2022] Open
Abstract
Background Despite the many advantages it offers, the percentage of dialysis patients that receive home dialysis [peritoneal dialysis (PD) or home haemodialysis (HHD)] in the Netherlands has declined over the last decade. Pre-dialysis education could stimulate the use of home dialysis. This article presents the results of the pre-dialysis programme GUIDE, with regard to the following question: Does the implementation of a structured pre-dialysis programme with a home-focused approach increase the number of pre-dialysis patients that choose and receive home dialysis? Methods The GUIDE process starts when a patient has an eGFR of 15 mL/min/1.73 m2. The process begins with a home visit from a case manager and the completion of questionnaires by the patient, the case manager and the nephrologist. A multidisciplinary meeting (MDM) is held to determine a specific patient profile (or treatment recommendation). This is followed by patient education, a second MDM and finally the selection of the treatment by the patient and the nephrologist. This retrospective observational study describes the selection process of all patients that received a treatment recommendation between 12 September 2013 and 18 December 2014 at Meander Medical Centre. Data were collected by file research and analysis of questionnaires. Results One hundred and two patients were included. They started the process at a mean eGFR of 12.3 mL/min/1.73 m2. Home dialysis was recommended for 62.8% of the patients who were advised to have dialysis treatment. Of the patients that opted for dialysis, 34.2% chose PD and 8.2% chose HHD; 22.9% started home dialysis as their first therapy, compared with 17.6% in the months before implementation of GUIDE. Finally, 32.1% of the patients that received dialysis therapy received home dialysis. In the months before GUIDE, an average of just 19.5% of the patients that received dialysis received home dialysis. Conclusions In comparison to historical data, the pre-dialysis programme GUIDE increases the number of patients that choose and receive home dialysis.
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Affiliation(s)
- Josanne S de Maar
- Department of Internal Medicine, Meander Medical Centre, Amersfoort, The Netherlands
| | | | - Peter T Luik
- Department of Nephrology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Kwok Wai Mui
- Department of Nephrology, Meander Medical Centre, Amersfoort, The Netherlands
| | - E Christiaan Hagen
- Department of Nephrology, Meander Medical Centre, Amersfoort, The Netherlands
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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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Howard K, McFarlane PA, Marshall MR, Eastwood DO, Morton RL. Funding and planning: what you need to know for starting or expanding a home hemodialysis program. Hemodial Int 2015; 19 Suppl 1:S23-42. [PMID: 25925821 DOI: 10.1111/hdi.12243] [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
Planning and funding a home hemodialysis (HD) program requires a well-organized effort and close collaboration between clinicians and administrators. This resource provides guidance on the processes that are involved, including a thorough situational analysis of the dialysis landscape, emphasizing the opportunity for a home HD program; careful consideration of the clinical and operational characteristics of a proposed home HD program at your institution; the development of a compelling business case, highlighting the clinical and organizational benefits of a home HD program; and careful construction and evaluation of a request for proposal.
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Affiliation(s)
- Kirsten Howard
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Marshall MR, Young BA, Fox SJ, Cleland CJ, Walker RJ, Masakane I, Herold AM. The home hemodialysis hub: physical infrastructure and integrated governance structure. Hemodial Int 2015; 19 Suppl 1:S8-S22. [PMID: 25925827 DOI: 10.1111/hdi.12273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An effective home hemodialysis program critically depends on adequate hub facilities and support functions and on transparent and accountable organizational processes. The likelihood of optimal service delivery and patient care will be enhanced by fit-for-purpose facilities and implementation of a well-considered governance structure. In this article, we describe the required accommodation and infrastructure for a home hemodialysis program and a generic organizational structure that will support both patient-facing clinical activities and business processes.
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Affiliation(s)
- Mark R Marshall
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Renal Medicine, Counties Manukau District Health Board, Auckland, New Zealand
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Bennett PN, Schatell D, Shah KD. Psychosocial aspects in home hemodialysis: A review. Hemodial Int 2015; 19 Suppl 1:S128-34. [DOI: 10.1111/hdi.12258] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Paul N. Bennett
- Western Health; Deakin University; Melbourne Victoria Australia
| | - Dori Schatell
- Medical Education Institute, Inc.; Madison Wisconsin USA
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Mitra S, Cress C, Goovaerts T. Workforce development and models of care in home hemodialysis. Hemodial Int 2015; 19 Suppl 1:S43-51. [PMID: 25925823 DOI: 10.1111/hdi.12291] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sandip Mitra
- Department of Nephrology; Central Manchester University Hospitals; Manchester UK
| | - Cheryl Cress
- Department of Medicine; Washington University; St. Louis Missouri USA
| | - Tony Goovaerts
- Department of Nephrology; University Hospital St. Luc; Brussels Belgium
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12
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Tennankore KK, Chan CT, Curran SP. Intensive home haemodialysis: benefits and barriers. Nat Rev Nephrol 2012; 8:515-22. [DOI: 10.1038/nrneph.2012.145] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Reid C, Hall J, Boys J, Lewis S, Chang A. Self management of haemodialysis for End Stage Renal Disease: a systematic review. ACTA ACUST UNITED AC 2011. [DOI: 10.11124/jbisrir-2011-71] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Reid C, Hall J, Boys J, Lewis S, Chang A. Self management of haemodialysis for End Stage Renal Disease: a systematic review. ACTA ACUST UNITED AC 2011; 9:69-103. [DOI: 10.11124/01938924-201109030-00001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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