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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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Hayat A, Cho Y, Pascoe E, Krishnasamy R, Borlace M, Chen J, Boudville N, Sud K, Varnfield M, Francis R, Pitt R, Hughes JT, Johnson DW. Uptake and Outcomes of Peritoneal Dialysis among Aboriginal and Torres Strait Islander People: Analysis of Registry Data. Kidney Int Rep 2024; 9:1484-1495. [PMID: 38707791 PMCID: PMC11068974 DOI: 10.1016/j.ekir.2024.01.059] [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: 10/16/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Peritoneal dialysis (PD) enables people to use kidney replacement therapy (KRT) outside of healthcare-dependent settings, a strong priority of Aboriginal and Torres Strait Islander people. Methods We undertook an observational study analyzing registry data to describe access to PD and its outcome as the first KRT among Aboriginal and Torres Strait Islander people between January 1, 2004 and December 31 2020. Results Out of 4604 Aboriginal and Torres Strait Islander people, reflecting 10.4% of all Australians commencing KRT, PD was the first KRT modality among 665 (14.4%). PD utilization was 17.2% in 2004 to 2009 and 12.7% in 2016 to 2020 (P = 0.002); 1105 episodes of peritonitis were observed in 413 individuals, median of 3 (interquartile range [IQR], 2-5) episodes/patient. The crude peritonitis rate was 0.53 (95% confidence interval [CI], 0.50-0.56) episodes/patient-years without any significant changes over time. The median time to first peritonitis was 1.1 years. A decrease in the peritonitis incidence rate ratio (IRR) was observed in 2016 to 2020 (IRR, 0.63 [95% CI, 0.52-0.77], P < 0.001) compared to earlier eras (2010-2015: IRR, 0.90 [95% CI, 0.76-1.07], P = 0.23; Ref: 2004-2009). The cure rates decreased from 80.0% (n = 435) in 2004 to 2009, to 70.8% (n = 131) in 2016 to 2020 (P < 0.001). Conclusion Aboriginal and Torres Strait Islander people who utilized PD as their first KRT during 2004 to 2020 recorded a higher peritonitis rate than the current benchmark of 0.4 episodes/patient-years. The cure rates have worsened recently, which should be a big concern. There is an exigent need to address these gaps in kidney care for Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Ashik Hayat
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Yeoungjee Cho
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - E.M. Pascoe
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Rathika Krishnasamy
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Sunshine Coast University Hospital, Queensland, Australia
| | - Monique Borlace
- Department of Nephrology, Royal Adelaide Hospital, Adelaide, Australia
| | - Jenny Chen
- Department of Renal Medicine, Wollongong Hospital, Wollongong, Australia
- School of Medicine, University of Wollongong, Wollongong, Australia
| | - Neil Boudville
- Medical School, University of Western Australia, Perth, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Kamal Sud
- Nepean KIdney Research Centre, Department of Renal Medicine, Nepean Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - M. Varnfield
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Australian e-Health Research Centre; CSIRO, Brisbane, Australia
| | - Ross Francis
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Rochelle Pitt
- Inala Indigenous Health Services, Queensland, Australia
| | - Jaquelyne T. Hughes
- Royal Darwin Hospital, Northern Territory, Darwin, Australia
- Rural and Remote Health, College of Medicine and Public Health, Flinders University Northern Territory, Nhulunbuy, Australia
- Wagadagam tribe of near west Torres Strait
| | - David Wayne Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
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Assessing the Delivery of Coordinated Care to Patients with Advanced Chronic Kidney Disease in Ontario, Canada: A Survey of Patients and Healthcare Professionals. Int J Integr Care 2021; 21:30. [PMID: 34220394 PMCID: PMC8231462 DOI: 10.5334/ijic.5587] [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] [Indexed: 12/04/2022] Open
Abstract
Introduction: Patients with advanced Chronic Kidney Disease (CKD) have complex health needs, and thus require care that is coordinated across professionals and organizations. This study aimed to describe the extent of coordinated care delivery for patients with advanced CKD from the perspectives of both patients and healthcare professionals. Methods: The Coordination Scale of the Patient Assessment of Chronic Illness Care (PACIC-26) survey was administered to a random sample of 14,257 patients on maintenance dialysis or receiving care in end-stage kidney disease preparation clinics in Ontario, Canada. A five-item survey was administered to 596 multidisciplinary nephrology professionals. Results: Among the 1,925 patient respondents, 67% reported they had been referred to an allied health professional; 19% had been encouraged to attend programs in the community; and 34% had been told how their visits with other types of doctors helped their treatment (% reporting “always” or “most of the time”). Patient responses were significantly different by treatment modality/setting, but not by gender or geographic location of treatment facility. Among the 276 professional respondents, 37% reported their patients’ care was well-coordinated across settings; 56% reported participating in interdisciplinary care planning discussions; and 53% reported they are aware of appropriate home and community services to support their patients (% reporting “always” or “most of the time”). Conclusion: The results suggest that care for patients with advanced CKD in Ontario is not consistently coordinated. Healthcare professionals may enhance patient perceptions of coordinated care through explicit communication with patients about how the professionals they see and treatments or services they receive influence their overall health and well-being. At a systems level, there is a need to improve professional awareness of and linkages to home- and community-based services.
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Alghamdi AA, Almotairy KA, Aljoaid RM, Al Turkistani NA, Domyati RW, Morsy Abdelrahman MM, Samer Shobain K, Uys CM. The Impact of a Pre-Dialysis Educational Program on the Mode of Renal Replacement Therapy in a Saudi Hospital: A Retrospective Cohort Study. Cureus 2020; 12:e11981. [PMID: 33312832 PMCID: PMC7725448 DOI: 10.7759/cureus.11981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background Self-care and peritoneal dialysis (PD) benefits have been underutilized in patients with end-stage renal disease (ESRD). The pre-dialysis education program (PDEP) has been generally introduced as an acceptable tool in increasing the rates of PD and has been reportedly recommended for ESRD patients as part of the introduced care. We aim to study the effect of PDEP on ESRD and whether they would prefer PD of center-based hemodialysis (HD). Methods This is a retrospective cohort study that was done at King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia, in the dialysis center. Data were collected on patients and included demographics, preference of renal replacement therapy modality, and other possible factors that may affect patient choices such as educational level, economic status, and age. Results A total of 213 ESRD patients that met our criteria were included, with a total of 75 patients receiving PDEP. Out of those who received the PDEP, 57.3% and 42.7% of patients decided to perform HD and PD, respectively. There was a significant impact of PDEP on reducing HD choice [OR (95% CI) = 0.11 (0.05-0.24); P-value < 0.001]. Infections did not occur in 50.5% of the included patients while 45.8%, 3.3%, and 0.5% had central line-associated bloodstream infection (CLABSI), other infections, and peritonitis, respectively. Most of the PD patients (81.8%) did not have an infection as compared to 42.3% of the HD patients. HD was also associated with increased admission days [OR (95% CI) = 1.27 (1.07-1.51); P-value = 0.007]. Conclusion We found that PDEP positively impacted the rate of PD while PD was associated with favorable outcomes and lower infection rates, emphasizing the importance of an educational program.
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Affiliation(s)
- Ahlam A Alghamdi
- Health Education Department, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Khalid A Almotairy
- Family Medicine: Health Education Department, King Fahad Armed Forces Hospital, Jeddah, SAU
| | | | | | | | | | | | - Cathariena M Uys
- Nursing: Quality Department, King Fahad Armed Forces Hospital, Jeddah, SAU
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Wong JH, Pierratos A, Oreopoulos DG, Mohammad R, Benjamin–Wong F, Chan CT. The Use of Nocturnal Home Hemodialysis as Salvage Therapy for Patients Experiencing Peritoneal Dialysis Failure. Perit Dial Int 2020. [DOI: 10.1177/089686080702700613] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Failure of peritoneal dialysis (PD) results in poor quality of life and worsening morbidity in patients with end-stage renal disease (ESRD). Traditionally, hospital-based conventional hemodialysis has been the only option for this patient population. We hypothesized that nocturnal home hemodialysis (NHD), 3 – 6 sessions per week, 6 – 8 hours per session, is a suitable alternative salvage therapy for this vulnerable patient group. Methods This is a descriptive cohort study of all consecutive ESRD patients failing PD that were converted to NHD at the University Health Network and Humber River Regional Hospital from 2003 to 2005. Our primary objective was to describe the changes in clinical and biochemical indices before and after conversion from PD to NHD. Results 69 patients required transfer from PD to another form of renal replacement therapy during the period of interest. Our pilot cohort included 8 ESRD patients (5 males, 3 females; age 53 ± 7 years). Mean duration on PD was 4.8 ± 4.6 years. NHD delivered a higher dose of dialysis, as reflected by lower plasma creatinine concentration 1 year after beginning NHD (from 1107 ± 312 μmol/L with PD to 649 ± 309 μmol/L, p = 0.01) and a rise in standardized Kt/V (from 2.21 ± 0.73 with PD to 4.49 ± 1.92 after 6 months of NHD, to 4.51 ± 1.77 after 1 year of NHD; p < 0.001). There was a progressive and sustained rise in plasma albumin after conversion to NHD (from 31 ± 4 g/L with PD to 36 ± 4 g/L after 6 months of NHD, to 39 ± 2 g/L after 1 year of NHD; p = 0.001). Hemoglobin concentrations increased (from 102 ± 13 to 125 ± 7 g/L, p = 0.03), while erythropoietin requirement tended to fall (from 17500 ± 8669 to 9197 ± 7573 U/week). Plasma phosphate fell (from 2.1 ± 0.6 to 1.1 ± 0.3 mmol/L, p = 0.01) despite a decrease in phosphate binder requirement. Blood pressure profile also tended to improve after conversion to NHD. Conclusion Nocturnal HD represents a promising, viable, alternative renal replacement therapy for patients experiencing PD failure. The clinical impact of transferring ESRD patients failing PD to NHD deserves further investigation.
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Affiliation(s)
- Joseph H.S. Wong
- Division of Nephrology, Queen Elizabeth Hospital, Hong Kong, China
| | | | | | - Reem Mohammad
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
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Elhassan EA, Kaballo B, Fedail H, Abdelraheem MB, Ali T, Medani S, Tammam L, Basheir I, Taha A, Mandour M, Awad KE, Abu-Aisha H. Peritoneal Dialysis in the Sudan. Perit Dial Int 2020. [DOI: 10.1177/089686080702700505] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background End-stage renal disease is a significant social and economic burden on the Sudan. Continuous ambulatory peritoneal dialysis (CAPD) was recently introduced as a national service and is provided free of charge by the Federal State. We present here an overview of our experience and outcomes after the first 20 months of operation of the National Program, displaying its organization and patient and technique survival, peritonitis rates, and adequacy parameters of the first patients to undergo CAPD. Methods As a national experiment, the program was sequentially launched in 5 adult and 2 pediatric centers in Khartoum, the capital city of the country. The data include the entire 111 patients who underwent CAPD from June 2005 to January 2007. All data were reported to, and analyzed at, the head office of the Sudan National Peritoneal Dialysis Program. Results CAPD is the modality exclusively utilized thus far. Automated PD will be added to the program this year. By 30 January 2007, the total number of patients enrolled was 111. Their age range was 1 – 75 (median 56) years. 20 patients (18%) were shifted to hemodialysis and 5 patients received living related kidney transplants. Two died of severe septicemia due to peritonitis; 16 (14%) others died of non-PD-related causes. There were 60 cases of peritonitis in 839 patient-months, which equates to an overall peritonitis rate of 1 episode every 14 months (0.87 episodes per year at risk). The individual center rates varied. A critical review of cases at the end of the first year showed a statistically significant age difference, with peritonitis being more common in the younger patients. Mean age of patients that developed peritonitis was 30.53 years, whereas that for peritonitis-free patients was 44.09 years ( p = 0.025). All patients that had peritonitis presented with abdominal pain and had a cloudy effluent; none had exit-site or tunnel infection. The culture-negative peritonitis rate was 53%. Pseudomonas species were responsible for 13.3% and Staphylococcus aureus for 6.7%. Touch contamination was the likely mechanism behind 46.7% of the episodes. There were 3 cases of refractory peritonitis and a single case of relapsing peritonitis. Concerning PD adequacy, average Kt/V urea was 1.74; weekly creatinine clearance was 62.5 L/1.73 m2. Average normalized protein catabolic rate, as a measure of dietary protein intake in patients in a steady state, was 1.17 g/kg. These measures indicate that the overall program adequacy was satisfactory and the values fall within the recommended ranges. Conclusion The first 20 months of operation of the Sudan's National Peritoneal Dialysis Program have proven that it is a promising project with multifaceted success. The adequacy indicators are acceptable but the cumulative peritonitis incidence is above that recommended, indicating several areas for potential improvement. Although CAPD is highly cost-effective, ongoing difficulties, including the cost of medications and laboratory tests, are being sorted out with official support and public involvement.
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Affiliation(s)
| | | | | | | | - Tigani Ali
- Soba University Hospital Khartoum, Sudan
| | - Safaa Medani
- Jaafar Ibn Auf Pediatric Hospital Khartoum, Sudan
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Chan C, Combes G, Davies S, Finkelstein F, Firanek C, Gomez R, Jager KJ, George VJ, Johnson DW, Lambie M, Madero M, Masakane I, McDonald S, Misra M, Mitra S, Moraes T, Nadeau-Fredette AC, Mukhopadhyay P, Perl J, Pisoni R, Robinson B, Ryu DR, Saran R, Sloand J, Sukul N, Tong A, Szeto CC, Van Biesen W. Transition Between Different Renal Replacement Modalities: Gaps in Knowledge and Care-The Integrated Research Initiative. Perit Dial Int 2019; 39:4-12. [PMID: 30692232 DOI: 10.3747/pdi.2017.00242] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/06/2018] [Indexed: 12/27/2022] Open
Abstract
Patients with end-stage kidney disease (ESKD) have different options to replace the function of their failing kidneys. The "integrated care" model considers treatment pathways rather than individual renal replacement therapy (RRT) techniques. In such a paradigm, the optimal strategy to plan and enact transitions between the different modalities is very relevant, but so far, only limited data on transitions have been published. Perspectives of patients, caregivers, and health professionals on the process of transitioning are even less well documented. Available literature suggests that poor coordination causes significant morbidity and mortality.This review briefly provides the background, development, and scope of the INTErnational Group Research Assessing Transition Effects in Dialysis (INTEGRATED) initiative. We summarize the literature on the transition between different RRT modalities. Further, we present an international research plan to quantify the epidemiology and to assess the qualitative aspects of transition between different modalities.
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Affiliation(s)
| | - Christopher Chan
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Gill Combes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Simon Davies
- Institute for Applied Clinical Sciences, Keele University, Keele, UK, and Department of Nephrology, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | | | | | | | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, The Netherlands
| | | | | | - Mark Lambie
- Institute for Applied Clinical Sciences, Keele University, Keele, UK, and Department of Nephrology, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | | | - Ikuto Masakane
- Department of Nephrology, Yabuki Hospital, Yamagata, Japan
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia, and University of Adelaide, Adelaide, Australia
| | - Madhukar Misra
- Department of Medicine, Division of Nephrology, University of Missouri, Columbia, MO, USA
| | - Sandip Mitra
- Nephrology Department, Central Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Thyago Moraes
- Nephrology, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | | | | | - Jeff Perl
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Ronald Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Rajiv Saran
- Division of Nephrology, Department of Medicine & Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - James Sloand
- Renal Division, Baxter Healthcare Corporation, Deerfield, IL, USA
| | - Nidhi Sukul
- Nephrology Department, University of Michigan, Ann Arbor, MI, USA
| | - Allison Tong
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Cheuk-Chun Szeto
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Otero González A, Iglesias Forneiro A, Camba Caride MJ, Pérez Melón C, Borrajo Prol MP, Novoa Fernández E, Arenas Moncaleano IG, Uribe Moya S, Lagoa Labrador F. Supervivencia en hemodiálisis vs. diálisis peritoneal y por transferencia de técnica. Experiencia en Ourense 1976-2012. Nefrologia 2015; 35:562-6. [DOI: 10.1016/j.nefro.2015.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/03/2015] [Indexed: 10/22/2022] Open
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Nadeau-Fredette AC, Chan CT, Cho Y, Hawley CM, Pascoe EM, Clayton PA, Polkinghorne KR, Boudville N, Leblanc M, Johnson DW. Outcomes of integrated home dialysis care: a multi-centre, multi-national registry study. Nephrol Dial Transplant 2015; 30:1897-904. [PMID: 26044832 DOI: 10.1093/ndt/gfv132] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/06/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The 'integrated home dialysis' model involving initiation of peritoneal dialysis (PD) first followed by home haemodialysis (HHD) has previously been proposed as an optimal form of dialysis that maximizes the advantages of both modalities. While this model has great potential, its clinical outcomes, especially compared with direct HHD initiation, remain uncertain. METHODS All incident home dialysis patients from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry between 2000 and 2012 were included. Propensity score matching was performed to evaluate patients initially treated with PD followed by HHD ('PD + HHD'), PD without subsequent transition to HHD ('PD only') and HHD without subsequent transition to PD ('HHD only'). The composite primary outcome was death and home dialysis technique failure (defined as transfer to facility haemodialysis for 90 days). Groups were compared using a Cox proportional hazards model. RESULTS The 2:1 matched cohort included 84 patients in the 'PD + HHD' group, 168 patients in the 'HHD only' group and 168 patients in the 'PD only' group. Compared with the 'PD + HHD' group, death and home dialysis technique failure was similar for patients treated with 'HHD only' [hazard ratio (HR) 0.92, 95% confidence interval (CI) 0.52-1.62; P = 0.77] and higher for those treated with 'PD only' (HR 3.22, 95% CI 1.97-5.25; P < 0.001). CONCLUSION Patients treated with PD first followed by HHD had a risk of death and home dialysis technique failure that was comparable to those treated with HHD as the only home dialysis modality and inferior to those treated with PD as the only home dialysis modality. These results support the 'integrated home dialysis model' in patients who initiate dialysis with PD.
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Affiliation(s)
- Annie-Claire Nadeau-Fredette
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Université de Montreal, Montreal, Canada
| | - Christopher T Chan
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Yeoungjee Cho
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Carmel M Hawley
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Elaine M Pascoe
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kevan R Polkinghorne
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Department of Nephrology, Monash Medical Centre Monash Health, Clayton, Australia Departments of Medicine & Epidemiology & Preventative Medicine, Monash University, Melbourne, Australia
| | - Neil Boudville
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | | | - David W Johnson
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
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10
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Mendelssohn DC. Debate: Should dialysis at home be mandatory for all suitable ESRD patients?: patients should not be forced onto home dialysis. Semin Dial 2014; 28:155-8. [PMID: 25439673 DOI: 10.1111/sdi.12323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Outcomes are similar between hospital-based hemodialysis and less expensive home-based therapies, especially home peritoneal dialysis. Because of this, some have argued that all suitable patients should be forced to these less expensive modalities. However, such an approach would violate the ethical principles of autonomy and maleficence, and would run counter to the movement toward patient-centered care. Therefore, from a North American perspective, home dialysis should be actively promoted for suitable patients, but should not be mandatory. Extending these arguments into newer paradigms of home- and community-based dialysis, with paid assistance, will be a challenge as traditional cost effectiveness arguments may not be definitive and effective. Nephrology will need to embrace new methods for evaluation of therapies and to develop and endorse sophisticated principles of advocacy to influence health care policy and funding decision makers to maximize nonhospital-based, patient-centered care and improve outcomes in the future.
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11
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Nadeau-Fredette AC, Bargman JM, Chan CT. Clinical outcome of home hemodialysis in patients with previous peritoneal dialysis exposure: evaluation of the integrated home dialysis model. Perit Dial Int 2014; 35:316-23. [PMID: 24584602 DOI: 10.3747/pdi.2013.00163] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 09/03/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Home dialysis is a cost-effective modality of renal replacement therapy associated with excellent outcomes. Peritoneal dialysis (PD) is the most common home-based modality, but technique failure remains a problem. Transfer from PD to home hemodialysis (HHD) allows the patient to continue with a home-based modality, but the outcomes of patients transitioning to HHD after PD are largely unknown. METHODS In a retrospective cohort study, including all consecutive HHD patients between January 1996 and December 2011, we evaluated the outcomes of patients with previous PD exposure compared to those without. The primary outcome was the cumulative patient and technique survival. Secondary outcomes included time to first hospitalization and hospitalization rate. Data were compared using the log-rank test and a multivariable Cox proportional hazards model. RESULTS Among our cohort of 207 consecutive HHD patients, 35 (17%) had previous exposure to PD. Median renal replacement therapy (RRT) vintage (12.3 years, interquartile range (IQR) 8.5 - 18.9 vs 0.9 years, IQR 0.2 - 7.5, p < 0.001) and Charlson comorbidity index (CCI) (4, IQR 2 - 6 vs 3, IQR 2 - 4, p = 0.044) were higher among patients with PD exposure than those without. Despite the difference in vintage, cumulative patient and technique survival was similar in the two groups, in both unadjusted (log-rank p = 0.893) and Cox adjusted models (hazard ratio (HR) 1.15, 95% confidence interval (CI) 0.51 - 2.59) for patients with PD exposure compared to those without. The time to first hospitalization was shorter in patients with previous PD exposure compared to PD-naïve patients (log-rank p = 0.021). This association was preserved in the Cox proportional model (HR 1.65, 95% CI 1.08 - 2.54). CONCLUSION Despite a higher burden of comorbidity, patients with previous PD exposure had similar cumulative patient and technique survival on HHD compared to those without PD exposure. Whenever possible, HHD should be considered in PD patients in need of a new dialysis modality.
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Affiliation(s)
| | - Joanne M Bargman
- Toronto General Hospital - University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Christopher T Chan
- Toronto General Hospital - University Health Network, University of Toronto, Toronto, Ontario, Canada
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Cotovio P, Rocha A, Carvalho MJ, Teixeira L, Mendonça D, Cabrita A, Rodrigues A. Better outcomes of peritoneal dialysis in diabetic patients in spite of risk of loss of autonomy for home dialysis. Perit Dial Int 2014; 34:775-80. [PMID: 24385330 DOI: 10.3747/pdi.2012.00111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Diabetes mellitus is a leading cause of chronic renal failure, challenging therapy strategies. Patients with diabetes may benefit from peritoneal dialysis (PD) but higher technique failure is feared. Our purpose was to critically evaluate clinical outcomes of this modality in diabetics, in order to find quality improvement strategies in these risk patients. METHODS A registry-based study of 432 incident patients, 23% with diabetes, from a university hospital PD program was performed. Traditional methods (Kaplan-Meier, Cox models) and innovative survival analysis, taking competing risks into account, were performed, as well as exploring the trends in cohorts according to the decade of PD start. RESULTS In spite of the detrimental effect of diabetes in patient survival compared to non-diabetics (77%, 52% vs 86%, 71%, at 2 and 4 years, respectively; p < 0.0001) the hazard ratio (HR) for death decreased in the more contemporary cohort (0.303, 95% confidence interval (CI) 0.150 - 0.614, p < 0.001). It is noteworthy that diabetes was not associated with lower technique survival: 74%, 51% vs 79%, 57%, at 2 and 4 years, respectively (p = not significant (NS)). On multivariate analysis, diabetes was an independent predictor for mortality, but not for technique failure. The hazard ratio (HR) for technique failure also decreased in the more recent cohort (0.566, 95% CI 0.348 - 0.919, p = 0.021). Among reasons for transfer to hemodialysis, proportion of ultrafiltration failure was similar between groups (26% vs 22%, p = NS), but drop-out due to loss of autonomy occurred more in the group with diabetes (23% vs 5%, p = 0.004), mainly due to ischemic stroke. The hospitalization rate was also higher in diabetic patients (1.39 vs 0.84 episodes per patient-year (E/PY), p = 0.004) but the peritonitis rate was not increased (0.53 vs 0.61 E/PY, p = NS). CONCLUSION PD was an effective long-term renal replacement therapy in diabetics, without higher rates of technique failure, ultrafiltration failure or peritonitis. Better outcomes were achieved in the contemporary cohort. The menace of autonomy loss due to stroke and higher hospitalization rates enhance the need for assisted PD strategies and better control of comorbidities.
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Affiliation(s)
- P Cotovio
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra; Nephrology Department, Centro Hospitalar do Porto - Hospital de Santo António and UMIB/ICBAS-University of Porto (UP); UnIFai, ICBAS-UP; PDMA, UP; ISP, UP; and Populations Studies Department, ICBAS-UP Porto, Portugal
| | - A Rocha
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra; Nephrology Department, Centro Hospitalar do Porto - Hospital de Santo António and UMIB/ICBAS-University of Porto (UP); UnIFai, ICBAS-UP; PDMA, UP; ISP, UP; and Populations Studies Department, ICBAS-UP Porto, Portugal
| | - M J Carvalho
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra; Nephrology Department, Centro Hospitalar do Porto - Hospital de Santo António and UMIB/ICBAS-University of Porto (UP); UnIFai, ICBAS-UP; PDMA, UP; ISP, UP; and Populations Studies Department, ICBAS-UP Porto, Portugal
| | - L Teixeira
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra; Nephrology Department, Centro Hospitalar do Porto - Hospital de Santo António and UMIB/ICBAS-University of Porto (UP); UnIFai, ICBAS-UP; PDMA, UP; ISP, UP; and Populations Studies Department, ICBAS-UP Porto, Portugal Nephrology Department, Centro Hospitalar e Universitário de Coimbra; Nephrology Department, Centro Hospitalar do Porto - Hospital de Santo António and UMIB/ICBAS-University of Porto (UP); UnIFai, ICBAS-UP; PDMA, UP; ISP, UP; and Populations Studies Department, ICBAS-UP Porto, Portugal Nephrology Department, Centro Hospitalar e Universitário de Coimbra; Nephrology Department, Centro Hospitalar do Porto - Hospital de Santo António and UMIB/ICBAS-University of Porto (UP); UnIFai, ICBAS-UP; PDMA, UP; ISP, UP; and Populations Studies Department, ICBAS-UP Porto, Portugal
| | - D Mendonça
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra; Nephrology Department, Centro Hospitalar do Porto - Hospital de Santo António and UMIB/ICBAS-University of Porto (UP); UnIFai, ICBAS-UP; PDMA, UP; ISP, UP; and Populations Studies Department, ICBAS-UP Porto, Portugal Nephrology Department, Centro Hospitalar e Universitário de Coimbra; Nephrology Department, Centro Hospitalar do Porto - Hospital de Santo António and UMIB/ICBAS-University of Porto (UP); UnIFai, ICBAS-UP; PDMA, UP; ISP, UP; and Populations Studies Department, ICBAS-UP Porto, Portugal
| | - A Cabrita
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra; Nephrology Department, Centro Hospitalar do Porto - Hospital de Santo António and UMIB/ICBAS-University of Porto (UP); UnIFai, ICBAS-UP; PDMA, UP; ISP, UP; and Populations Studies Department, ICBAS-UP Porto, Portugal
| | - A Rodrigues
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra; Nephrology Department, Centro Hospitalar do Porto - Hospital de Santo António and UMIB/ICBAS-University of Porto (UP); UnIFai, ICBAS-UP; PDMA, UP; ISP, UP; and Populations Studies Department, ICBAS-UP Porto, Portugal
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Ribitsch W, Haditsch B, Otto R, Schilcher G, Quehenberger F, Roob JM, Rosenkranz AR. Effects of a pre-dialysis patient education program on the relative frequencies of dialysis modalities. Perit Dial Int 2013; 33:367-71. [PMID: 23547278 DOI: 10.3747/pdi.2011.00255] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Pre-dialysis education can guide the choice of the dialysis modality best tailored to meet the needs and preferences of individual patients with chronic kidney disease. METHODS In a retrospective single-center cohort study, we evaluated the impact of a pre-dialysis education program on the incidence rates of patients using hemodialysis (HD) and peritoneal dialysis (PD) in our unit. The frequency distribution of dialysis modalities between people attending our education program and people not attending the program (control group) was analyzed for the 4-year period 2004 - 2008. RESULTS From among all the incident chronic kidney disease 5D patients presenting during the 4-year period, we analyzed 227 who started dialysis either with an arteriovenous fistula or a PD catheter. In that cohort, 70 patients (30.8%) took part in the education program, and 157 (69.2%) did not receive structured pre-dialysis counseling. In the group receiving education, 38 patients (54.3%) started with PD, and 32 (45.7%), with HD. In the standard-care group not receiving education, 44 patients (28%) started with PD, and 113 (72%), with HD (p < 0.001). CONCLUSIONS Our multidisciplinary pre-dialysis program had a significant impact on the frequency distribution of dialysis modalities, increasing the proportion of patients initiating dialysis with PD.
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Affiliation(s)
- Werner Ribitsch
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Lecouf A, Ryckelynck JP, Ficheux M, Henri P, Lobbedez T. A NEW PARADIGM: HOME THERAPY FOR PATIENTS WHO START DIALYSIS IN AN UNPLANNED WAY. J Ren Care 2013; 39 Suppl 1:50-5. [DOI: 10.1111/j.1755-6686.2013.00336.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Boissinot L, Landru I, Cardineau E, Zagdoun E, Ryckelycnk JP, Lobbedez T. Is transition between peritoneal dialysis and hemodialysis really a gradual process? Perit Dial Int 2013; 33:391-7. [PMID: 23284075 DOI: 10.3747/pdi.2011.00134] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Transfer to hemodialysis (HD) is a frequent cause of peritoneal dialysis (PD) cessation. In the present study, we set out to describe the transition period between PD and HD. METHODS All patients in 4 centers of Basse-Normandie who had been treated with PD for more than 90 days and who were permanently transferred to HD between 1 January 2005 and 31 December 2009 were retrospectively reviewed. The rate of unplanned HD start was evaluated. RESULTS In the 60 patients (39 men, 21 women) included in the study, median score on the Charlson comorbidity index at PD initiation was 5 [interquartile range (IQR): 3 - 7], median age at HD initiation was 62 years (IQR: 54 - 76 years), and median duration on PD was 22 months (IQR: 12 - 36 months). Among the 60 patients, 37 had an unplanned HD initiation. Peritonitis was the most frequent cause of unplanned HD start (n = 20), and dialysis inadequacy (n = 11), the main cause of planned HD start. During the transition period, all patients were hospitalized. Median duration of hospitalization was 4.5 days (IQR: 0 - 25.5 days). Within 2 months after HD initiation, 9 patients died. Two months after starting HD, 6 of the remaining 51 patients were being treated in a self-care HD unit and only 23 patients had a mature fistula. CONCLUSIONS Unplanned HD start is a common problem in patients transferred from PD. Further studies are needed to improve the rate of planned HD start in PD patients transferred to HD.
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Bender FH. Avoiding harm in peritoneal dialysis patients. Adv Chronic Kidney Dis 2012; 19:171-8. [PMID: 22578677 DOI: 10.1053/j.ackd.2012.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 04/05/2012] [Accepted: 04/06/2012] [Indexed: 12/16/2022]
Abstract
This review is focused on minimizing complications and avoiding harm in peritoneal dialysis (PD) patients. Issues related to planning for PD are covered first, with emphasis on PD versus hemodialysis outcomes. Catheter types and insertion techniques are described next, including relevant recommendations by the International Society for Peritoneal Dialysis. A brief review of both noninfectious and infectious complications follows, with emphasis on cardiovascular and metabolic complications. Finally, recommendations for preventing PD-related infections are provided. In conclusion, with proper catheter insertion technique, good training, and attention to detail during the tenure in PD, excellent outcomes can be obtained in a well-informed motivated patient.
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Najafi I, Hosseini M, Atabac S, Sanadgol H, Majelan NN, Seirafian S, Naghibi M, Makhdoumi K, Saddadi F, Soleymanian T. Patient outcome in primary peritoneal dialysis patients versus those transferred from hemodialysis and transplantation. Int Urol Nephrol 2011; 44:1237-42. [PMID: 22090190 DOI: 10.1007/s11255-011-0068-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 09/23/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND According to the concept of integrated care, renal transplantation, peritoneal dialysis (PD), and hemodialysis (HD) should be considered three complementary methods of renal replacement therapy. This study tried to evaluate patient outcomes in three different groups of PD patients, namely primary PD patients, those transferred to PD with failing kidney transplant, and those transferred to PD from HD. METHOD From January 1, 1995, to end of 2006 from 26 PD centers, 1,355 patients including demographic, clinical and laboratory data, which were monthly collected through questionnaires, were enrolled in the study. We compared patients' characteristics, factors affecting patient survival, and patient outcomes between primary PD patients (group 1, n = 1,067), patients transferred from transplantation (group 2, n = 43) and those transferred from HD (group 3, n = 245), which had been on HD for at least 3 months before switching to PD. RESULTS There was no difference in the proportion of patients with diabetes in the three groups. Overall, 238 patients (17.5%) were transferred to HD but there was no significant difference in PD technique survival on between the three groups. Death occurred in 256 (24%), 3 (7%) and 65 (26.5%) subjects in groups 1, 2 and 3, respectively. Most patients (81.5%) in group 2 underwent re-transplantation. The Kaplan-Meier survival rates were not different between the three groups. In the Cox multiple regression model, age, presence of diabetes and serum albumin level significantly influenced patient survival. CONCLUSION We concluded that PD could be considered safe for patients experiencing complications on HD, as well as for those with renal transplantation.
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Affiliation(s)
- Iraj Najafi
- Nephrology Department of Shariati Hospital and Shafa Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Cotovio P, Rocha A, Rodrigues A. Peritoneal dialysis in diabetics: there is room for more. Int J Nephrol 2011; 2011:914849. [PMID: 22013524 PMCID: PMC3195540 DOI: 10.4061/2011/914849] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 07/05/2011] [Accepted: 08/15/2011] [Indexed: 12/21/2022] Open
Abstract
End stage renal disease diabetic patients suffer from worse clinical outcomes under dialysis-independently of modality. Peritoneal dialysis offers them the advantages of home therapy while sparing their frail vascular capital and preserving residual renal function. Other benefits and potential risks deserve discussion. Predialysis intervention with early nephrology referral, patient education, and multidisciplinary support are recommended. Skilled and updated peritoneal dialysis protocols must be prescribed to assure better survival. Optimized volume control, glucose-sparing peritoneal dialysis regimens, and elective use of icodextrin are key therapy strategies. Nutritional evaluation and support, preferential use of low-glucose degradation products solutions, and prescription of renin-angiotensin-aldosterone system acting drugs should also be part of the panel to improve diabetic care under peritoneal dialysis.
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Affiliation(s)
- P Cotovio
- Nephrology Department, Centro Hospitalar de Coimbra (CHC), Quinta dos Vales, 3041-801 S. Martinho do Bispo, Portugal
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Covic A, Bammens B, Lobbedez T, Segall L, Heimburger O, Van Biesen W, Fouque D, Vanholder R. Reply. Nephrol Dial Transplant 2010. [DOI: 10.1093/ndt/gfq368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Najafi I, Hakemi M, Safari S, Atabak S, Sanadgol H, Nouri-Majalan N, Ardalan MR, Moghadam AG, Ashegh H, Keshvari A. The Story of Continuous Ambulatory Peritoneal Dialysis in Iran. Perit Dial Int 2010; 30:430-3. [DOI: 10.3747/pdi.2008.00235] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Iraj Najafi
- Shafa CAPD Research Center, Dialysis and Transplant Patients Association (DATPA), Tehran, Iran
| | - Monirossadat Hakemi
- Shafa CAPD Research Center, Dialysis and Transplant Patients Association (DATPA), Tehran, Iran
| | - Saeed Safari
- Shafa CAPD Research Center, Dialysis and Transplant Patients Association (DATPA), Tehran, Iran
| | - Shahnaz Atabak
- Shafa CAPD Research Center, Dialysis and Transplant Patients Association (DATPA), Tehran, Iran
| | - Hoshang Sanadgol
- Shafa CAPD Research Center, Dialysis and Transplant Patients Association (DATPA), Tehran, Iran
| | - Nader Nouri-Majalan
- Shafa CAPD Research Center, Dialysis and Transplant Patients Association (DATPA), Tehran, Iran
| | - Mohamad Reza Ardalan
- Shafa CAPD Research Center, Dialysis and Transplant Patients Association (DATPA), Tehran, Iran
| | - Ali Ghafari Moghadam
- Shafa CAPD Research Center, Dialysis and Transplant Patients Association (DATPA), Tehran, Iran
| | - Hossein Ashegh
- Shafa CAPD Research Center, Dialysis and Transplant Patients Association (DATPA), Tehran, Iran
| | - Amir Keshvari
- Shafa CAPD Research Center, Dialysis and Transplant Patients Association (DATPA), Tehran, Iran
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Benaroia M, Mendelssohn DC. The home dialysis first paradigm: suitability and transitioning. Int Urol Nephrol 2010; 42:715-7. [DOI: 10.1007/s11255-010-9792-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 06/05/2010] [Indexed: 10/19/2022]
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Dialysis modality choices among chronic kidney disease patients: identifying the gaps to support patients on home-based therapies. Int Urol Nephrol 2010; 42:759-64. [PMID: 20563843 DOI: 10.1007/s11255-010-9793-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 06/05/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Home dialysis is a cost-effective renal replacement strategy, which provides improved quality of life compared to conventional in-center hemodialysis (CHD). To date, most studies support the use of multidisciplinary chronic kidney disease (CKD) clinics to facilitate timely initiation of dialysis. This is an observational cohort study examining 486 patients with CKD over the period of 2001-2007 to ascertain potential demographic differences among patients transitioned to in-center versus home dialysis. SUBJECTS AND METHODS From January 2001 to December 2007, 486 patients with CKD attended the multidisciplinary renal management clinic at the University Health Network in Toronto. RESULTS One hundred and fifty-three of the 486 patients were initiated on renal replacement therapy [59 to center hemodialysis (CHD), 15 to home hemodialysis (HHD) and 79 to home peritoneal dialysis (PD)]. HHD patients were younger (48 ± 15 years) than those who selected CHD (62 ± 16 years) or PD (64 ± 16 years). Although the gender distribution was similar overall, the percentage of single males was higher in CHD versus home dialysis patients (29 vs. 15%, P < 0.05). There were no significant differences in other demographic, clinical and biochemical parameters at the time of dialysis initiation. Disinterest in home dialysis by patients and their families (25.4%) and lack of social support (12.1%) constituted the main barriers to home dialysis. Medical contraindications for home dialysis were present among 11% of the patients. Other less frequent barriers were inadequate space, communication barrier and inability to perform their own dialysis. CONCLUSIONS Sixty-one percent of patients requiring dialysis chose a home dialysis modality. Patients' and their families' disinterest in home dialysis and lack of support (either perceived or actual) represented the major overall barriers to adoption of home dialysis.
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Abstract
The countries of the Middle East have a cumulative population of 261.1 million and a mean gross national income per capita of US$9500. The total number of patients with end-stage renal disease (ESRD) in the Middle East is almost 100000, the mean prevalence being 430 per million population (pmp). The first implementation of intermittent peritoneal dialysis (PD) in the Middle East occurred in Turkey in 1968; continuous ambulatory PD started in Saudi Arabia, Turkey, and Kuwait in the 1980s; and automated PD, in Turkey in 1998. The total active PD patients in the region number approximately 8170. With 5750 patients, Turkey ranks first, followed by Iran and Saudi Arabia with 1150 and 771 patients respectively. Penetration of PD with respect to the ESRD population is 7.5%, and with respect to dialysis overall is 10.2%. The dialysis rate in the region, 312 pmp, is almost half the European number of 581 pmp, with a PD prevalence of 32 pmp (range: 0 – 81 pmp). The number of active PD patients has risen dramatically in the main countries since the end of the 1990s: Turkey, to 5750 from 1030; Saudi Arabia, to 771 from 132; and Iran to 1150 from 0.
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Affiliation(s)
- Iraj Najafi
- Shafa CAPD Research Center and Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Mendelssohn DC, Mujais SK, Soroka SD, Brouillette J, Takano T, Barre PE, Mittal BV, Singh A, Firanek C, Story K, Finkelstein FO. A prospective evaluation of renal replacement therapy modality eligibility. Nephrol Dial Transplant 2008; 24:555-61. [DOI: 10.1093/ndt/gfn484] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mendelssohn D. Peritoneal Dialysis in Ontario. Perit Dial Int 2008. [DOI: 10.1177/089686080802800219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- D.C. Mendelssohn
- Department of Nephrology Humber River Regional Hospital Toronto, Ontario, Canada
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Mujais S. Opinion: What Are the Problems with Using the Peritoneal Membrane for Long-Term Dialysis? Semin Dial 2007. [DOI: 10.1111/j.1525-139x.2007.00385_5.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
While assisted PD may prove helpful for a subset of new patients, its overall effect will be small. A trend towards a small increase in incident PD rate will not translate directly into an equivalent rise in PD prevalence. Important questions about cost effectiveness and about long-term impact of home PD assistance on modality distribution remain unanswered.
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Affiliation(s)
- D C Mendelssohn
- Department of Nephrology, Humber River Regional Hospital, Toronto, Canada
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Nesrallah G, Mendelssohn DC. Modality options for renal replacement therapy: The integrated care concept revisited. Hemodial Int 2006; 10:143-51. [PMID: 16623666 DOI: 10.1111/j.1542-4758.2006.00086.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
As the End-stage renal disease population continues to grow, innovative strategies that optimize patient outcomes while capitalizing on the relative strengths of the existing modalities must be sought. Renal transplantation remains the preferred form of renal replacement therapy, but given the limited supply of donor organs, dialytic therapies will continue to constitute a large part of the modality mix. Matching patients to the most suitable modalities requires that a number of factors be considered. These include the patient's autonomy, medical and social factors, system-related issues, patient outcomes, and finances. While peritoneal dialysis and hemodialysis (HD) have traditionally been viewed as competing modalities, we propose that they, along with home and frequent HD regimens, may be used in a complementary manner, which is based on current evidence, and may provide optimal outcomes while containing treatment costs. In this review, we attempt to synthesize the current literature describing the various issues that affect modality selection, and offer an approach to achieving a balance between these many competing factors.
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Affiliation(s)
- Gihad Nesrallah
- Department of Nephrology, Humber River Regional Hospital, Toronto, ON, Canada
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Goovaerts T, Jadoul M, Goffin E. Influence of a Pre-Dialysis Education Programme (PDEP) on the mode of renal replacement therapy. Nephrol Dial Transplant 2005; 20:1842-7. [PMID: 15919693 DOI: 10.1093/ndt/gfh905] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The distribution of renal replacement therapy (RRT) modalities among patients varies from country to country, and is often influenced by non-medical factors. In our department, patients progressing towards end-stage renal disease (ESRD) go through a structured Pre-Dialysis Education Programme (PDEP). The goals of the programme, based on both individualized information session(s) given by an experienced nurse to the patient and family and the use of in-house audio-visual tapes, are to inform on all modalities of RRT, in order to decrease anxiety and promote self-care RRT modalities. METHODS To evaluate the influence of our PDEP on the choice of RRT modalities, we retrospectively reviewed the modalities chosen by all consecutive patients starting a first RRT in our institution between December 1994 and March 2000. RESULTS Two hundred and forty-two patients started a first RRT during the study period. Fifty-seven patients, median age 66 (24-80) years, were directed towards in-centre haemodialysis (HD) for medical or psycho-social reasons (seven of whom were not involved in the PDEP); the remaining 185 patients, median age 53 (7-81) years, with no major medical complications, went through our PDEP. Eight of them (4%) received a pre-emptive renal transplantation. The therapeutic options of the other 177 patients were as follows: 75 (40%) patients, median age 65 (20-81) years opted for in-centre HD, while 102 patients opted for a self-care modality; 55 (31%) patients, median age 56 (7-77) years, chose peritoneal dialysis, 30 (16%) patients, median age 49 (21-68) years, chose to perform self-care HD in our satellite unit, and 17 (9%) patients, median age 46 (19-70) years, opted for home HD. Interestingly, in the whole cohort of patients, the cause of ESRD was associated with the RRT modality: the proportion of patients with chronic glomerulonephritis or chronic interstitial nephritis on self-care therapy was significantly higher than that of patients with nephrosclerosis, diabetic nephropathy or unknown cause of ESRD. CONCLUSION In our centre offering all treatment RRT modalities, a high percentage of patients exposed to a structured PDEP start with a self-care RRT modality. This leaves in-centre HD for patients needing medical and nursing care, or for patients refusing to participate in their treatment. Additional large studies, preferably with a randomized design, should delineate the cost-benefit of such a PDEP on the final choice of a RRT modality.
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Affiliation(s)
- Tony Goovaerts
- Department of Nephrology, Cliniques Universitaires St Luc, Université catholique do Louvain, Av Hippocrate 10, 1200 Brussels, Belgium
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Affiliation(s)
- Andreas Pierratos
- Humber River Regional Hospital, and University of Toronto, Toronto, Ontario, Canada.
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Van Biesen W, Veys N, Vanholder R, Lameire N. New concepts in peritoneal dialysis: new wine in old barrels? Artif Organs 2003; 27:398-405. [PMID: 12752197 DOI: 10.1046/j.1525-1594.2003.00965.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Van Biesen W, Veys N, Vanholder R, Lameire N. The role of APD in the improvement of outcomes in an ESRD program. Semin Dial 2002; 15:422-6. [PMID: 12437538 DOI: 10.1046/j.1525-139x.2002.00104.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We review the role of automated peritoneal dialysis (APD) in improving outcomes of an end-stage renal disease (ESRD) program. As the "integrated care approach" becomes accepted as the preferred strategy for treatment of ESRD patients, we looked for the potential place of APD in such an approach. APD has probably the same advantages as CAPD as a first-line renal replacement modality in suitable patients willing to perform PD. There is currently no hard evidence that residual renal function (RRF) should decline more rapidly in APD than in CAPD, at least if a dry abdomen during the day is avoided. The detection of peritonitis is probably more delayed in APD, but the frequency of peritonitis is lower, and there is no hard evidence pointing to a poorer outcome of peritonitis in APD as compared to CAPD. Quality of life is at least as good in APD, which is mostly related to the increased possibilities for adapting the exchange pattern to employment-related time frames. APD also has the potential to prolong technique success in patients failing CAPD rather than transferring them to hemodialysis. Nevertheless, APD remains more expensive and technically complicated, thereby missing the beauty of CAPD's simplicity. Therefore we believe that APD has its role in an integrated approach and that all patients should be informed of its potential. It would, however, not be correct to present APD as the preferred PD method for all patients, as it also has some drawbacks that make it less suitable for some categories of patients. In all cases, patients should have a free and informed choice.
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Affiliation(s)
- Wim Van Biesen
- Renal Division, University Hospital Ghent, Ghent, Belgium.
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