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Gong Y, Xie L, Yu S. Long-Term In-Center Nocturnal Hemodialysis Improves Renal Anemia and Malnutrition and Life Quality of Older Patients with Chronic Renal Failure. Clin Interv Aging 2022; 17:915-923. [PMID: 35686029 PMCID: PMC9172732 DOI: 10.2147/cia.s358472] [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: 02/25/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022] Open
Abstract
Background Older patients with chronic renal failure (CRF) which currently is referred to as end-stage renal disease (ESRD) are associated with higher mortality. In-center nocturnal dialysis (INHD) is a new blood purification model, which is characterized by longer sessions and nighttime administration. However, no data for the efficacy of INHD in older patients with ESRD are available. This study is to analyze the effect of INHD in the treatment of older patients with ESRD. Methods A retrospective, observational study was conducted in a university teaching hospital. Seventy-two patients with ESRD receiving INHD were enrolled. They were divided into the older ESRD patients (age ≥60) group (n = 22) and the non-older ESRD patients (age <60) group (n = 50). The causes of older ESRD patients and non-older ESRD patients receiving INHD were analyzed. Differences of laboratory test indicators of older patients with ESRD before INHD and after INHD were compared. Quality of life for older ESRD patients receiving INHD was assessed by using the Kidney Disease Quality of Life-36 Instrument (KDQOL-36). Results Serum concentration of hemoglobin and serum concentration of albumin of older patients with ESRD increased significantly after INHD (p < 0.05). There were similar results in the non-older cohort (p ≤ 0.05). Scores of five KDQOL-36 subscales increased significantly after INHD (p ≤ 0.001) indicated that the quality of life for old patients with ESRD was significantly improved after INHD. Conclusion INHD is an effective blood purification therapy that can improve the condition of renal anemia, and it may provide a potential positive impact in the malnutrition of older and non-older patients with ESRD. INHD can improve the quality of life of older patients with ESRD. The results will provide a basis for formulating new policies of blood purification therapy for older patients.
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Affiliation(s)
- Yu Gong
- Department of Internal Medicine, Division of Nephrology, Telemedicine Center, Shanghai Municipal Eighth People's Hospital, Shanghai, People's Republic of China
| | - Liangyu Xie
- Department of Internal Medicine, Division of Nephrology, Shanghai Changzheng Hospital, Shanghai, People's Republic of China
| | - Shengqiang Yu
- Department of Internal Medicine, Division of Nephrology, Shanghai Changzheng Hospital, Shanghai, People's Republic of China
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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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Tennankore KK, Na Y, Wald R, Chan CT, Perl J. Short daily-, nocturnal- and conventional-home hemodialysis have similar patient and treatment survival. Kidney Int 2018; 93:188-194. [DOI: 10.1016/j.kint.2017.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/26/2017] [Accepted: 06/08/2017] [Indexed: 10/19/2022]
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Pauly RP, Eastwood DO, Marshall MR. Patient safety in home hemodialysis: quality assurance and serious adverse events in the home setting. Hemodial Int 2016; 19 Suppl 1:S59-70. [PMID: 25925825 DOI: 10.1111/hdi.12248] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Interest in home hemodialysis (HD) is high because of the reported benefits and its excellent safety record. However, the potential for serious adverse events (AEs) exists when patients perform HD in their homes without supervision. We review the epidemiology of dialysis-related emergencies during home HD, and present a conceptual and practical framework for the prevention and management of serious AEs for those patients performing home HD. In addition, we describe a formal monitored and iterative quality assurance program, and make suggestions for the future development of safety strategies to mitigate the risk of AEs in home HD.
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Affiliation(s)
- Robert P Pauly
- Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, Alberta, Canada
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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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Chazot C, Farrington K, Nistor I, Van Biesen W, Joosten H, Teta D, Siriopol D, Covic A. Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients. Int Urol Nephrol 2015; 47:1809-16. [PMID: 26377489 DOI: 10.1007/s11255-015-1107-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 12/11/2022]
Abstract
In the last decade, an increasing number of patients over 75 years of age are starting renal replacement therapy. Frailty is highly prevalent in elderly patients with end-stage renal disease (ESRD) in the context of the increased prevalence of some ESRD-associated conditions: protein-energy wasting, inflammation, anaemia, acidosis or hormonal disturbances. There are currently no hard data to support guidance on the optimal duration of dialysis for frail/elderly ESRD patients. The current debate is not about starting dialysis or managing conservatory frail ESRD patients, but whether a more intensive regimen once dialysis is initiated (for whatever reasons and circumstances) would improve patients' outcome. The most important issue is that all studies performed with extended/alternative dialysis regimens do not specifically address this particular type of patients and therefore all the inferences are derived from the general ESRD population. Care planning should be responsive to end-of-life needs whatever the treatment modality. Care in this setting should focus on symptom control and quality of life rather than life extension. We conclude that, similar to the general dialysed population, extensive application of more intensive dialysis schedules is not based on solid evidence. However, after a thorough clinical evaluation, a limited period of a trial of intensive dialysis could be prescribed in more problematic patients.
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Affiliation(s)
| | - Ken Farrington
- Renal Unit, Lister Hospital, Stevenage, Hertfordshire, UK
- Postgraduate Medical School, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Ionut Nistor
- ERBP, Ghent University Hospital, Ghent, Belgium
- Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Wim Van Biesen
- ERBP, Ghent University Hospital, Ghent, Belgium
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Hanneke Joosten
- Department of Internal Medicine, UMCG, Groningen, The Netherlands
| | - Daniel Teta
- Service of Nephrology, Department of Medicine, University Hospital Lausanne, Lausanne, Switzerland
| | - Dimitrie Siriopol
- Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Adrian Covic
- Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.
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Tennankore KK, Kim SJ, Baer HJ, Chan CT. Survival and hospitalization for intensive home hemodialysis compared with kidney transplantation. J Am Soc Nephrol 2014; 25:2113-20. [PMID: 24854268 PMCID: PMC4147990 DOI: 10.1681/asn.2013111180] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/10/2014] [Indexed: 12/25/2022] Open
Abstract
Canadian patients receiving intensive home hemodialysis (IHHD; ≥16 hours per week) have survival comparable to that of deceased donor kidney transplant recipients in the United States, but a comparison with Canadian kidney transplant recipients has not been conducted. We conducted a retrospective cohort study of consecutive, adult IHHD patients and kidney transplant recipients between 2000 and 2011 at a large Canadian tertiary care center. The primary outcome was time-to-treatment failure or death for IHHD patients compared with expanded criteria, standard criteria, and living donor recipients, and secondary outcomes included hospitalization rate. Treatment failure was defined as a permanent switch to an alternative dialysis modality for IHHD patients, and graft failure for transplant recipients. The cohort comprised 173 IHHD patients and 202 expanded criteria, 642 standard criteria, and 673 living donor recipients. There were 285 events in the primary analysis. Transplant recipients had a reduced risk of treatment failure/death compared with IHHD patients, with relative hazards of 0.45 (95% confidence interval [95% CI], 0.31 to 0.67) for living donor recipients, 0.39 (95% CI, 0.26 to 0.59) for standard criteria donor recipients, and 0.42 (95% CI, 0.26 to 0.67) for expanded criteria donor recipients. IHHD patients had a lower hospitalization rate in the first year of treatment compared with standard criteria donor recipients and in the first 3 months of treatment compared with living donor and expanded criteria donor recipients. In this cohort, kidney transplantation was associated with superior treatment and patient survival, but higher early rates of hospitalization, compared with IHHD.
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Affiliation(s)
| | - S Joseph Kim
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Heather J Baer
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; and Department of Epidemiology, Harvard School of Public Health, Boston Massachusetts
| | - Christopher T Chan
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Aydede SK, Komenda P, Djurdjev O, Levin A. Chronic kidney disease and support provided by home care services: a systematic review. BMC Nephrol 2014; 15:118. [PMID: 25033891 PMCID: PMC4127071 DOI: 10.1186/1471-2369-15-118] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 06/19/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Chronic diseases, such as chronic kidney disease (CKD), are growing in incidence and prevalence, in part due to an aging population. Support provided through home care services may be useful in attaining a more efficient and higher quality care for CKD patients. METHODS A systematic review was performed to identify studies examining home care interventions among adult CKD patients incorporating all outcomes. Studies examining home care services as an alternative to acute, post-acute or hospice care and those for long-term maintenance in patients' homes were included. Studies with only a home training intervention and those without an applied research component were excluded. RESULTS Seventeen studies (10 cohort, 4 non-comparative, 2 cross-sectional, 1 randomized) examined the support provided by home care services in 15,058 CKD patients. Fourteen studies included peritoneal dialysis (PD), two incorporated hemodialysis (HD) and one included both PD and HD patients in their treatment groups. Sixteen studies focused on the dialysis phase of care in their study samples and one study included information from both the dialysis and pre-dialysis phases of care. Study settings included nine single hospital/dialysis centers and three regional/metropolitan areas and five were at the national level. Studies primarily focused on nurse assisted home care patients and mostly examined PD related clinical outcomes. In PD studies with comparators, peritonitis risks and technique survival rates were similar across home care assisted patients and comparators. The risk of mortality, however, was higher for home care assisted PD patients. While most studies adjusted for age and comorbidities, information about multidimensional prognostic indices that take into account physical, psychological, cognitive, functional and social factors among CKD patients was not easily available. CONCLUSIONS Most studies focused on nurse assisted home care patients on dialysis. The majority were single site studies incorporating small patient populations. There are gaps in the literature regarding the utility of providing home care to CKD patients and the impact this has on healthcare resources.
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Affiliation(s)
- Sema K Aydede
- School of Population and Public Health, The University of British Columbia and Provincial Health Services Authority, 700-1380 Burrard Street, Vancouver, BC V6Z 2H3, Canada
| | - Paul Komenda
- Faculty of Medicine, Section of Nephrology, University of Manitoba and Seven Oaks General Hospital, Room 2PD02 – 2300 McPhillips Street, Winnipeg, MB R2V 3M3, Canada
| | - Ognjenka Djurdjev
- British Columbia Provincial Renal Agency, Providence Bldg, Room 570.4, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Adeera Levin
- Division of Nephrology, Providence Bldg, Room 6010A, The University of British Columbia and British Columbia Provincial Renal Agency, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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Tennankore K, Nadeau-Fredette AC, Chan CT. Intensified home hemodialysis: clinical benefits, risks and target populations. Nephrol Dial Transplant 2013; 29:1342-9. [DOI: 10.1093/ndt/gft383] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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