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Cheetham MS, Ethier I, Krishnasamy R, Cho Y, Palmer SC, Johnson DW, Craig JC, Stroumza P, Frantzen L, Hegbrant J, Strippoli GF. Home versus in-centre haemodialysis for people with kidney failure. Cochrane Database Syst Rev 2024; 4:CD009535. [PMID: 38588450 PMCID: PMC11001293 DOI: 10.1002/14651858.cd009535.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Home haemodialysis (HHD) may be associated with important clinical, social or economic benefits. However, few randomised controlled trials (RCTs) have evaluated HHD versus in-centre HD (ICHD). The relative benefits and harms of these two HD modalities are uncertain. This is an update of a review first published in 2014. This update includes non-randomised studies of interventions (NRSIs). OBJECTIVES To evaluate the benefits and harms of HHD versus ICHD in adults with kidney failure. SEARCH METHODS We contacted the Information Specialist and searched the Cochrane Kidney and Transplant Register of Studies up to 9 October 2022 using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov. We searched MEDLINE (OVID) and EMBASE (OVID) for NRSIs. SELECTION CRITERIA RCTs and NRSIs evaluating HHD (including community houses and self-care) compared to ICHD in adults with kidney failure were eligible. The outcomes of interest were cardiovascular death, all-cause death, non-fatal myocardial infarction, non-fatal stroke, all-cause hospitalisation, vascular access interventions, central venous catheter insertion/exchange, vascular access infection, parathyroidectomy, wait-listing for a kidney transplant, receipt of a kidney transplant, quality of life (QoL), symptoms related to dialysis therapy, fatigue, recovery time, cost-effectiveness, blood pressure, and left ventricular mass. DATA COLLECTION AND ANALYSIS Two authors independently assessed if the studies were eligible and then extracted data. The risk of bias was assessed, and relevant outcomes were extracted. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) or standardised mean difference (SMD) and 95% CI for continuous outcomes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Meta-analysis was performed on outcomes where there was sufficient data. MAIN RESULTS From the 1305 records identified, a single cross-over RCT and 39 NRSIs proved eligible for inclusion. These studies were of varying design (prospective cohort, retrospective cohort, cross-sectional) and involved a widely variable number of participants (small single-centre studies to international registry analyses). Studies also varied in the treatment prescription and delivery (e.g. treatment duration, frequency, dialysis machine parameters) and participant characteristics (e.g. time on dialysis). Studies often did not describe these parameters in detail. Although the risk of bias, as assessed by the Newcastle-Ottawa Scale, was generally low for most studies, within the constraints of observational study design, studies were at risk of selection bias and residual confounding. Many study outcomes were reported in ways that did not allow direct comparison or meta-analysis. It is uncertain whether HHD, compared to ICHD, may be associated with a decrease in cardiovascular death (RR 0.92, 95% CI 0.80 to 1.07; 2 NRSIs, 30,900 participants; very low certainty evidence) or all-cause death (RR 0.80, 95% CI 0.67 to 0.95; 9 NRSIs, 58,984 patients; very low certainty evidence). It is also uncertain whether HHD may be associated with a decrease in hospitalisation rate (MD -0.50 admissions per patient-year, 95% CI -0.98 to -0.02; 2 NRSIs, 834 participants; very low certainty evidence), compared with ICHD. Compared with ICHD, it is uncertain whether HHD may be associated with receipt of kidney transplantation (RR 1.28, 95% CI 1.01 to 1.63; 6 NRSIs, 10,910 participants; very low certainty evidence) and a shorter recovery time post-dialysis (MD -2.0 hours, 95% CI -2.73 to -1.28; 2 NRSIs, 348 participants; very low certainty evidence). It remains uncertain if HHD may be associated with decreased systolic blood pressure (SBP) (MD -11.71 mm Hg, 95% CI -21.11 to -2.46; 4 NRSIs, 491 participants; very low certainty evidence) and decreased left ventricular mass index (LVMI) (MD -17.74 g/m2, 95% CI -29.60 to -5.89; 2 NRSIs, 130 participants; low certainty evidence). There was insufficient data to evaluate the relative association of HHD and ICHD with fatigue or vascular access outcomes. Patient-reported outcome measures were reported using 18 different measures across 11 studies (QoL: 6 measures; mental health: 3 measures; symptoms: 1 measure; impact and view of health: 6 measures; functional ability: 2 measures). Few studies reported the same measures, which limited the ability to perform meta-analysis or compare outcomes. It is uncertain whether HHD is more cost-effective than ICHD, both in the first (SMD -1.25, 95% CI -2.13 to -0.37; 4 NRSIs, 13,809 participants; very low certainty evidence) and second year of dialysis (SMD -1.47, 95% CI -2.72 to -0.21; 4 NRSIs, 13,809 participants; very low certainty evidence). AUTHORS' CONCLUSIONS Based on low to very low certainty evidence, HHD, compared with ICHD, has uncertain associations or may be associated with decreased cardiovascular and all-cause death, hospitalisation rate, slower post-dialysis recovery time, and decreased SBP and LVMI. HHD has uncertain cost-effectiveness compared with ICHD in the first and second years of treatment. The majority of studies included in this review were observational and subject to potential selection bias and confounding, especially as patients treated with HHD tended to be younger with fewer comorbidities. Variation from study to study in the choice of outcomes and the way in which they were reported limited the ability to perform meta-analyses. Future research should align outcome measures and metrics with other research in the field in order to allow comparison between studies, establish outcome effects with greater certainty, and avoid research waste.
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Affiliation(s)
- Melissa S Cheetham
- Renal Unit, Sunshine Coast University Hospital, Birtinya, Australia
- Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Isabelle Ethier
- Department of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
- Health Innovation and Evaluation Hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Rathika Krishnasamy
- Renal Unit, Sunshine Coast University Hospital, Birtinya, Australia
- Faculty of Medicine, The University of Queensland, Herston, Australia
- Australasian Kidney Trials Network, Translational Research Institute, Woolloongabba, Australia
| | - Yeoungjee Cho
- Faculty of Medicine, The University of Queensland, Herston, Australia
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Jonathan C Craig
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Paul Stroumza
- Medical Office, Diaverum Marseille, Marseille, France
| | - Luc Frantzen
- Medical Office, Diaverum Marseille, Marseille, France
| | - Jorgen Hegbrant
- Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Giovanni Fm Strippoli
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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2
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Bitar W, Helve J, Kanerva M, Honkanen E, Rauta V, Haapio M, Finne P. Severe infections in peritoneal dialysis and home hemodialysis patients: An inception cohort study. PLoS One 2023; 18:e0286579. [PMID: 37314998 DOI: 10.1371/journal.pone.0286579] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/19/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES Infections are the most common non-cardiovascular cause of death among dialysis patients. Earlier studies have shown similar or higher risk of infectious complications in peritoneal dialysis (PD) compared to hemodialysis (HD) patients, but comparisons to home HD patients have been rare. We investigated the risk of severe infections after start of continuous ambulatory PD (CAPD) and automated PD (APD) as compared to home HD. METHODS All adult patients (n = 536), who were on home dialysis at day 90 from starting kidney replacement therapy (KRT) between 2004 and 2017 in Helsinki healthcare district, were included. We defined severe infection as an infection with C-reactive protein of 100 mg/l or higher. Cumulative incidence of first severe infection was assessed considering death as a competing risk. Hazard ratios were estimated using Cox regression with propensity score adjustment. RESULTS The risk of getting a severe infection during the first year of dialysis was 35% for CAPD, 25% for APD and 11% for home HD patients. During five years of follow-up, the hazard ratio of severe infection was 2.8 [95% CI 1.6-4.8] for CAPD and 2.2 [95% CI 1.4-3.5] for APD in comparison to home HD. Incidence rate of severe infections per 1000 patient-years was 537 for CAPD, 371 for APD, and 197 for home HD patients. When excluding peritonitis, the incidence rate was not higher among PD than home HD patients. CONCLUSIONS CAPD and APD patients had higher risk of severe infections than home HD patients. This was explained by PD-associated peritonitis.
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Affiliation(s)
- Wisam Bitar
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Jaakko Helve
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Finnish Registry for Kidney Diseases, Finnish Kidney and Liver Association, Helsinki, Finland
| | - Mari Kanerva
- Department of Infectious Diseases, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Eero Honkanen
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Virpi Rauta
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- IT Management, Helsinki and Uusimaa Hospital District, Helsinki, Finland
| | - Mikko Haapio
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Patrik Finne
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Finnish Registry for Kidney Diseases, Finnish Kidney and Liver Association, Helsinki, Finland
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3
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Two Years' Experience of Intensive Home Hemodialysis with the Physidia S 3 System: Results from the RECAP Study. J Clin Med 2023; 12:jcm12041357. [PMID: 36835894 PMCID: PMC9958970 DOI: 10.3390/jcm12041357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/20/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
The RECAP study reports results and outcomes (clinical performances, patient acceptance, cardiac outcomes, and technical survival) achieved with the S3 system used as an intensive home hemodialysis (HHD) platform over a three-year French multicenter study. Ninety-four dialysis patients issued from ten dialysis centers and treated more than 6 months (mean follow-up: 24 months) with S3 were included. A two-hour treatment time was maintained in 2/3 of patients to deliver 25 L of dialysis fluid, while 1/3 required up to 3 h to achieve 30 L. The additional convection volume produced by means of the SeCoHD tool (internal filtration backfiltration) was 3 L/session, and the net ultrafiltration produced to achieve dry weight was 1.4 L/session. On a weekly basis, an average 156 L of dialysate corresponding to 94 L of urea clearance when considering 85% dialysate saturation under low flow conditions was delivered. Such urea clearance was equivalent to 9.2 [8.0-13.0] mL/min weekly urea clearance and a standardized Kt/V of 2.5 [1.1-4.5]. The predialysis concentration of selected uremic markers remained remarkably stable over time. Fluid volume status and blood pressure were adequately controlled by means of a relatively low ultrafiltration rate (7.9 mL/h/kg). Technical survival on S3 was 72% and 58% at 1 and 2 years, respectively. The S3 system was easily handled and kept by patients at home, as indicated by technical survival. Patient perception was improved, while treatment burden was reduced. Cardiac features (assessed in a subset of patients) tended to improve over time. Intensive hemodialysis relying on the S3 system offers a very appealing option for home treatment with quite satisfactory results, as shown in the RECAP study throughout a two-year follow-up time, and offers the best bridging solution to kidney transplantation.
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4
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van Lieshout TS, Vonk S, Driehuis E, Roeterdink AJ, Goto NA, Vogels T, Kooijman W, Bart J, Broese van Groenou MI, van Jaarsveld BC, Abrahams AC. Exploring experiences and health-related quality of life of caregivers of patients who start home dialysis: study protocol for a prospective, multicentre cohort study. BMJ Open 2022; 12:e064172. [PMID: 36356997 PMCID: PMC9660610 DOI: 10.1136/bmjopen-2022-064172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/29/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Starting dialysis not only has a major impact on the life of patients but also on their informal caregivers. Previous research shows greater burden and lower quality of life among caregivers of dialysis patients compared with the general population. Unfortunately, the evidence on the course of both positive and negative experience in caregivers of incident dialysis patients is scarce. Furthermore, well-designed, prospective, multicentre studies comparing caregiving of home dialysis patients with in-centre dialysis patients are lacking. This paper proposes a protocol to assess the trajectory of experiences (both positive and negative) and quality of life of caregivers of home dialysis patients compared with caregivers of in-centre dialysis patients. METHODS AND ANALYSIS This paper presents a protocol for a prospective, observational, multicentre cohort study which extends the ongoing Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes (DOMESTICO). This study will include at least 200 adult caregivers of patients who start dialysis therapy and have been included in the DOMESTICO study. Positive experiences of the caregivers will be the primary outcome parameter of this study, and negative experiences and health-related quality of life the secondary outcome parameters. Required support will be investigated as an exploratory finding. Outcome parameters will be assessed at baseline, and at 6 and 12 months after start of dialysis using validated questionnaires. ETHICS AND DISSEMINATION Ethical approval for this study has been obtained from the Medical Research Ethics Committee of the Amsterdam University Medical Centre. The results of this study will be disseminated by publication in a peer-reviewed journal and through presentations at conferences and seminars.
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Affiliation(s)
- T S van Lieshout
- Department of Nephrology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Internal Medicine, Northwest Clinics, Alkmaar, the Netherlands
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - S Vonk
- Department of Nephrology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - E Driehuis
- Department of Nephrology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A J Roeterdink
- Department of Nephrology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - N A Goto
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Geriatric Medicine, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands
| | - Tjfm Vogels
- Dialysis Center Maxima, Maxima Medical Center, Eindhoven, the Netherlands
| | - Wcs Kooijman
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jaj Bart
- Dutch Kidney Patients Association, Bussum, the Netherlands
| | - M I Broese van Groenou
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - B C van Jaarsveld
- Department of Nephrology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Diapriva Dialysis Center, Amsterdam, the Netherlands
| | - A C Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
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5
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Main Barriers to the Introduction of a Home Haemodialysis Programme in Poland: A Review of the Challenges for Implementation and Criteria for a Successful Programme. J Clin Med 2022; 11:jcm11144166. [PMID: 35887931 PMCID: PMC9321469 DOI: 10.3390/jcm11144166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Home dialysis in Poland is restricted to the peritoneal dialysis (PD) modality, with the majority of dialysis patients treated using in-centre haemodialysis (ICHD). Home haemodialysis (HHD) is an additional home therapy to PD and provides an attractive alternative to ICHD that combines dialysis with social distancing; eliminates transportation needs; and offers clinical, economic, and quality of life benefits. However, HHD is not currently provided in Poland. This review was performed to provide an overview of the main barriers to the introduction of a HHD programme in Poland. Main findings: The main high-level barrier to introducing HHD in Poland is the absence of specific health legislation required for clinician prescribing of HHD. Other barriers to overcome include clear definition of reimbursement, patient training and education (including infrastructure and experienced personnel), organisation of logistics, and management of complications. Partnering with a large care network for HHD represents an alternative option to payers for the provision of a new HHD service. This may reduce some of the barriers which need to be overcome when compared with the creation of a new HHD service and its supporting network due to the pre-existing infrastructure, processes, and staff of a large care network. Conclusions: Provision of HHD is not solely about the provision of home treatment, but also the organisation and definition of a range of support services that are required to deliver the service. HHD should be viewed as an additional, complementary option to existing dialysis modalities which enables choice of modality best suited to a patient’s needs.
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6
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OUP accepted manuscript. Nephrol Dial Transplant 2022; 37:1393-1395. [DOI: 10.1093/ndt/gfac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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7
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Guía de unidades de hemodiálisis 2020. Nefrologia 2021. [DOI: 10.1016/j.nefro.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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8
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Bitar W, Helve J, Honkanen E, Rauta V, Haapio M, Finne P. Similar survival on home hemodialysis and automated peritoneal dialysis: an inception cohort study. Nephrol Dial Transplant 2021; 37:1545-1551. [PMID: 34363472 PMCID: PMC9317172 DOI: 10.1093/ndt/gfab233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Several studies have shown superior survival of patients on home hemodialysis (HD) compared to peritoneal dialysis (PD), but patients on automated PD (APD) and continuous ambulatory PD (CAPD) have not been considered separately. As APD allows larger fluid volumes and may be more efficient than CAPD, we primarily compared patient survival between APD and home HD. METHODS All adult patients who started kidney replacement therapy (KRT) between 2004 and 2017 in the district of Helsinki-Uusimaa in Finland, and who were on one of the home dialysis modalities at 90 days from starting KRT, were included. We used intention-to-treat analysis.Survival of home HD, APD and CAPD patients was studied using Kaplan-Meier curves and Cox regression with adjustment for propensity scores that were based on extensive data on possible confounding factors. RESULTS The probability of surviving 5 years was 90% for home HD, 88% for APD and 56% for CAPD patients. After adjustment for propensity score, the hazard ratio of death was 1.1 [95% CI 0.52-2.4] for APD and 1.6 [95% CI 0.74-3.6] for CAPD in comparison to home HD. Censoring at the time of kidney transplantation or at transfer to in-center hemodialysis did not change the results. Characteristics of home HD and APD patients at the start of dialysis were similar, whereas patients on CAPD had higher median age and more comorbidities, and received kidney transplantation less frequently. CONCLUSIONS Home HD and APD patients had comparable characteristics and their survival appeared similar.
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Affiliation(s)
- Wisam Bitar
- Nephrology Department, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - Jaakko Helve
- Nephrology Department, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland.,Finnish Registry for Kidney Diseases, Helsinki, Finland
| | - Eero Honkanen
- Nephrology Department, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - Virpi Rauta
- Nephrology Department, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland.,Helsinki University Central Hospital, IT Management
| | - Mikko Haapio
- Nephrology Department, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - Patrik Finne
- Nephrology Department, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland.,Finnish Registry for Kidney Diseases, Helsinki, Finland
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9
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Blake PG, McCormick BB, Taji L, Jung JK, Ip J, Gingras J, Boll P, McFarlane P, Pierratos A, Aziz A, Yeung A, Patel M, Cooper R. Growing home dialysis: The Ontario Renal Network Home Dialysis Initiative 2012-2019. Perit Dial Int 2021; 41:441-452. [PMID: 33969759 DOI: 10.1177/08968608211012805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Ontario Renal Network (ORN), a provincial government agency in Ontario, Canada, launched an initiative in 2012 to increase home dialysis use province-wide. The initiative included a new modality-based funding formula, a standard mandatory informatics system, targets for prevalent home dialysis rates, the development of a 'network' of renal programmes with commitment to home dialysis and a culture of accountability with frequent meetings between ORN and each renal programme leadership to review their results. It also included funding of home dialysis coordinators, encouragement and funding of assisted peritoneal dialysis (PD), and support for catheter insertion and urgent start PD. Between 2012 and 2017, home dialysis use rose from 21.9% to 26.5% and then between 2017 and 2019 stabilised at 26% to 26.5%. Over 7 years, the absolute number of people on home dialysis increased 40% from 2222 to 3105, while the number on facility haemodialysis grew 11% from 7935 to 8767. PD prevalence rose from 16.6% to 20.9%, a relative increase of 25%. The initiative showed that a sustained multifaceted approach can increase home dialysis utilisation.
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Affiliation(s)
- Peter G Blake
- Ontario Renal Network, 573450Ontario Health, Toronto, Ontario, Canada.,Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.,10033London Health Sciences Centre, Ontario, Canada
| | - Brendan B McCormick
- Ontario Renal Network, 573450Ontario Health, Toronto, Ontario, Canada.,Division of Nephrology, Department of Medicine, 27337The Ottawa Hospital, Ontario, Canada
| | - Leena Taji
- Ontario Renal Network, 573450Ontario Health, Toronto, Ontario, Canada
| | - James Kh Jung
- Ontario Renal Network, 573450Ontario Health, Toronto, Ontario, Canada
| | - Jane Ip
- Ontario Renal Network, 573450Ontario Health, Toronto, Ontario, Canada
| | - Joanie Gingras
- Ontario Renal Network, 573450Ontario Health, Toronto, Ontario, Canada
| | - Phil Boll
- Ontario Renal Network, 573450Ontario Health, Toronto, Ontario, Canada.,Trillium Health Partners, Mississauga, Ontario, Canada
| | - Phil McFarlane
- Ontario Renal Network, 573450Ontario Health, Toronto, Ontario, Canada.,Division of Nephrology, Department of Medicine, University of Toronto, Ontario, Canada.,St Michaels Hospital, Toronto, Ontario, Canada
| | | | - Anas Aziz
- Ontario Renal Network, 573450Ontario Health, Toronto, Ontario, Canada
| | - Angie Yeung
- Ontario Renal Network, 573450Ontario Health, Toronto, Ontario, Canada
| | - Monisha Patel
- Ontario Renal Network, 573450Ontario Health, Toronto, Ontario, Canada
| | - Rebecca Cooper
- Ontario Renal Network, 573450Ontario Health, Toronto, Ontario, Canada
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10
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Tennankore KK, Nadeau-Fredette AC, Vinson AJ. Survival comparisons in home hemodialysis: Understanding the present and looking to the future. Nephrol Ther 2021; 17S:S64-S70. [PMID: 33910701 DOI: 10.1016/j.nephro.2020.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/13/2020] [Indexed: 10/21/2022]
Abstract
A number of studies have compared relative survival for home hemodialysis patients (including longer hours/more frequent schedules) and other forms of renal replacement therapy. While informative, many of these studies have been limited by issues pertaining to their observational design including selection bias and residual confounding. Furthermore the few randomized controlled trials that have been conducted have been underpowered to detect a survival difference. Finally, in the face of a growing recognition of the value of patient-important outcomes beyond survival, the focus of comparisons between dialysis modalities may be changing. In this review, we will discuss the determinants of survival for patients receiving home hemodialysis and address the various studies that have compared relative survival for differing home hemodialysis schedules to each of in-center hemodialysis, peritoneal dialysis and transplantation. We will conclude this review by discussing whether there is an ongoing role for survival analyses in home hemodialysis.
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Affiliation(s)
- Karthik K Tennankore
- Dalhousie University/Nova Scotia Health Authority, 5082 Dickson Building, 5820, University Avenue, NS B3H 1V8 Halifax, Canada.
| | | | - Amanda J Vinson
- Dalhousie University/Nova Scotia Health Authority, 5082 Dickson Building, 5820, University Avenue, NS B3H 1V8 Halifax, Canada
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11
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Zang X, Du X, Li L, Mei C. Complications and outcomes of urgent-start peritoneal dialysis in elderly patients with end-stage renal disease in China: a retrospective cohort study. BMJ Open 2020; 10:e032849. [PMID: 32205371 PMCID: PMC7103849 DOI: 10.1136/bmjopen-2019-032849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To investigate the complications and survival of elderly patients with end-stage renal disease (ESRD) who received urgent-start peritoneal dialysis (USPD) or urgent-start haemodialysis (USHD), and to explore the value of peritoneal dialysis (PD) as the emergent dialysis method for elderly patients with ESRD. DESIGN Retrospective cohort study. SETTING Two tertiary care hospitals in Shanghai, China. PARTICIPANTS Chinese patients (n=542) >65 years of age with estimated glomerular filtration rate ≤15 mL/min/m2 who received urgent-start dialysis between 1 January 2005 and 31 December 2015, and with at least 3 months of treatment. Patients who converted to other dialysis methods, regardless of the initial dialysis method, were excluded, as well as those with comorbidities that could significantly affect their dialysis outcomes. PRIMARY AND SECONDARY OUTCOME MEASURES Dialysis-related complications and survival were compared. Patients were followed until death, stopped PD, transfer to other dialysis centres, loss to follow-up or 31 December 2016. RESULTS There were 309 patients in the USPD group and 233 in the USHD group. The rate of dialysis-related complications within 30 days after catheter implantation was significantly lower in the USPD group compared with the USHD group (4.5% vs 10.7%, p=0.031). The 6-month and 1, 2 and 3-year survival rates were 95.3%, 91.4%, 86.6% and 64.8% in the USPD group, and 92.2%, 85.7%, 70.2% and 57.8% in the USHD group, respectively (p=0.023). The multivariable Cox regression analysis showed that USHD (HR=2.220, 95% CI 1.298 to 3.790; p=0.004), age (HR=1.025, 95% CI 1.013 to 1.043, p<0.001) and hypokalaemia (HR=0.678, 95% CI 0.487 to 0.970; p=0.032) were independently associated with death. CONCLUSIONS USPD was associated with slightly better survival compared with USHD. USPD was associated with fewer complications and better survival than USHD in elderly patients with ESRD.
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Affiliation(s)
- Xiujuan Zang
- Division of Nephrology, Kidney Institute, Changzheng Hospital, Second Military Medical University, Shanghai, China
- Division of Nephrology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Xiu Du
- Division of Nephrology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Lin Li
- Division of Nephrology, Kidney Institute, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Changlin Mei
- Division of Nephrology, Kidney Institute, Changzheng Hospital, Second Military Medical University, Shanghai, China
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12
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Bonenkamp AA, van Eck van der Sluijs A, Hoekstra T, Verhaar MC, van Ittersum FJ, Abrahams AC, van Jaarsveld BC. Health-Related Quality of Life in Home Dialysis Patients Compared to In-Center Hemodialysis Patients: A Systematic Review and Meta-analysis. Kidney Med 2020; 2:139-154. [PMID: 32734235 PMCID: PMC7380444 DOI: 10.1016/j.xkme.2019.11.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
RATIONALE & OBJECTIVE Dialysis patients judge health-related quality of life (HRQoL) as an essential outcome. Remarkably, little is known about HRQoL differences between home dialysis and in-center hemodialysis (HD) patients worldwide. STUDY DESIGN Systematic review and meta-analysis. SETTING & STUDY POPULATIONS Search strategies were performed on the Cochrane Library, Pubmed, and EMBASE databases between 2007 and 2019. Home dialysis was defined as both peritoneal dialysis and home HD. SELECTION CRITERIA FOR STUDIES Randomized controlled trials and observational studies that compared HRQoL in home dialysis patients versus in-center HD patients. DATA EXTRACTION The data extracted by 2 authors included HRQoL scores of different questionnaires, dialysis modality, and subcontinent. ANALYTICAL APPROACH Data were pooled using a random-effects model and results were expressed as standardized mean difference (SMD) with 95% CIs. Heterogeneity was explored using subgroup analyses. RESULTS Forty-six articles reporting on 41 study populations were identified. Most studies were cross-sectional in design (90%), conducted on peritoneal dialysis patients (95%), and used the 12-item or 36-item Short-Form Health Survey questionnaires (83%). More than half the studies showed moderate or high risk of bias. Pooled analysis of 4,158 home dialysis patients and 7,854 in-center HD patients showed marginally better physical HRQoL scores in home dialysis patients compared with in-center HD patients (SMD, 0.14; 95% CI, 0.04 to 0.24), although heterogeneity was high (I 2>80%). In a subgroup analysis, Western European home dialysis patients had higher physical HRQoL scores (SMD, 0.39; 95% CI, 0.17 to 0.61), while home dialysis patients from Latin America had lower physical scores (SMD, -0.20; 95% CI, -0.28 to -0.12). Mental HRQoL showed no difference in all analyses. LIMITATIONS No randomized controlled trials were found and high heterogeneity among studies existed. CONCLUSIONS Although pooled data showed marginally better physical HRQoL for home dialysis patients, the quality of design of the included studies was poor. Large prospective studies with adequate adjustments for confounders are necessary to establish whether home dialysis results in better HRQoL. TRIAL REGISTRATION PROSPERO 95985.
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Affiliation(s)
- Anna A. Bonenkamp
- Department of Nephrology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | | | - Tiny Hoekstra
- Department of Nephrology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Marianne C. Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frans J. van Ittersum
- Department of Nephrology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Alferso C. Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Brigit C. van Jaarsveld
- Department of Nephrology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
- Diapriva Dialysis Center, Amsterdam, the Netherlands
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13
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Marshall MR. The benefit of early survival on PD versus HD—Why this is (still) very important. Perit Dial Int 2020; 40:405-418. [DOI: 10.1177/0896860819895177] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
There are a number of misconceptions around the identified early survival benefit of peritoneal dialysis (PD) relative to hemodialysis (HD), including that such benefits “even out in the end” since the relative risk of death over time eventually encompasses 1.0 (or even an estimate that is unfavorable to PD); that the early benefit is, in fact, most likely due to unmeasured confounding; and such benefits are only due to the influence of central venous catheters and “crash starters” in the HD group. In fact, the early survival benefit results in a substantial gain of patient life years in PD cohorts relative to HD ones, even if it the benefit appears to “even out in the end,” is relatively insensitive to unmeasured confounding, and persists even when the effects of central venous catheters are accounted for. In this review, the calculations and arguments are made to support these tenets. Survival on dialysis is still one of the most important considerations for all stakeholders in the end-stage kidney disease community, including patients who rank it among their top priorities. Shared decision-making is a fundamental patient right and requires both balanced information and an iterative mechanism for a consensual decision based on shared understanding and purpose. A cornerstone of this process should be an explicit discussion of the early survival benefit of PD relative to HD.
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Affiliation(s)
- Mark R Marshall
- Department of Renal Medicine, Counties Manukau District Health Board, Auckland, New Zealand
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Medical Affairs, Baxter Healthcare (Asia) Pte Ltd, Singapore
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14
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Xue J, Li H, Zhou Q, Wen S, Zhou Q, Chen W. Comparison of peritoneal dialysis with hemodialysis on survival of diabetic patients with end-stage kidney disease: a meta-analysis of cohort studies. Ren Fail 2019; 41:521-531. [PMID: 31216914 PMCID: PMC6586097 DOI: 10.1080/0886022x.2019.1625788] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim: Renal replacement therapy was primary treatment for end stage kidney (ESRD) patients. Numbers of studies comparing peritoneal dialysis (PD) and hemodialysis (HD) yielded inconsistent results. The aim of this study was to assess the mortality risk between diabetic PD patients and those in HD. Methods: We included cohort studies comparing the risk of death among diabetic ESRD patients who receiving peritoneal dialysis or hemodialysis by searching Medline and Embase. Overall estimates were calculated using the random-effects model. Results: Seventeen studies were included in the meta-analyses. Mortality comparison between PD and HD in the diabetic ESRD patients showed PD significantly increased mortality rate (hazard ratio (HR) 1.20; 95% confidence interval (CI) 1.10–1.30; I2 = 89.1%). The overall HR using an intention-to-treat analysis was 1.23 with 95% CI (1.13 to 1.34). Meta-regression demonstrated PD patients from Asian country were associated with increase in mortality risk (coefficient = 0.270, SE = 0.112, p = .033). Limitation: The high heterogeneity in our meta-analyses undermined the robustness of the findings. Conclusion: ESRD patients with diabetes may benefit more from HD than PD.
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Affiliation(s)
- Jing Xue
- a Institute of Hospital Administration, Xiangya Hospital, Central South University , Changsha , Hunan , China.,b Department of Scientific Research , Xiangya Hospital, Central South University , Changsha , Hunan , China
| | - Huihui Li
- c Department of Nephrology , Xiangya Hospital, Central South University , Changsha , Hunan , China
| | - Quan Zhou
- d Department of Science and Education , The First People's Hospital of Changde City , Changde , Hunan , China
| | - Shiwu Wen
- e Department of Epidemiology and Community Medicine , University of Ottawa , Ottawa , Ontario , Canada.,f Clinical Epidemiology Program , Ottawa Hospital Research Institute , Ottawa , Ontario , Canada
| | - Qiaoling Zhou
- c Department of Nephrology , Xiangya Hospital, Central South University , Changsha , Hunan , China
| | - Wenhang Chen
- c Department of Nephrology , Xiangya Hospital, Central South University , Changsha , Hunan , China
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15
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Maruyama Y, Higuchi C, Io H, Wakabayashi K, Tsujimoto H, Tsujimoto Y, Yuasa H, Ryuzaki M, Ito Y, Nakamoto H. Comparison of peritoneal dialysis and hemodialysis as first renal replacement therapy in patients with end-stage renal disease and diabetes: a systematic review. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0234-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Diabetes has become the most common cause of end-stage renal disease (ESRD) requiring renal replacement therapy (RRT) in most countries around the world. Peritoneal dialysis (PD) is valuable for patients newly requiring RRT because of the preservation of residual renal function (RRF), higher quality of life, and hemodynamic stability in comparison with hemodialysis (HD). A previous systematic review produced conflicting results regarding patient survival. As several advances have been made in therapy for diabetic patients receiving PD, we conducted a systematic review of studies published after 2014 to determine whether incident PD or HD is advantageous for the survival of patients with diabetes.
Methods
For this systematic review, the MEDLINE, EMBASE, and CENTRAL databases were searched to identify articles published between February 2014 and August 2017. The quality of studies was assessed using the GRADE approach. Outcomes of interest were all-cause mortality; RRF; major morbid events, including cardiovascular disease (CVD) and infectious disease; and glycemic control. This review was performed using a predefined protocol published in PROSPERO (CRD42018104258).
Results
Sixteen studies were included in this review. All were retrospective observational studies, and the risk of bias, especially failure to adequately control confounding factors, was high. Among them, 15 studies investigated all-cause mortality in diabetic patients initiating PD and HD. Differences favoring HD were observed in nine studies, whereas those favoring PD were observed in two studies. Two studies investigated effects on CVD, and both demonstrated the superiority of incident HD. No study investigated the effect of any other outcome.
Conclusions
In the present systematic review, the risk of death tended to be higher among diabetic patients with ESRD newly initiating RRT with incident PD in comparison with incident HD. However, we could not obtain definitive results reflecting the superiority of PD or HD with regard to patient outcomes because of the severe risk of bias and the heterogeneity of management strategies for diabetic patients receiving dialysis. Further studies are needed to clarify the advantages of PD and HD as RRT for diabetic patients with ESRD.
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16
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Takura T, Hiramatsu M, Nakamoto H, Kuragano T, Minakuchi J, Ishida H, Nakayama M, Takahashi S, Kawanishi H. Health economic evaluation of peritoneal dialysis based on cost-effectiveness in Japan: a preliminary study. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:579-590. [PMID: 31576157 PMCID: PMC6768123 DOI: 10.2147/ceor.s212911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 08/20/2019] [Indexed: 11/23/2022] Open
Abstract
Background In Japan, the medical expenditures associated with dialysis have garnered considerable interest; however, a cost-effectiveness evaluation of peritoneal dialysis (PD) is yet to be evaluated. In particular, the health economics of the “PD first” concept, which can be advantageous for clinical practice and healthcare systems, must be evaluated. Methods This multicenter study investigated the cost-effectiveness of PD. The major effectiveness indicator was quality-adjusted life year (QALY), with a preference-based utility value based on renal function, and the cost indicator was the amount billed for a medical service at each medical institution for qualifying illnesses. In comparison with hemodialysis (HD), a baseline analysis of PD therapy was conducted using a cost-utility analysis (CUA). Continuous ambulatory PD (CAPD) and automated PD (APD) were compared based on the incremental cost-utility ratio (ICUR) and propensity score (PS) with a limited number of cases. Results The mean duration since the start of PD was 35.0±14.4 months. The overall CUA for PD (179 patients) was USD 55,019/QALY, which was more cost effective (USD/monthly utility) compared with that for HD for 12–24 months (4,367 vs. 4,852; p<0.05). The CUA reported significantly better results in the glomerulonephritis group than in the other diseases, and the baseline CUA was significantly age sensitive. The utility score was higher in the APD group (mean age, 70.1±3.5 years) than in the CAPD group (mean age, 70.6±4.2 years; 0.987 vs. 0.860; p<0.05, 9 patients). Compared with CAPD, APD had an overall ICUR of USD 126,034/QALY. Conclusion The cost-effectiveness of PD was potentially good in the elderly and in patients on dialysis for <24 months. Therefore, the prevalence of PD may influence the public health insurance system, particularly when applying the “PD first” concept.
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Affiliation(s)
- Tomoyuki Takura
- Department of Health Economy and Society Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Makoto Hiramatsu
- Outpatient Center Hospital, Okayama Saiseikai General Hospital, Okayama City, Okayama, Japan
| | - Hidetomo Nakamoto
- General Intrarenal Medicine, Saitama Medical University, Saitama, Japan
| | - Takahiro Kuragano
- Internal Medicine (Nephrology and Dialysis), Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
| | - Jun Minakuchi
- Nephrology (Endocrinology), Kawashima Hospital, Tokushima City, Tokushima, Japan
| | | | | | - Susumu Takahashi
- Head Office, International Kidney Evaluation Association Japan, Tokyo, Japan
| | - Hideki Kawanishi
- Artificial Organs and Surgery, Tsuchiya General Hospital, Hiroshima City, Hiroshima, Japan
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17
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Vinson AJ, Perl J, Tennankore KK. Survival Comparisons of Home Dialysis Versus In-Center Hemodialysis: A Narrative Review. Can J Kidney Health Dis 2019; 6:2054358119861941. [PMID: 31321065 PMCID: PMC6628511 DOI: 10.1177/2054358119861941] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/28/2019] [Indexed: 12/22/2022] Open
Abstract
Purpose of review: Many observational studies have demonstrated a survival benefit with home dialysis compared with in-center dialysis; however, results have been conflicting. The purpose of this review was to identify pitfalls and limitations in existing literature and examine the challenges of studying home and in-center dialysis populations. Sources of information: Original research articles were identified from MEDLINE using search terms “in-center hemodialysis,” “home hemodialysis,” “conventional hemodialysis,” “nocturnal hemodialysis,” and “short daily hemodialysis.” Methods: A focused review and critical appraisal of existing home versus in-center hemodialysis survival literature was conducted to identify potential causes for variability in the observed survival outcomes. Key findings: The controversy in existing literature stems from the challenges of randomizing patients to home versus in-center hemodialysis modalities, and therefore a reliance on observational comparisons for study. In many cases, these observational analyses have been limited by selection bias (variabilities in populations included, inclusion of both incident and prevalent cohorts, and variabilities in dialysis intensity), as well as residual confounding. Furthermore, the studies that do exist lack generalizability in many cases. Limitations: There are few randomized controlled trials examining the survival benefit of home versus in-center hemodialysis and existing observational studies are often limited by bias and reduced generalizability. These limitations comprise the body of this review. Implications: This review examines challenges surrounding survival comparisons with home versus in-center hemodialysis and identify important directions for future study.
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Affiliation(s)
- Amanda J Vinson
- Division of Nephrology, Department of Medicine, Nova Scotia Health Authority, Halifax, Canada
| | - Jeffrey Perl
- Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada
| | - Karthik K Tennankore
- Division of Nephrology, Department of Medicine, Nova Scotia Health Authority, Halifax, Canada
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18
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Marshall MR, Hsiao CY, Li PK, Nakayama M, Rabindranath S, Walker RC, Yu X, Palmer SC. Association of incident dialysis modality with mortality: a protocol for systematic review and meta-analysis of randomized controlled trials and cohort studies. Syst Rev 2019; 8:55. [PMID: 30782218 PMCID: PMC6379951 DOI: 10.1186/s13643-019-0972-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/04/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND At least 2.6 million adults and children receive dialysis treatment for end-stage kidney disease (ESKD) worldwide. The large majority of these receive hemodialysis (HD), while the remaining receive peritoneal dialysis (PD). Peritoneal dialysis may be associated with similar mortality outcomes as HD, and patient-reported outcomes are potentially increased with PD. Existing evidence for the mortality associated with PD was summarized over 20 years ago, and there has been greater marginal improvement in survival with PD relative to HD since that time. It is therefore timely to reexamine the question of differential mortality by modality and summarize evidence from more contemporary practice settings. METHODS/DESIGN Electronic databases will be systematically searched for publications that report the association between dialysis modality (HD or PD) with death from any cause and cause-specific death in incident patients with end-stage kidney disease. The database searches will be supplemented by searching through citations and references and consultation with experts. Studies published before 1995 will be excluded. Screening of both titles and abstracts will be done by two independent reviewers. All disagreements will be resolved by an independent third reviewer. A quantitative meta-analysis of effect sizes and standard errors will be applied. DISCUSSION Our systematic review will update previous evidence summaries and provide a quantitative and standardized assessment of the contemporary literature comparing HD and PD including published and unpublished non-English studies from greater China, Taiwan, and Japan. This review will inform shared decision-making around initial dialysis modality choice and jurisdiction-level considerations of dialysis practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018111829.
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Affiliation(s)
- Mark R Marshall
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. .,Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand. .,Baxter Healthcare (Asia) Pte Ltd, Singapore, Singapore.
| | - Chun-Yuan Hsiao
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Philip K Li
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Masaaki Nakayama
- Research Division of Chronic Kidney Disease and Dialysis Treatment, Tohoku University Hospital, Sendai, Japan.,Nephrology Department, St Lukes International Hospital, Tokyo, Japan
| | - S Rabindranath
- Department of Nephrology, Waikato District Hospital, Hamilton, New Zealand
| | - Rachael C Walker
- Nursing and Health Science, Eastern Institute of Technology, Hawke's Bay, New Zealand
| | - Xueqing Yu
- Institute of Nephrology, Guangdong Medical University, Dongguan, Guangdong, China.,Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
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19
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Rydell H, Ivarsson K, Almquist M, Segelmark M, Clyne N. Improved long-term survival with home hemodialysis compared with institutional hemodialysis and peritoneal dialysis: a matched cohort study. BMC Nephrol 2019; 20:52. [PMID: 30760251 PMCID: PMC6375181 DOI: 10.1186/s12882-019-1245-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/01/2019] [Indexed: 11/28/2022] Open
Abstract
Background The survival rate for dialysis patients is poor. Previous studies have shown improved survival with home hemodialysis (HHD), but this could be due to patient selection, since HHD patients tend to be younger and healthier. The aim of the present study is to analyse the long-term effects of HHD on patient survival and on subsequent renal transplantation, compared with institutional hemodialysis (IHD) and peritoneal dialysis (PD), taking age and comorbidity into account. Methods Patients starting HHD as initial renal replacement therapy (RRT) were matched with patients on IHD or PD, according to gender, age, Charlson Comorbidity Index and start date of RRT, using the Swedish Renal Registry from 1991 to 2012. Survival analyses were performed as intention-to-treat (disregarding changes in RRT) and per-protocol (as on initial RRT). Results A total of 152 patients with HHD as initial RRT were matched with 608 IHD and 456 PD patients, respectively. Median survival was longer for HHD in intention-to-treat analyses: 18.5 years compared with 11.9 for IHD (p < 0.001) and 15.0 for PD (p = 0.002). The difference remained significant in per-protocol analyses omitting the contribution of subsequent transplantation. Patients on HHD were more likely to receive a renal transplant compared with IHD and PD, although treatment modality did not affect subsequent graft survival (p > 0.05). Conclusion HHD as initial RRT showed improved long-term patient survival compared with IHD and PD. This survival advantage persisted after matching and adjusting for a higher transplantation rate. Dialysis modality had no impact on subsequent graft survival.
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Affiliation(s)
- Helena Rydell
- Department of Clinical Sciences Lund, University, Skane University Hospital, Nephrology Lund, Lund, Sweden.
| | - Kerstin Ivarsson
- Department of Clinical Sciences Lund, Pediatric psychiatry, Lund University, Skane University Hospital, Lund, Sweden
| | - Martin Almquist
- Department of Clinical Sciences, Lund University, Skane University Hospital Lund Surgery, Lund, Sweden
| | - Mårten Segelmark
- Department of Clinical Sciences Lund, University, Skane University Hospital, Nephrology Lund, Lund, Sweden
| | - Naomi Clyne
- Department of Clinical Sciences Lund, University, Skane University Hospital, Nephrology Lund, Lund, Sweden
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20
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Walker RC, Morton RL, Palmer SC, Marshall MR, Tong A, Howard K. A Discrete Choice Study of Patient Preferences for Dialysis Modalities. Clin J Am Soc Nephrol 2018; 13:100-108. [PMID: 29051145 PMCID: PMC5753315 DOI: 10.2215/cjn.06830617] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/22/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Improved knowledge about factors that influence patient choices when considering dialysis modality could facilitate health care interventions to increase rates of home dialysis. We aimed to quantify the attributes of dialysis care and the tradeoffs that patients consider when making decisions about dialysis modalities. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a prospective, discrete choice experiment survey with random parameter logit analysis to quantify preferences and tradeoffs for attributes of dialysis treatment in 143 adult patients with CKD expected to require RRT within 12 months (predialysis). The attributes included schedule flexibility, patient out of pocket costs, subsidized transport services, level of nursing support, life expectancy, dialysis training time, wellbeing on dialysis, and dialysis schedule (frequency and duration). We reported outcomes using β-coefficients with corresponding odds ratios and 95% confidence intervals for choosing home-based dialysis (peritoneal dialysis or hemodialysis) compared with facility hemodialysis. RESULTS Home-based therapies were significantly preferred with the following attributes: longer survival (odds ratio per year, 1.63; 95% confidence interval, 1.25 to 2.12), increased treatment flexibility (odds ratio, 9.22; 95% confidence interval, 2.71 to 31.3), improved wellbeing (odds ratio, 210; 95% confidence interval, 15 to 2489), and more nursing support (odds ratio, 87.3; 95% confidence interval, 3.8 to 2014). Respondents were willing to accept additional out of pocket costs of approximately New Zealand $400 (United States $271) per month (95% confidence interval, New Zealand $333 to $465) to receive increased nursing support. Patients were willing to accept out of pocket costs of New Zealand $223 (United States $151) per month (95% confidence interval, New Zealand $195 to $251) for more treatment flexibility. CONCLUSIONS Patients preferred home dialysis over facility-based care when increased nursing support was available and when longer survival, wellbeing, and flexibility were expected. Sociodemographics, such as age, ethnicity, and income, influenced patient choice.
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Affiliation(s)
- Rachael C. Walker
- School of Public Health and
- Renal Department, Hawke’s Bay District Health Board, Hawke’s Bay, New Zealand
| | - Rachael L. Morton
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Suetonia C. Palmer
- Department of Nephrology, Christchurch Hospital, Christchurch, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Mark R. Marshall
- Baxter Healthcare (Asia-Pacific), Shanghai, China
- School of Medicine, University of Auckland, Auckland, New Zealand
- Department of Renal Medicine, Counties Manukau Health, Auckland, New Zealand; and
| | - Allison Tong
- School of Public Health and
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
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21
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Morfín JA, Yang A, Wang E, Schiller B. Transitional dialysis care units: A new approach to increase home dialysis modality uptake and patient outcomes. Semin Dial 2017; 31:82-87. [DOI: 10.1111/sdi.12651] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- José A. Morfín
- Division of Nephrology; Department of Medicine; UC Davis School of Medicine; Sacramento CA USA
| | - Alex Yang
- Satellite Healthcare; San Jose CA USA
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22
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Lovell S, Walker RJ, Schollum JBW, Marshall MR, McNoe BM, Derrett S. To dialyse or delay: a qualitative study of older New Zealanders' perceptions and experiences of decision-making, with stage 5 chronic kidney disease. BMJ Open 2017; 7:e014781. [PMID: 28360253 PMCID: PMC5372046 DOI: 10.1136/bmjopen-2016-014781] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Issues related to renal replacement therapy in elderly people with end stage kidney disease (ESKD) are complex. There is inadequate empirical data related to: decision-making by older populations, treatment experiences, implications of dialysis treatment and treatment modality on quality of life, and how these link to expectations of ageing. STUDY POPULATION Participants for this study were selected from a larger quantitative study of dialysis and predialysis patients aged 65 years or older recruited from three nephrology services across New Zealand. All participants had reached chronic kidney disease (CKD) stage 5 and had undergone dialysis education but had not started dialysis or recently started dialysis within the past 6 months. METHODOLOGY Serial qualitative interviews were undertaken to explore the decision-making processes and subsequent treatment experiences of patients with ESKD.Analytical approach: A framework method guided the iterative process of analysis. Decision-making codes were generated within NVivo software and then compared with the body of the interviews. RESULTS Interviews were undertaken with 17 participants. We observed that decision-making was often a fluid process, rather than occurring at a single point in time, and was heavily influenced by perceptions of oneself as becoming old, social circumstances, life events and health status. LIMITATIONS This study focuses on participants' experiences of decision-making about treatment and does not include perspectives of their nephrologists or other members of the nephrology team. CONCLUSIONS Older patients often delay dialysis as an act of self-efficacy. They often do not commit to a dialysis decision following predialysis education. Delaying decision-making and initiating dialysis were common. This was not seen by participants as a final decision about therapy. Predialysis care and education should be different for older patients, who will delay decision-making until the time of facing obvious uraemic symptoms, threatening blood tests or paternalistic guidance from their nephrologist. TRIAL REGISTRATION NUMBER Australasian Clinical Trials Registry ACTRN 12611000024943; results.
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Affiliation(s)
- Sarah Lovell
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Robert J Walker
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Mark R Marshall
- Department of Renal Medicine, Counties Manukau Health, Auckland, New Zealand
- School of Medicine, University of Auckland, Auckland, New Zealand
- Medical Affairs, Baxter Healthcare (Asia) Pte Ltd, Singapore
| | - Bronwen M McNoe
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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23
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Walker RC, Howard K, Morton RL. Home hemodialysis: a comprehensive review of patient-centered and economic considerations. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 9:149-161. [PMID: 28243134 PMCID: PMC5317253 DOI: 10.2147/ceor.s69340] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Internationally, the number of patients requiring treatment for end-stage kidney disease (ESKD) continues to increase, placing substantial burden on health systems and patients. Home hemodialysis (HD) has fluctuated in its popularity, and the rates of home HD vary considerably between and within countries although there is evidence suggesting a number of clinical, survival, economic, and quality of life (QoL) advantages associated with this treatment. International guidelines encourage shared decision making between patients and clinicians for the type of dialysis, with an emphasis on a treatment that aligned to the patients’ lifestyle. This is a comprehensive literature review of patient-centered and economic impacts of home HD with the studies published between January 2000 and July 2016. Data from the primary studies representing both efficiency and equity of home HD were presented as a narrative synthesis under the following topics: advantages to patients, barriers to patients, economic factors influencing patients, cost-effectiveness of home HD, and inequities in home HD delivery. There were a number of advantages for patients on home HD including improved survival and QoL and flexibility and potential for employment, compared to hospital HD. Similarly, there were several barriers to patients preferring or maintaining home HD, and the strategies to overcome these barriers were frequently reported. Good evidence reported that indigenous, low-income, and other socially disadvantaged individuals had reduced access to home HD compared to other forms of dialysis and that this situation compounds already-poor health outcomes on renal replacement therapy. Government policies that minimize barriers to home HD include reimbursement for dialysis-related out-of-pocket costs and employment-retention interventions for home HD patients and their family members. This review argues that home HD is a cost-effective treatment, and increasing the proportion of patients on this form of dialysis compared to hospital HD will result in a more equitable distribution of good health outcomes for individuals with ESKD.
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Affiliation(s)
- Rachael C Walker
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Hawke's Bay District Health Board, Hastings, New Zealand
| | - Kirsten Howard
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Sydney Medical School, University of Sydney, Sydney, Australia
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Pike E, Hamidi V, Ringerike T, Wisloff T, Klemp M. More Use of Peritoneal Dialysis Gives Significant Savings: A Systematic Review and Health Economic Decision Model. J Clin Med Res 2016; 9:104-116. [PMID: 28090226 PMCID: PMC5215014 DOI: 10.14740/jocmr2817w] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2016] [Indexed: 11/23/2022] Open
Abstract
Background Patients with end-stage renal disease (ESRD) are in need of renal replacement therapy as dialysis and/or transplantation. The prevalence of ESRD and, thus, the need for dialysis are constantly growing. The dialysis modalities are either peritoneal performed at home or hemodialysis (HD) performed in-center (hospital or satellite) or home. We examined effectiveness and cost-effectiveness of HD performed at different locations (hospital, satellite, and home) and peritoneal dialysis (PD) at home in the Norwegian setting. Methods We conducted a systematic review for patients above 18 years with end-stage renal failure requiring dialysis in several databases and performed several meta-analyses of existing literature. Mortality and major complications that required were our main clinical outcomes. The quality of the evidence for each outcome was evaluated using GRADE. Cost-effectiveness was assessed by developing a probabilistic Markov model. The analysis was carried out from a societal perspective, and effects were expressed in quality-adjusted life-years. Uncertainties in the base-case parameter values were explored with a probabilistic sensitivity analysis. Scenario analyses were conducted by increasing the proportion of patients receiving PD with a corresponding reduction in HD patients in-center both for Norway and Europian Union. We assumed an annual growth rate of 4% in the number of dialysis patients, and a relative distribution between PD and HD in-center of 30% and 70%, respectively. Results From a societal perspective and over a 5-year time horizon, PD was the most cost-effective dialysis alternative. We found no significant difference in mortality between peritoneal and HD modalities. Our scenario analyses showed that a shift toward more patients on PD (as a first choice) with a corresponding reduction in HD in-center gave a saving over a 5-year period of 32 and 10,623 million EURO, respectively, for Norway and the European Union. Conclusions PD was the most cost-effective dialysis alternative and was comparable with HD regarding efficacy outcomes. There are significant saving potentials if more end-stage renal patients are started on PD instead of HD.
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Affiliation(s)
- Eva Pike
- Norwegian Institute of Public Health, Oslo, Norway
| | - Vida Hamidi
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Torbjorn Wisloff
- Norwegian Institute of Public Health, Oslo, Norway; Department of Pharmacology, University of Oslo, Norway
| | - Marianne Klemp
- Norwegian Institute of Public Health, Oslo, Norway; Department of Pharmacology, University of Oslo, Norway
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Abstract
In light of the recent emphasis on patient-centered outcomes and quality of life for patients with kidney disease, we contend that the nephrology community should no longer fund, perform, or publish studies that compare survival by dialysis modality. These studies have become redundant; they are methodologically limited, unhelpful in practice, and therefore a waste of resources. More than two decades of these publications show similar survival between patients undergoing peritoneal dialysis and those receiving thrice-weekly conventional hemodialysis, with differences only for specific subgroups. In clinical practice, modality choice should be individualized with the aim of maximizing quality of life, patient-reported outcomes, and achieving patient-centered goals. Expected survival is often irrelevant to modality choice. Even for the younger and fitter home hemodialysis population, quality of life, not just duration of survival, is a major priority. On the other hand, increasing evidence suggests that patients with ESRD continue to experience poor quality of life because of high symptom burden, unsolved clinical problems, and unmet needs. Patients care more about how they will live instead of how long. It is our responsibility to align our research with their needs. Only by doing so can we meet the challenges of ESRD patient care in the coming decades.
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Affiliation(s)
- Martin B. Lee
- Division of Nephrology, University Medicine Cluster, National University Health System, Singapore; and
| | - Joanne M. Bargman
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
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Sun TYT, Voss D, Beechey D, Lam-Po-Tang M. Comparison of peritoneal dialysis catheter insertion techniques: Peritoneoscopic, radiological and laparoscopic : A single-centre study. Nephrology (Carlton) 2016; 21:416-22. [DOI: 10.1111/nep.12621] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/02/2015] [Accepted: 08/30/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Tina Y-T Sun
- Department of Renal Medicine; Counties Manukau DHB; Auckland New Zealand
| | - David Voss
- Department of Renal Medicine; Counties Manukau DHB; Auckland New Zealand
| | - Denise Beechey
- Department of Renal Medicine; Counties Manukau DHB; Auckland New Zealand
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Vega A, Sequí MJ, Abad S, Yuste C, Santos A, Macías N, López-Gómez JM. Daily Home Hemodialysis Is an Available Option for Renal Replacement Therapy in Spain. Ther Apher Dial 2016; 20:408-12. [PMID: 26991430 DOI: 10.1111/1744-9987.12400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/12/2015] [Accepted: 12/10/2015] [Indexed: 11/29/2022]
Abstract
The objective of the present study was to analyze the characteristics and survival of patients from our hospital who started home hemodialysis. We analyzed all patients receiving home hemodialysis from 1969 to 2015 (51 patients; age 45 ± 23 years; men 77%). We collected characteristics, hospital admission, and mortality. After a median follow-up of 43 (22-76) months, we found 0-1 hospital admissions per year. Sixty-nine percent received a kidney transplant, and the global mortality was 10%. Survival at 5 years was 96%. Mean equivalent renal urea clearance was 15.6 ± 4.2 mL/min, the β-2 microglobulin reduction rate was 67 ± 18%, the number of antihypertension drugs was 0.7 ± 0.3, and the erythropoietin resistance index was 3.7 ± 2.1 IU/kg/week/g/dL. Daily home hemodialysis is a viable option for renal replacement therapy and should be offered alongside other therapies.
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Affiliation(s)
- Almudena Vega
- Nephrology Unit, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Soraya Abad
- Nephrology Unit, Hospital Gregorio Marañón, Madrid, Spain
| | - Claudia Yuste
- Nephrology Unit, Hospital Gregorio Marañón, Madrid, Spain
| | - Alba Santos
- Nephrology Unit, Hospital Gregorio Marañón, Madrid, Spain
| | - Nicolás Macías
- Nephrology Unit, Hospital Gregorio Marañón, Madrid, Spain
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Nadeau-Fredette AC, Hawley C, Pascoe E, Chan CT, Leblanc M, Clayton PA, Polkinghorne KR, Boudville N, Johnson DW. Predictors of Transfer to Home Hemodialysis after Peritoneal Dialysis Completion. Perit Dial Int 2015; 36:547-54. [PMID: 26526050 DOI: 10.3747/pdi.2015.00121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/09/2015] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND The aim of the present study was to evaluate the predictors of transfer to home hemodialysis (HHD) after peritoneal dialysis (PD) completion. ♦ METHODS All Australian and New Zealand patients treated with PD on day 90 after initiation of renal replacement therapy between 2000 and 2012 were included. Completion of PD was defined by death, transplantation, or hemodialysis (HD) for 180 days or more. Patients were categorized as "transferred to HHD" if they initiated HHD fewer than 180 days after PD had ended. Multivariable logistic regression was used to evaluate predictors of transfer to HHD in a restricted cohort experiencing PD technique failure; a competing-risks analysis was used in the unrestricted cohort. ♦ RESULTS Of 10 710 incident PD patients, 3752 died, 1549 underwent transplantation, and 2915 transferred to HD, among whom 156 (5.4%) started HHD. The positive predictors of transfer to HHD in the restricted cohort were male sex [odds ratio (OR): 2.81], obesity (OR: 2.20), and PD therapy duration (OR: 1.10 per year). Negative predictors included age (OR: 0.95 per year), infectious cause of technique failure (OR: 0.48), underweight (OR: 0.50), kidney disease resulting from hypertension (OR: 0.38) or diabetes (OR: 0.32), race being Maori (OR: 0.65) or Aboriginal and Torres Strait Islander (OR: 0.30). Comparable results were obtained with a competing-risks model. ♦ CONCLUSIONS Transfer to HHD after completion of PD is rare and predicted by patient characteristics at baseline and at the time of PD end. Transition to HHD should be considered more often in patients using PD, especially when they fulfill the identified characteristics.
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Affiliation(s)
- Annie-Claire Nadeau-Fredette
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Université de Montreal, Montreal, Quebec, Canada
| | - Carmel Hawley
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, University of Queensland, Brisbane, Australia
| | - Elaine Pascoe
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Christopher T Chan
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Sydney Medical School, University of Sydney, Sydney
| | - Kevan R Polkinghorne
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, Monash Medical Centre Monash Health, Clayton Department of Medicine and of Epidemiology and Preventive Medicine, Monash University, Melbourne
| | - Neil Boudville
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - David W Johnson
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, University of Queensland, Brisbane, Australia
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Hu W, Zhang Y, Sigdel KR. The effects of Panax notoginseng saponins on the cytokines and peritoneal function in rats with peritoneal fibrosis. Ren Fail 2015; 37:1507-13. [PMID: 26371362 DOI: 10.3109/0886022x.2015.1088350] [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: 01/13/2023] Open
Abstract
BACKGROUND Due to the long-term and chronic exposure to the peritoneal dialysis fluid, patients could develop peritoneal fibrosis and ultrafiltration failure which compromises treatment efficacy and outcome, and fibrosis is the major cause of peritoneal dialysis (PD) withdraw among patients. METHODS Twenty-one male WISTAR rats were randomly assigned to three groups, namely saline group, standard peritoneal dialysis fluid (PDF) group, and panax notoginseng saponins (PNS) group. Peritoneal fibrosis was induced by daily injection of PDF for 4 weeks. After execution, multiple histological techniques including HE and Masson's trichrome staining and transmission electron microscopy (TEM) were applied to observe the pathological changes and concentrations of multiple cytokines may involve in the process of fibrosis were determined by enzyme-linked immune sorbent assay (ELISA). Biochemistry parameters were determined by automated chemistry analyzer. RESULTS PNS can significantly inhibit the expression of transforming growth factor beta (TGF-β1), connective tissue growth factor (CTGF), and monocyte chemoattractant protein (MCP-1) in the peritoneum of rats. Furthermore, pathological damages, including extracellular matrix deposition, vascularization, and fibroblast, were ameliorated in PNS group when being compared with standard PDF group. Peritoneal functions were improved by regular PNS treatment with significantly elevated ultrafiltration. CONCLUSION PNS is capable of improving peritoneal function in subjects with PDF exposure and can possibly applied in patients with PD after further verification.
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Affiliation(s)
- Weiping Hu
- a Department of Nephrology , First Affiliated Hospital of Xiamen University , Xiamen , People's Republic of China
| | - Yanlin Zhang
- a Department of Nephrology , First Affiliated Hospital of Xiamen University , Xiamen , People's Republic of China
| | - Keshav Raj Sigdel
- a Department of Nephrology , First Affiliated Hospital of Xiamen University , Xiamen , People's Republic of China
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Nadeau-Fredette AC, Hawley CM, Pascoe EM, Chan CT, Clayton PA, Polkinghorne KR, Boudville N, Leblanc M, Johnson DW. An Incident Cohort Study Comparing Survival on Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry). Clin J Am Soc Nephrol 2015; 10:1397-407. [PMID: 26068181 PMCID: PMC4527016 DOI: 10.2215/cjn.00840115] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 04/20/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Home dialysis is often recognized as a first-choice therapy for patients initiating dialysis. However, studies comparing clinical outcomes between peritoneal dialysis and home hemodialysis have been very limited. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This Australia and New Zealand Dialysis and Transplantation Registry study assessed all Australian and New Zealand adult patients receiving home dialysis on day 90 after initiation of RRT between 2000 and 2012. The primary outcome was overall survival. The secondary outcomes were on-treatment survival, patient and technique survival, and death-censored technique survival. All results were adjusted with three prespecified models: multivariable Cox proportional hazards model (main model), propensity score quintile-stratified model, and propensity score-matched model. RESULTS The study included 10,710 patients on incident peritoneal dialysis and 706 patients on incident home hemodialysis. Treatment with home hemodialysis was associated with better patient survival than treatment with peritoneal dialysis (5-year survival: 85% versus 44%, respectively; log-rank P<0.001). Using multivariable Cox proportional hazards analysis, home hemodialysis was associated with superior patient survival (hazard ratio for overall death, 0.47; 95% confidence interval, 0.38 to 0.59) as well as better on-treatment survival (hazard ratio for on-treatment death, 0.34; 95% confidence interval, 0.26 to 0.45), composite patient and technique survival (hazard ratio for death or technique failure, 0.34; 95% confidence interval, 0.29 to 0.40), and death-censored technique survival (hazard ratio for technique failure, 0.34; 95% confidence interval, 0.28 to 0.41). Similar results were obtained with the propensity score models as well as sensitivity analyses using competing risks models and different definitions for technique failure and lag period after modality switch, during which events were attributed to the initial modality. CONCLUSIONS Home hemodialysis was associated with superior patient and technique survival compared with peritoneal dialysis.
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Affiliation(s)
- Annie-Claire Nadeau-Fredette
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Medicine, Université de Montreal, Montreal, Canada
| | - Carmel M Hawley
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Elaine M Pascoe
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Christopher T Chan
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kevan R Polkinghorne
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Department of Nephrology, Monash Medical Centre, Monash Health, Clayton, Australia; Departments of Medicine, Epidemiology, and Preventative Medicine, Monash University, Melbourne, Australia; and
| | - Neil Boudville
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Martine Leblanc
- Department of Medicine, Université de Montreal, Montreal, Canada
| | - David W Johnson
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia;
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Aspden T, Wolley MJ, Ma TM, Rajah E, Curd S, Kumar D, Lee S, Pireva K, Taule'alo O, Tiavale P, Kam AL, Suh JS, Kennedy J, Marshall MR. Understanding barriers to optimal medication management for those requiring long-term dialysis: rationale and design for an observational study, and a quantitative description of study variables and data. BMC Nephrol 2015; 16:102. [PMID: 26162369 PMCID: PMC4499205 DOI: 10.1186/s12882-015-0097-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 06/25/2015] [Indexed: 12/05/2022] Open
Abstract
Background Rates of medication non-adherence in dialysis patients are high, and improving adherence is likely to improve outcomes. Few data are available regarding factors associated with medication adherence in dialysis patients, and these data are needed to inform effective intervention strategies. Methods/design This is an observational cross-sectional study of a multi-ethnic dialysis cohort from New Zealand, with the main data collection tool being an interviewer-assisted survey. A total of 100 participants were randomly sampled from a single centre, with selection stratified by ethnicity and dialysis modality (facility versus home). The main outcome measure is self-reported medication adherence using the Morisky 8-Item Medication Adherence Scale (MMAS-8). Study data include demographic, clinical, social and psychometric characteristics, the latter being constructs of health literacy, medication knowledge, beliefs about medications, and illness perceptions. Psychometric constructs were assessed through the following survey instruments; health literacy screening questions, the Medication Knowledge Evaluation Tool (Okuyan et al.), the Beliefs about Medication Questionnaire (Horne et al.), the Brief Illness Perception Questionnaire (Broadbent et al.). Using the study data, reliability analysis for internal consistency is satisfactory for the scales evaluating health literacy, medication knowledge, and beliefs about medications, with Chronbach’s α > 0.7 for all. Reliability analysis indicated poor internal consistency for scales relating to illness perceptions. MMAS-8 and all psychometric scores are normally distributed in the study data. Discussion This study will provide important information on the factors involved in medication non-adherence in New Zealand dialysis patients. The resulting knowledge will inform long-term initiatives to reduce medication non-adherence in dialysis patients, and help ensure that they are addressing appropriate and evidence based targets for intervention. Electronic supplementary material The online version of this article (doi:10.1186/s12882-015-0097-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Trudi Aspden
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Rd, Auckland, 1142, New Zealand.
| | - Martin J Wolley
- School of Medicine, University of Queensland, 288 Herston Road, Brisbane, 4006, Australia.
| | - Tian M Ma
- Department of Renal Medicine, Counties Manukau District Health Board, Hospital Road, Otahuhu, Auckland, 1640, New Zealand.
| | - Edwin Rajah
- Marketing Department, Faculty of Business, Auckland University of Technology, 46 Wakefield St, Auckland, 1010, New Zealand.
| | - Samantha Curd
- Formerly of the School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Rd, Auckland, 1142, New Zealand.
| | - Dharni Kumar
- Formerly of the School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Rd, Auckland, 1142, New Zealand.
| | - Sophia Lee
- Formerly of the School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Rd, Auckland, 1142, New Zealand.
| | - Krenare Pireva
- Formerly of the School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Rd, Auckland, 1142, New Zealand.
| | - Olita Taule'alo
- Formerly of the School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Rd, Auckland, 1142, New Zealand.
| | - Porsche Tiavale
- Formerly of the School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Rd, Auckland, 1142, New Zealand.
| | - Angela L Kam
- Pharmacy Services, Counties Manukau District Health Board, Hospital Road, Otahuhu, Auckland, 1640, New Zealand.
| | - Jun S Suh
- Department of Renal Medicine, Counties Manukau District Health Board, Hospital Road, Otahuhu, Auckland, 1640, New Zealand.
| | - Julia Kennedy
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Rd, Auckland, 1142, New Zealand.
| | - Mark R Marshall
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Rd, Auckland, 1142, New Zealand.
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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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Non-diabetic renal diseases in a multi-ethnic New Zealand cohort with type 2 diabetes mellitus: clinical and histopathological features. Pathology 2015; 46:424-32. [PMID: 24977738 DOI: 10.1097/pat.0000000000000135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aims of this study were to identify non-diabetic renal disease (NDRD), including obesity related glomerulopathy (ORG) in diabetic patients, and compare the findings with those of pure diabetic nephropathy (DN).Ninety-three renal biopsies from diabetic patients were reviewed retrospectively, along with their clinical findings at biopsy and their estimated glomerular filtration rate (eGFR) over 5 years follow-up. DN and focal segmental glomerulosclerosis (FSGS) were diagnosed on blinded histology review, together with assessment of renal compartment histology. Other NDRD were diagnosed on full review.Most patients were obese with poor renal function at biopsy. NDRD occurred in more than two-thirds of biopsies. FSGS and interstitial nephritis were common. Patients with pure FSGS presented earlier, and had favourable histological features and clinical course. Most FSGS patients fulfilled criteria for ORG. Biopsies with interstitial nephritis showed more functional glomerular tissue, and most patients retained good renal function. Adverse prognostic features were DN versus NDRD, nodular grade of DN, low eGFR at biopsy, and severe chronic histological changes.In this population, ORG mechanisms contribute to renal injury. FSGS is frequent, and should be diagnosed separately from any DN. Biopsy to confirm suspicion of interstitial nephritis should be performed even if retinopathy is present.
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François K, Bargman JM. Evaluating the benefits of home-based peritoneal dialysis. Int J Nephrol Renovasc Dis 2014; 7:447-55. [PMID: 25506238 PMCID: PMC4260684 DOI: 10.2147/ijnrd.s50527] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Peritoneal dialysis (PD) is an effective renal replacement strategy for patients suffering from end-stage renal disease. PD offers patient survival comparable to or better than in-center hemodialysis while preserving residual kidney function, empowering patient autonomy, and reducing financial burden to payors. The majority of patients suffering from kidney failure are eligible for PD. In patients with cardiorenal syndrome and uncontrolled fluid status, PD is of particular benefit, decreasing hospitalization rates and duration. This review discusses the benefits of chronic PD, performed by the patient or a caregiver at home. Recognition of the benefits of PD is a cornerstone in stimulating the use of this treatment strategy.
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Affiliation(s)
- Karlien François
- Division of Nephrology, University Health Network Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Joanne M Bargman
- Division of Nephrology, University Health Network Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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