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Overgaard CB, Chan W, Chowdhary S, Zur RL, Wainstein R, Džavík V, Chan CT, Floras JS. Coronary and Systemic Vasodilator Responsiveness of Patients Receiving Conventional Intermittent or Nocturnal Hemodialysis. Hypertension 2024; 81:1996-2005. [PMID: 39041205 DOI: 10.1161/hypertensionaha.124.22790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 07/09/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Nocturnal hemodialysis (nHD) restores the attenuated brachial artery vasodilator responsiveness of patients receiving conventional intermittent hemodialysis (iHD). Its impact on coronary vasodilatation is unknown. METHODS We evaluated 25 patients on hemodialysis who fulfilled transplant criteria: 15 on iHD (4-hour sessions, 3 d/wk) and 10 on nHD (≈40 h/wk over 8-10-hour sessions) plus 6 control participants. Following diagnostic angiography, left anterior descending (LAD) coronary flow reserve and mean luminal diameter were quantified at baseline and during sequential intracoronary administration of adenosine (infusion and bolus), nitroglycerin (bolus), acetylcholine (infusion), acetylcholine coinfused with vitamin C, and, finally, sublingual nitroglycerin. RESULTS Coronary flow reserve in those receiving nHD was augmented relative to iHD (3.28±0.26 versus 2.17±0.12 [mean±SEM]; P<0.03) but attenuated, relative to controls (4.80±0.63; P=0.011). Luminal dilatations induced by intracoronary adenosine and nitroglycerin were similar in nHD and controls but blunted in the iHD cohort (P<0.05 versus both). ACh elicited vasodilatation in controls but constriction in both dialysis groups (both P<0.05, versus control); vitamin C coinfusion had no effect. Sublingual nitroglycerin increased mid-left anterior descending diameter and reduced mean arterial pressure in controls (+15.2±2.68%; -16.00±1.60%) and in nHD recipients (+14.78±5.46%; -15.82±1.32%); iHD responses were markedly attenuated (+1.9±0.86%; -5.89±1.41%; P<0.05, all comparisons). CONCLUSIONS Coronary and systemic vasodilator responsiveness to both adenosine and nitroglycerin is augmented in patients receiving nHD relative to those receiving iHD, whereas vasoconstrictor responsiveness to acetylcholine does not differ. By improving coronary conduit and microvascular function, nHD may reduce the cardiovascular risk of patients on dialysis.
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Affiliation(s)
- Christopher B Overgaard
- Harold and Esther Mecklinger Family and the Posluns Family Cardiac Catheterization Research Laboratory, Mount Sinai Hospital, Toronto, ON, Canada (C.B.O., W.C., S.C., R.W., J.S.F.)
- University Health Network and Sinai Health Department of Medicine, Division of Cardiology (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., C.T.C., J.S.F.)
- Peter Munk Cardiac Centre, University Health Network (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., J.S.F.)
- Department of Medicine (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., C.T.C., J.S.F.), University of Toronto, ON, Canada
| | - William Chan
- Harold and Esther Mecklinger Family and the Posluns Family Cardiac Catheterization Research Laboratory, Mount Sinai Hospital, Toronto, ON, Canada (C.B.O., W.C., S.C., R.W., J.S.F.)
- University Health Network and Sinai Health Department of Medicine, Division of Cardiology (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., C.T.C., J.S.F.)
- Peter Munk Cardiac Centre, University Health Network (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., J.S.F.)
- Department of Medicine (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., C.T.C., J.S.F.), University of Toronto, ON, Canada
- Western Health, St. Albans, VIC, Australia (W.C.)
| | - Saqib Chowdhary
- Harold and Esther Mecklinger Family and the Posluns Family Cardiac Catheterization Research Laboratory, Mount Sinai Hospital, Toronto, ON, Canada (C.B.O., W.C., S.C., R.W., J.S.F.)
- University Health Network and Sinai Health Department of Medicine, Division of Cardiology (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., C.T.C., J.S.F.)
- Peter Munk Cardiac Centre, University Health Network (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., J.S.F.)
- Department of Medicine (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., C.T.C., J.S.F.), University of Toronto, ON, Canada
- Manchester University NHS Foundation Trust, United Kingdom (S.C.)
| | - Rebecca L Zur
- University Health Network and Sinai Health Department of Medicine, Division of Cardiology (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., C.T.C., J.S.F.)
- Peter Munk Cardiac Centre, University Health Network (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., J.S.F.)
- Department of Medicine (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., C.T.C., J.S.F.), University of Toronto, ON, Canada
- Department of Psychiatry (R.L.Z.), University of Toronto, ON, Canada
| | - Rodrigo Wainstein
- Harold and Esther Mecklinger Family and the Posluns Family Cardiac Catheterization Research Laboratory, Mount Sinai Hospital, Toronto, ON, Canada (C.B.O., W.C., S.C., R.W., J.S.F.)
- University Health Network and Sinai Health Department of Medicine, Division of Cardiology (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., C.T.C., J.S.F.)
- Peter Munk Cardiac Centre, University Health Network (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., J.S.F.)
- Department of Medicine (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., C.T.C., J.S.F.), University of Toronto, ON, Canada
- Hospital de Clínicas de Porto Alegre, Federal University do Rio Grande do Sul, Brazil (R.W.)
| | - Vladimír Džavík
- University Health Network and Sinai Health Department of Medicine, Division of Cardiology (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., C.T.C., J.S.F.)
- Peter Munk Cardiac Centre, University Health Network (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., J.S.F.)
- Department of Medicine (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., C.T.C., J.S.F.), University of Toronto, ON, Canada
| | - Christopher T Chan
- University Health Network and Sinai Health Department of Medicine, Division of Cardiology (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., C.T.C., J.S.F.)
- Department of Medicine (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., C.T.C., J.S.F.), University of Toronto, ON, Canada
| | - John S Floras
- Harold and Esther Mecklinger Family and the Posluns Family Cardiac Catheterization Research Laboratory, Mount Sinai Hospital, Toronto, ON, Canada (C.B.O., W.C., S.C., R.W., J.S.F.)
- University Health Network and Sinai Health Department of Medicine, Division of Cardiology (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., C.T.C., J.S.F.)
- Peter Munk Cardiac Centre, University Health Network (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., J.S.F.)
- Department of Medicine (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., C.T.C., J.S.F.), University of Toronto, ON, Canada
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Platnich JM, Pauly RP. Patient Training and Patient Safety in Home Hemodialysis. Clin J Am Soc Nephrol 2024; 19:1045-1050. [PMID: 38190130 PMCID: PMC11321743 DOI: 10.2215/cjn.0000000000000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
The success of a home hemodialysis program depends largely on a patient safety framework and the risk tolerance of a home dialysis program. Dialysis treatments require operators to perform dozens of steps repeatedly and reliably in a complex procedure. For home hemodialysis, those operators are patients themselves or their care partners, so attention to safety and risk mitigation is front of mind. While newer, smaller, and more user-friendly dialysis machines designed explicitly for home use are slowly entering the marketplace, teaching patients to perform their own treatments in an unsupervised setting hundreds of times remains a foundational programmatic obligation regardless of machine. Just how safe is home hemodialysis? How does patient training affect this safety? There is a surprising lack of literature surrounding these questions. No consensus exists among home hemodialysis programs regarding optimized training schedules or methods, with each program adopting its own approach on the basis of local experience. Furthermore, there are little available data on the safety of home hemodialysis as compared with conventional in-center hemodialysis. This review will outline considerations for training patients on home hemodialysis, discuss the safety of home hemodialysis with an emphasis on the risk of serious and life-threatening adverse effects, and address the methods by which adverse events are monitored and prevented.
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Affiliation(s)
- Jaye M Platnich
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Nishibori N, Okazaki M, Miura Y, Hishida M, Kurasawa S, Imaizumi T, Kato N, Kosugi T, Kuro-o M, Kasuga H, Kaneda F, Maruyama S. Association of calciprotein particles with serum phosphorus among patients undergoing conventional and extended-hours haemodialysis. Clin Kidney J 2024; 17:sfae121. [PMID: 38873576 PMCID: PMC11170037 DOI: 10.1093/ckj/sfae121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Indexed: 06/15/2024] Open
Abstract
Background and hypothesis Extended-hours haemodialysis (HD) is associated with better clinical outcomes than conventional HD. We investigated whether extended-hours HD and conventional HD have varying effects on blood levels of calciprotein particles (CPPs) and phosphorus, which have been identified as major pathogenic molecules for vascular calcification. Methods Patients who underwent conventional or extended in-centre daytime HD between January and March 2020 were included. Plasma CPP levels, representing only secondary CPPs (CPP-II), were measured in pre-dialysis samples. Linear and non-linear associations between CPPs and serum phosphorus levels were examined across dialysis modalities. Results A total of 382 participants (185 undergoing extended-hours HD and 197 undergoing conventional HD) were included in the analysis. The median age of participants was 71 years, 65% of the patients were men and the mean phosphorus level was 5.4 mg/dl. Plasma CPP (CPP-II) levels were lower in the extended-hours HD group than in the conventional HD group [40 018 (arbitrary units) AU versus 75 728 AU; P < .01]. Multivariable linear regression analysis showed that extended-hours HD was associated with lower natural logarithmic plasma CPP (CPP-II) levels: -0.64 (95% confidence interval -0.74 to -0.55). A restricted cubic spline function indicated that extended-hours HD was associated with lower plasma CPP (CPP-II) levels across levels of serum phosphorus, with significant differences observed between groups, especially in hyperphosphataemic conditions (P for interaction <.01). Conclusions The extended-hours HD group had lower CPP levels than the conventional HD group despite no significant differences in serum phosphorus levels, which may contribute to better clinical outcomes in patients on extended-hours HD.
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Affiliation(s)
- Nobuhiro Nishibori
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Okazaki
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, CA, USA
| | - Yutaka Miura
- Division of Anti-Aging Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
| | - Manabu Hishida
- Department of Nephrology, Kaikoukai Josai Hospital, Nagoya, Japan
| | - Shimon Kurasawa
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Imaizumi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Noritoshi Kato
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoki Kosugi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Makoto Kuro-o
- Division of Anti-Aging Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
| | - Hirotake Kasuga
- Department of Nephrology, Nagoya Kyoritsu Hospital, Nagoya, Japan
| | | | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Roberts MA, Davies CE, Brown L, Chua SJ, Irish G, Kairaitis L, Krishnasamy R, See E, Semple D, Toussaint ND, Viecelli AK, Polkinghorne KR. Greater haemodialysis exposure ('quotidian haemodialysis') has different mortality associations by patient age group. Clin Kidney J 2024; 17:sfae103. [PMID: 38938326 PMCID: PMC11210063 DOI: 10.1093/ckj/sfae103] [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: 10/16/2023] [Indexed: 06/29/2024] Open
Abstract
Background Worldwide, most people requiring kidney replacement therapy receive haemodialysis (HD) three times per week. Greater HD time and/or frequency may improve survival, but implementation requires understanding potential benefits across the range of patients. Methods Using data from the Australia and New Zealand Dialysis and Transplant Registry, we assessed whether quotidian HD (defined as >3 sessions/week and/or >5 h/session) was associated with reduced mortality in adult patients. The primary outcome of all-cause mortality was analysed by a time-varying Cox proportional hazards model with quotidian HD as the exposure of interest. Results Of 24 138 people who received HD between 2011 and 2019, 2632 (10.9%) received quotidian HD at some stage. These patients were younger, more likely male and more likely to receive HD at home. Overall, quotidian versus standard HD was associated with a decreased risk for all-cause mortality {crude hazard ratio [HR] 0.50 [95% confidence interval (CI) 0.45-0.56]}, but an interaction between quotidian HD and age was identified (P = .005). Stratified by age groups and splitting follow-up time where proportional hazards were violated, the corresponding HR compared with standard HD was 2.43 (95% CI 1.56-3.79) for people >75 years of age in the first year of quotidian HD, 1.52 (95% CI 0.89-2.58) for 1-3 years and 0.95 (95% CI 0.51-1.78) for ≥3 years. There was no significant survival advantage in younger people. Conclusions Although quotidian HD conferred survival benefit in crude analyses, people ≥75 years of age had greater mortality with quotidian HD than standard HD. The mortality benefit in younger people was attenuated when adjusted for known confounders.
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Affiliation(s)
- Matthew A Roberts
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Christopher E Davies
- Faculty of Health and Medical Science, Adelaide Medical School, Adelaide, South Australia, Australia
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Leanne Brown
- Murtupuni Centre for Rural and Remote Health & Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
- School of Nursing and Midwifery, Griffith University Brisbane, South Bank, Queensland, Australia
| | - Su Jen Chua
- Department of Nephrology, Alfred Health, Prahran, Victoria, Australia
| | - Georgina Irish
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Central and North Adelaide Renal and Transplant Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lukas Kairaitis
- Department of Renal Medicine, Blacktown Hospital, Blacktown, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Rathika Krishnasamy
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Emily See
- Department of Nephrology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Nephrology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - David Semple
- Department of Renal Medicine, Auckland District Health Board, Auckland, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nigel D Toussaint
- Department of Nephrology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Andrea K Viecelli
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia
| | - Kevan R Polkinghorne
- Department of Medicine, Southern Clinical School, Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia
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5
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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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6
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Tavares FS, de Luca Corrêa H, Wilund KR, Deus LA, de Araújo TB, Tzanno-Martins C, da Motta Vilalva Mestrinho VM, Dos Santos RL, Reis AL, Souza FH, de Sousa Ulisses LR, Cardoso HSS, Pascoal IJF, Guimarães VCC, de Oliveira Gomes L, Neves RVP, Dos Santos Rosa T. Exploring the impact of short daily haemodialysis on muscle strength and bone health in end-stage kidney disease patients. J Cachexia Sarcopenia Muscle 2024; 15:718-725. [PMID: 38272859 PMCID: PMC10995248 DOI: 10.1002/jcsm.13428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 11/15/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Short-daily haemodialysis (SDH) has been strongly recommended over conventional haemodialysis (CHD) for end-stage kidney disease patients, though few studies have directly compared the effects of these two haemodialysis (HD) modalities on clinical variables related to patient's health. METHODS We conducted a cross-sectional study in individuals undergoing HD, comparing epidemiological, clinical, metabolic, inflammatory, anthropometric, bone health/metabolism, and skeletal muscle function according to dialysis modality. One-hundred seventy-eight patients (20.8% females, 62 ± 2.5 years old), were analysed in this study, 86 (48%) of whom were undergoing CHD versus 92 (51%) who were undergoing SDH. RESULTS SDH patients had significantly higher serum albumin levels (3.93 vs. 3.66 g/dL, P < 0.0001) and higher Kt/v (2.6 vs. 2.38, P < 0.0001). SDH group presented a significantly lower number of erythropoietin-stimulating agents compared with CHD group (percentage: 53.3 vs. 83.7%, P < 0.0001) and had lower levels of serum phosphate (4.9 vs. 5.3 mg/dL, P = 0.004) and parathyroid hormone (PTH) (398.4 vs. 480.4 pg/mL, P < 0.001) compared with CHD patients. In terms of bone health and metabolism, SDH patients had significantly higher total BMD, femur BMD, lumbar BMD, and femoral neck BMD compared with CHD patients (all P < 0.05). SDH patients also had lower anti-osteogenic and inflammatory biomarkers, including FGF23, sclerostin, TNF, IL-18, IL-17a, and C-reactive peptide (all P < 0.05). CHD modality was demonstrated to be a risk factor for low BMD (odds ratio: 4.02; 95% CI: 1.59-10.2, P = 0.003). In terms of skeletal muscle function, SDH patients had significantly higher 6-minute walking test (444.6 vs. 424.9 m, P = 0.04) and higher fat-free mass (52.3 vs. 51.68 kg, P = 0.02) compared with CHD patients. Higher fat-free mass and handgrip strength were associated with a 34% and 23% lower risk of low BMD, respectively. SDH patients had lower levels of the uremic toxin asymmetric dimethyl-l-arginine (ADMA) (1.8 vs. 2.07 μM, P = 0.002) and fasting blood glucose (132.6 vs. 141.7 mg/dL, P < 0.02) than CHD group. SDH patients also displayed higher levels of haemoglobin when compared with CHD group (11.9 vs. 10.2 g/dL, P < 0.0001). CONCLUSIONS The present study improves our understanding of the relationship between dialysis modality and clinical variables that may influence HD patient's health. Grip strength and lean mass were positively correlated with bone mineral density in HD patients regardless of dialysis modality. SDH was associated with better bone mineral density, inflammatory profile, and skeletal muscle function when compared with CHD patients. These findings provide more evidence of the clinical benefits of SDH that should be explored in greater detail.
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Affiliation(s)
| | - Hugo de Luca Corrêa
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Kenneth R Wilund
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Lysleine Alves Deus
- Graduate Program of Genomic Sciences and Biotechnology, Catholic University of Brasilia, Brasilia, Brazil
| | | | | | | | - Rafael Lavarini Dos Santos
- Graduate Program of Genomic Sciences and Biotechnology, Catholic University of Brasilia, Brasilia, Brazil
| | - Andrea Lucena Reis
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
| | | | | | | | | | | | | | | | - Thiago Dos Santos Rosa
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
- Graduate Program of Genomic Sciences and Biotechnology, Catholic University of Brasilia, Brasilia, Brazil
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7
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Ok E, Demirci C, Asci G, Yuksel K, Kircelli F, Koc SK, Erten S, Mahsereci E, Odabas AR, Stuard S, Maddux FW, Raimann JG, Kotanko P, Kerr PG, Chan CT. Patient Survival With Extended Home Hemodialysis Compared to In-Center Conventional Hemodialysis. Kidney Int Rep 2023; 8:2603-2615. [PMID: 38106580 PMCID: PMC10719649 DOI: 10.1016/j.ekir.2023.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/04/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction More frequent and/or longer hemodialysis (HD) has been associated with improvements in numerous clinical outcomes in patients on dialysis. Home HD (HHD), which allows more frequent and/or longer dialysis with lower cost and flexibility in treatment planning, is not widely used worldwide. Although, retrospective studies have indicated better survival with HHD, this issue remains controversial. In this multicenter study, we compared thrice-weekly extended HHD with in-center conventional HD (ICHD) in a large patient population with a long-term follow-up. Methods We matched 349 patients starting HHD between 2010 and 2014 with 1047 concurrent patients on ICHD by using propensity scores. Patients were followed-up with from their respective baseline until September 30, 2018. The primary outcome was overall survival. Secondary outcomes were technique survival; hospitalization; and changes in clinical, laboratory, and medication parameters. Results The mean duration of dialysis session was 418 ± 54 minutes in HHD and 242 ± 10 minutes in patients on ICHD. All-cause mortality rate was 3.76 and 6.27 per 100 patient-years in the HHD and the ICHD groups, respectively. In the intention-to-treat analysis, HHD was associated with a 40% lower risk for all-cause mortality than ICHD (hazard ratio [HR] = 0.60; 95% confidence interval [CI] 0.45 to 0.80; P < 0.001). In HHD, the 5-year technical survival was 86.5%. HHD treatment provided better phosphate and blood pressure (BP) control, improvements in nutrition and inflammation, and reduction in hospitalization days and medication requirement. Conclusion These results indicate that extended HHD is associated with higher survival and better outcomes compared to ICHD.
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8
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Quinn RR, Lam NN. Home Dialysis in North America: The Current State. Clin J Am Soc Nephrol 2023; 18:1351-1358. [PMID: 37523194 PMCID: PMC10578635 DOI: 10.2215/cjn.0000000000000273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023]
Abstract
There is widespread interest in expanding the uptake of home dialysis in North America. Although kidney transplantation should be the preferred option in eligible patients, home hemodialysis (HD) and peritoneal dialysis (PD) offer cost-effective options for KRT. In this review, the motivation for promoting home dialysis is presented, and the literature supporting it is critically reviewed. Randomized comparisons of home HD and PD with in-center HD have been challenging to conduct and provide only limited information. Nonrandomized studies are heterogeneous in their design and have often yielded conflicting results. They are prone to bias, and this must be carefully considered when evaluating this literature. Home modalities seem to have equivalent clinical outcomes and quality of life when compared with in-center HD. However, the cost of providing home therapies, particularly PD, is lower than conventional, in-center HD. Measures of home dialysis utilization, the philosophy behind their measurement, and important factors to consider when interpreting them are discussed. The importance of understanding measures of home dialysis utilization in the context of rates of kidney failure, the proportion of individuals who opt for conservative care, and rates of kidney transplantation is highlighted, and a framework for proposing targets is presented, using PD as an example.
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Affiliation(s)
- Robert R Quinn
- Cumming School of Medicine , University of Calgary , Calgary, Canada, and
- Department of Community Health Sciences , University of Calgary , Calgary, Canada
| | - Ngan N Lam
- Cumming School of Medicine , University of Calgary , Calgary, Canada, and
- Department of Community Health Sciences , University of Calgary , Calgary, Canada
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9
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Tang W, Zhang Y, Wang Z, Yuan X, Chen X, Yang X, Qi Z, Zhang J, Li J, Xie X. Development and validation of a multivariate model for predicting heart failure hospitalization and mortality in patients receiving maintenance hemodialysis. Ren Fail 2023; 45:2255686. [PMID: 37732398 PMCID: PMC10515690 DOI: 10.1080/0886022x.2023.2255686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Heart failure (HF) in patients undergoing maintenance hemodialysis (MHD) increases their hospitalization rates, mortality, and economic burden significantly. We aimed to develop and validate a predictive model utilizing contemporary deep phenotyping for individual risk assessment of all-cause mortality or HF hospitalization in patients on MHD. MATERIALS AND METHODS A retrospective review was conducted from January 2017 to October 2022, including 348 patients receiving MHD from four centers. The variables were adjusted by Cox regression analysis, and the clinical prediction model was constructed and verified. RESULTS The median follow-up durations were 14 months (interquartile range [IQR] 9-21) for the modeling set and 14 months (9-20) for the validation set. The composite outcome occurred in 72 (29.63%) of 243 patients in the modeling set and 39 (37.14%) of 105 patients in the validation set. The model predictors included age, albumin, history of cerebral hemorrhage, use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers/"sacubitril/valsartan", left ventricular ejection fraction, urea reduction ratio, N-terminal prohormone of brain natriuretic peptide, and right atrial size. The C-index was 0.834 (95% CI 0.784-0.883) for the modeling set and 0.853 (0.798, 0.908) for the validation set. The model exhibited excellent calibration across the complete risk profile, and the decision curve analysis (DCA) suggested its ability to maximize patient benefits. CONCLUSION The developed prediction model offered an accurate and personalized assessment of HF hospitalization risk and all-cause mortality in patients with MHD. It can be employed to identify high-risk patients and guide treatment and follow-up.
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Affiliation(s)
- Wenwu Tang
- Department of Nephrology, Second Clinical College of Nanchong North Sichuan Medical College, Nanchong Central Hospital, Nanchong, P.R. China
| | - Ying Zhang
- Department of Nephrology, Second Clinical College of Nanchong North Sichuan Medical College, Nanchong Central Hospital, Nanchong, P.R. China
| | - Zhixin Wang
- Department of Nephrology, Second Clinical College of Nanchong North Sichuan Medical College, Nanchong Central Hospital, Nanchong, P.R. China
| | - Xinzhu Yuan
- Department of Nephrology, Second Clinical College of Nanchong North Sichuan Medical College, Nanchong Central Hospital, Nanchong, P.R. China
| | - Xiaoxia Chen
- Department of Nephrology, Suining Central Hospital, Suining, P.R. China
| | - Xiaohua Yang
- Department of Nephrology, Guangyuan Central Hospital, Guangyuan, P.R. China
| | - Zhirui Qi
- North Sichuan Medical College, Nanchong, P.R. China
| | - Ju Zhang
- Department of Nephrology, Guangyuan Central Hospital, Guangyuan, P.R. China
| | - Jie Li
- General Practice Department of Nanchong North, Sichuan Medical College, Nanchong, P.R. China
| | - Xisheng Xie
- Department of Nephrology, Second Clinical College of Nanchong North Sichuan Medical College, Nanchong Central Hospital, Nanchong, P.R. China
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10
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Couchoud C, Ayav C. [REIN and international collaboration]. Nephrol Ther 2023; 18:90-93. [PMID: 37638517 DOI: 10.1016/s1769-7255(22)00576-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
On the occasion of the 20th anniversary of the REIN (French Renal Epidemiology and Information Network), a summary work on the contributions of the national French ESKD register was carried out. On the issue of its international role, the following key messages were retained. Right from its inception, the REIN registry has been integrated into the family of European registries under the direction of the European society ERA and its registry based at the Academic Medical Centre of Amsterdam. In this context, the registry has been a part of numerous international publications and projects financed by the European Commission. The expertise of the Agency of Biomedicine and REIN on the registries has been sought on several occasions in the context of setting up registries of replacement therapies. Several foreign students outside the European Union have also been able to come and work in the REIN national coordination.
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Affiliation(s)
- Cécile Couchoud
- Coordination nationale REIN, Agence de la biomédecine, Saint-Denis-La Plaine, France
| | - Carole Ayav
- Coordination régionale REIN Lorraine, CIC 1433 Épidémiologie clinique, CHRU Nancy, INSERM, Université de Lorraine, Délégation à la recherche clinique et à l’innovation, Vandoeuvre-lès-Nancy, France
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11
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Gupta U, Kumar N, Lata A, Singh P, Arun RK. Bio-inspired self-pumping microfluidic device for cleaning of urea using reduced graphene oxide (rGO) modified polymeric nanohybrid membrane. Int J Biol Macromol 2023; 241:124614. [PMID: 37119905 DOI: 10.1016/j.ijbiomac.2023.124614] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/17/2023] [Accepted: 04/22/2023] [Indexed: 05/01/2023]
Abstract
In vitro technology facilitates the replication of in vivo tissues more accurately than conventional cell-based artificial organs, enabling researchers to mimic both the structural and functional characteristics of natural systems. Here, we demonstrate a novel spiral-shaped self-pumping microfluidic device for the cleaning of urea by incorporating reduced graphene oxide (rGO) modified a Polyethersulfone (PES) nanohybrid membrane for efficient filtration capacity. The spiral-shaped microfluidic chip is a two-layer configuration of polymethyl methacrylate (PMMA) integrated with the modified filtration membrane. In essence, the device replicates the main features of the kidney (Glomerulus), i.e., a nano-porous membrane modified with reduced graphene oxide to separate the sample fluid from the upper layer and collect the biomolecule-free fluid through the bottom of the device. We have achieved a cleaning efficiency of 97.94 ± 0.6 % using this spiral shaped microfluidic system. The spiral-shaped microfluidic device integrated with nanohybrid membrane has potential for organ-on-a-chips applications.
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Affiliation(s)
- Upasana Gupta
- Department of Chemical Engineering, Indian Institute of Technology Jammu, India
| | - Natish Kumar
- Department of Chemical Engineering, Indian Institute of Technology Jammu, India
| | - Akash Lata
- Department of Chemical Engineering, Indian Institute of Technology Jammu, India
| | - Preeti Singh
- Academy of Scientific and Innovative Research, New Delhi, India
| | - Ravi Kumar Arun
- Department of Chemical Engineering, Indian Institute of Technology Jammu, India.
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12
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Masuda T, Nakaura T, Funama Y, Sato T, Masuda S, Yoshiura T, Gotanda R, Arao K, Imaizumi H, Arao S, Ono A, Hiratsuka J, Awai K. Effect of patient characteristics on vessel enhancement on arterio-venous fistula CT angiography in a retrospective cohort study. Medicine (Baltimore) 2023; 102:e33328. [PMID: 36961162 PMCID: PMC10036065 DOI: 10.1097/md.0000000000033328] [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] [Received: 10/05/2021] [Accepted: 02/28/2023] [Indexed: 03/25/2023] Open
Abstract
To evaluate the effects of various patient characteristics on vessel enhancement on arterio-venous fistula (AVF) computed tomography (CT) angiography (AVF-CT angiography). A total of 127 patients with suspected or confirmed shunt stenosis and internal AVF complications were considered for inclusion in a retrospective cohort study. The tube voltage was 120 kVp, and the tube current was changed from 300 to 770 mA to maintain the image quality (noise index: 14) using automatic tube current modulation. To evaluate the effects of age, sex, body size, and scan delay on the CT number of the brachial artery or vein, we used correlation coefficients and multivariate regression analyses. There was a significant positive correlation between the CT number of the brachial artery or vein and age (R = 0.21 or 0.23, P < .01). The correlations were inverse with the height (r = -0.45 or -0.42), total body weight (r = -0.52 or -0.50), body mass index (r = -0.21 or -0.23), body surface area (body surface area [BSA]; r = -0.56 or -0.54), and lean body weight (r = -0.55 or -0.53) in linear regression analysis (P < .01 for all). There was a significant correlation between the CT number of the brachial artery or vein and scan delay (R = 0.19 or 01.9, P < .01). Only the BSA had significant effects on the CT number in multivariate regression analysis (P < .01). The BSA was significantly correlated with the CT number of the brachial artery or vein on AVF-CT angiography.
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Affiliation(s)
- Takanori Masuda
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshinori Funama
- Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomoyasu Sato
- Department of Diagnostic Radiology, Tsuchiya General Hospital, Naka-ku, Hiroshima, Japan
| | - Shouko Masuda
- Department of Radiological Technologist, Kawamura Clinic, Hiroshima, Japan
| | - Takayuki Yoshiura
- Department of Radiological Technology, Tsuchiya General Hospital, Naka-ku, Hiroshima, Japan
| | - Rumi Gotanda
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Keiko Arao
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Hiromasa Imaizumi
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Shinichi Arao
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Atsushi Ono
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Junichi Hiratsuka
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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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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Uzun Kenan B, Demircioglu Kilic B, Akbalık Kara M, Taktak A, Karabay Bayazit A, Yuruk Yildirim ZN, Delibas A, Aytac MB, Conkar S, Kaya Aksoy G, Donmez O, Yel S, Saygili S, Akaci O, Buyukkaragoz B, Alpay H, Bakkaloglu SA. Evaluation of the Claria sharesource system from the perspectives of patient/caregiver, physician, and nurse in children undergoing automated peritoneal dialysis. Pediatr Nephrol 2023; 38:471-477. [PMID: 35562513 PMCID: PMC9106572 DOI: 10.1007/s00467-022-05563-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Automated peritoneal dialysis (APD) is increasingly preferred worldwide. By using a software application (Homechoice with Claria sharesource system (CSS)) with a mod-M added to the APD device, details of the home dialysis treatment become visible for PD nurses and physicians, allowing for close supervision. We aimed to evaluate the perceptions of patients/caregivers, PD nurses, and physicians about the advantages and disadvantages of CSS. METHODS Three different web-based questionnaires for patients/caregivers, nurses, and physicians were sent to 15 pediatric nephrology centers with more than 1 year of experience with CSS. RESULTS Respective questionnaires were answered by 30 patients/caregivers, 22 pediatric nephrologists, and 15 PD nurses. Most of the nurses and physicians (87% and 73%) reported that CSS improved patient monitoring. A total of 73% of nurses suggested that CCS is not well known by physicians, while half of them reported reviewing CSS data for all patients every morning. Sixty-eight percent of physicians thought that CSS helps save time for both patients/caregivers and healthcare providers by reducing visits. However, only 20% of patients/caregivers reported reduced hospital visits. A total of 90% of patients/caregivers reported that being under constant monitoring made them feel safe, and 83% stated that the patient's sleep quality improved. CONCLUSIONS A remote monitoring APD system, CSS, can be successfully applied with children for increased adherence to dialysis prescription by giving shared responsibility and may help increase the patient's quality of life. This platform is more commonly used by nurses than physicians. Its potential benefits should be evaluated in further well-designed clinical studies with larger patient groups. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Bahriye Uzun Kenan
- Department of Pediatric Nephrology, Gazi University School of Medicine, Besevler, Ankara, Turkey
| | | | | | - Aysel Taktak
- Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey
| | | | | | - Ali Delibas
- Mersin University School of Medicine, Mersin, Turkey
| | | | - Secil Conkar
- Ege University School of Medicine, Izmir, Turkey
| | | | - Osman Donmez
- Uludag University School of Medicine, Bursa, Turkey
| | - Sibel Yel
- Erciyes University School of Medicine, Kayseri, Turkey
| | - Seha Saygili
- Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Okan Akaci
- Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Bahar Buyukkaragoz
- Department of Pediatric Nephrology, Gazi University School of Medicine, Besevler, Ankara, Turkey
| | - Harika Alpay
- Marmara University School of Medicine, Istanbul, Turkey
| | - Sevcan A Bakkaloglu
- Department of Pediatric Nephrology, Gazi University School of Medicine, Besevler, Ankara, Turkey.
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15
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Safety and efficacy of hemodialysis and peritoneal dialysis in treating end-stage diabetic nephropathy: a meta-analysis of randomized controlled trials. Int Urol Nephrol 2022; 54:2901-2909. [DOI: 10.1007/s11255-022-03194-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
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Safety and Efficacy of Short Daily Hemodialysis with Physidia S 3 System: Clinical Performance Assessment during the Training Period. J Clin Med 2022; 11:jcm11082123. [PMID: 35456216 PMCID: PMC9031690 DOI: 10.3390/jcm11082123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Background: A growing body of scientific evidence indicates that clinical outcomes of hemodialysis patients can be improved with short daily dialysis treatment. Current in-center hemodialysis machines do not fulfill the requirements needed for self-care home hemodialysis (HHD) treatment. In line with the reviviscence of home therapy, several hemodialysis devices have been developed and deployed for treatment. Physidia S3 is one of these new dialysis delivery systems featuring an appealing design and functionalities intended for daily HHD treatment. Methods: In this French multicenter proof-of-concept study enrolling 13 training centers, we report our preliminary experience with a special focus on quantifying clinical performances in short daily HHD treatment performed during the training period of the patients. Results: Among the 80 patients included in this study, a total of 249 sessions could be analyzed. Dialysis dose, estimated from weekly standardized Kt/V, was maintained at 2.22 [1.95–2.61] with a normalized protein catabolic rate of 0.93 [0.73–1.18] g/kg/24 h. Furthermore, anemia and nutritional status were adequately controlled as indicated by 11.6 ± 1.4 g/dL of hemoglobin level and 39.4 ± 5.7 g/L of serum albumin as well as electrolyte disorders. Conclusions: The safety and efficacy of the S3 therapy concept relying on a short daily hemodialysis treatment using a bagged delivery system are in total agreement with daily HHD recommendations. Clinical performances are aligned to the metabolic needs of the vast majority of HHD patients. Currently ongoing studies at home will provide further evidence and value of this therapeutic approach.
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Shao G, Himmelfarb J, Hinds BJ. Strategies for optimizing urea removal to enable portable kidney dialysis: A reappraisal. Artif Organs 2022; 46:997-1011. [PMID: 35383963 DOI: 10.1111/aor.14185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/23/2021] [Accepted: 01/10/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Portable hemodialysis has the potential to improve health outcomes and quality of life for patients with kidney failure at reduced costs. Urea removal, required for dialysate regeneration, is a central function of any existing/potential portable dialysis device. Urea in the spent dialysate coexists with non-urea uremic toxins, nutrients, and electrolytes, all of which will interfere with the urea removal efficiency, regardless of whether the underlying urea removal mechanism is based on urease conversion, direct urea adsorption, or oxidation. The aim of the current review is to identify the amount of the most prevalent chemicals being removed during a single dialysis session and evaluate the potential benefits of an urea-selective membrane for portable dialysis. METHODS We have performed a literature search using Web of Science and PubMed databases to find available articles reporting (or be able to calculate from blood plasma concentration) > 5 mg of individually quantified solutes removed during thrice-weekly hemodialysis sessions. If multiple reports of the same solute were available, the reported values were averaged, and the geometric mean of standard deviations was taken. Further critical literature analysis of reported dialysate regeneration methods was performed using Web of Science and PubMed databases. RESULTS On average, 46.0 g uremic retention solutes are removed in a single conventional dialysis session, out of which urea is only 23.6 g. For both urease- and sorbent-based urea removal mechanisms, amino acids, with 7.7 g removal per session, could potentially interfere with urea removal efficiency. Additionally for the oxidation-based urea removal system, plentiful nutrients such as glucose (24.0 g) will interfere with urea removal by competition. Using a nanofiltration membrane between dialysate and oxidation unit with a molecular weight cutoff (MWCO) of ~200 Da, 67.6 g of non-electrolyte species will be removed in a single dialysis session, out of which 44.0 g are non-urea molecules. If the membrane MWCO is further decreased to 120 Da, the mass of non-electrolyte non-urea species will drop to 9.3 g. Reverse osmosis membranes have been shown to be both effective at blocking the transport of non-urea species (creatinine for example with ~90% rejection ratio), and permissive for urea transport (~20% rejection ratio), making them a promising urea selective membrane to increase the efficiency of the oxidative urea removal system. CONCLUSIONS Compiled are quantified solute removal amounts greater than 5 mg per session during conventional hemodialysis treatments, to act as a guide for portable dialysis system design. Analysis shows that multiple chemical species in the dialysate interfere with all proposed portable urea removal systems. This suggests the need for an additional protective dialysate loop coupled to urea removal system and an urea-selective membrane.
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Affiliation(s)
- Guozheng Shao
- Department of Materials Science & Engineering, University of Washington, Seattle, Washington, USA.,Center for Dialysis Innovation, University of Washington, Seattle, Washington, USA
| | - Jonathan Himmelfarb
- Center for Dialysis Innovation, University of Washington, Seattle, Washington, USA.,Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Bruce J Hinds
- Department of Materials Science & Engineering, University of Washington, Seattle, Washington, USA.,Center for Dialysis Innovation, University of Washington, Seattle, Washington, USA
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18
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Semple DJ, Sypek M, Ullah S, Davies C, McDonald S. Mortality After Home Hemodialysis Treatment Failure and Return to In-Center Hemodialysis. Am J Kidney Dis 2021; 79:15-23.e1. [PMID: 34274359 DOI: 10.1053/j.ajkd.2021.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/11/2021] [Indexed: 11/11/2022]
Abstract
RATIONALE OBJECTIVE Patients on home hemodialysis (HHD) may eventually return to in-center hemodialysis (ICHD) for clinical, technical or psycho-social reasons. We studied the mortality of patients returning to ICHD after HHD comparing it to the mortality experience among patients receiving HHD and patients receiving ICHD without prior treatment with HHD. STUDY DESIGN Retrospective cohort study. SETTING PARTICIPANTS All patients represented in the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry who commenced HD during 2005-2015 and were treated for >90 days. EXPOSURES ICHD and/or HHD, and clinical characteristics at study entry. OUTCOMES Mortality and cause of death. ANALYTICAL APPROACH A time-varying multivariate Cox proportional hazards analysis with shared frailty was implemented to explore the association between patient treatment states and mortality. Patients were censored at the time of transplantation and change in treatment modality to peritoneal dialysis. RESULTS A total of 19,306 patients initiated HD and were treated for >90 days. The mean age of patients was 60.8y (SD=15.4y), 62% were male and 49% had diabetes. After HHD treatment failure, adjusted mortality was increased compared to continued HHD at 0-30 days (HR 3.93, 95% CI 2.09-7.40 p<0.001), 30-90 days (HR 3.34, 95% CI 1.98-5.62, p<0.001) and >90 days (HR 2.29, CI 1.84-2.85, p<0.001). LIMITATIONS Covariates recorded at dialysis initiation. Residual confounding underlying successful initiation of HHD treatment.Observational data lacking detail on cause of HHD treatment failure. CONCLUSIONS HHD treatment failure is associated with a significant increase in mortality compared to continued HHD. This risk was present in both the early (first 30 days and 30-90 days) and late (>90 days) periods after HHD treatment failure. Further investigation into the specific causes of treatment failure and death may highlight specific high-risk patients.
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Affiliation(s)
- David J Semple
- Department of Renal Medicine, Auckland District Health Board, Auckland, NZ; Faculty of Medical and Health Sciences, University of Auckland, Auckland, NZ.
| | - Matthew Sypek
- ANZDATA Registry, SA Health and Medical Research Institute, Adelaide, SA; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria
| | - Shahid Ullah
- ANZDATA Registry, SA Health and Medical Research Institute, Adelaide, SA; Adelaide Medical School, University of Adelaide, Adelaide, SA; College of Medicine and Public Health, Flinders University, Adelaide, SA
| | - Christopher Davies
- ANZDATA Registry, SA Health and Medical Research Institute, Adelaide, SA; Adelaide Medical School, University of Adelaide, Adelaide, SA
| | - Stephen McDonald
- ANZDATA Registry, SA Health and Medical Research Institute, Adelaide, SA; Adelaide Medical School, University of Adelaide, Adelaide, SA
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19
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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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20
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Chanliau J, Durand PY. Lowering dialysis sessions duration may be dangerous. BULLETIN DE LA DIALYSE À DOMICILE 2021. [DOI: 10.25796/bdd.v4i1.60263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Dialysis session in less duration - either to give a better quality of life for the patient or to optimize the organization the dialysis institution - may have bad repercussions on the quality of the treatment and therefore the quality of life of the patient.
According to the result of the publications listed in this work, we conclude that it is necessary to perform either longer sessions or more frequent treatments to limit the interval time between two sessions.
As this is difficult to perform by the providers, we recommend to develop home dialysis to obtain the best result.
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21
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Momciu B, Chan CT. Evaluating dialysis adequacy: Origins, evolution, and future directions. Semin Dial 2020; 33:468-474. [PMID: 33063393 DOI: 10.1111/sdi.12926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The expansion and transformation over time of dialysis therapies have been inexorably linked to the concept of adequacy. While initially the goal of dialysis was simple survival of patients until their next treatment, this changed with the publication of the National Cooperative Dialysis Study. It brought about a focus on defining adequate dialysis through measurements of the removal of small solutes, in particular urea. This spurred significant improvements in patient outcomes by standardizing therapy and providing benchmarks for each center to achieve. Over time, however, further research has found this narrow definition of adequacy to be insufficient to encompass the complexities of dialysis therapies. Factors such as residual kidney function (RKF), nutritional and volume status, and cardiovascular control all contribute to the outcomes for dialysis patients. We propose that an optimal definition of adequacy should not only focus on one factor but rather the interconnection and contribution to our patient's individual specific goals and their overall quality of life.
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Affiliation(s)
- Bogdan Momciu
- Division of Nephrology, University Health Network, Toronto, Canada
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22
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Jansz TT, Noordzij M, Kramer A, Laruelle E, Couchoud C, Collart F, Cases A, Arici M, Helve J, Waldum-Grevbo B, Rydell H, Traynor JP, Zoccali C, Massy ZA, Jager KJ, van Jaarsveld BC. Survival of patients treated with extended-hours haemodialysis in Europe: an analysis of the ERA-EDTA Registry. Nephrol Dial Transplant 2020; 35:488-495. [PMID: 31740955 PMCID: PMC7056951 DOI: 10.1093/ndt/gfz208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/13/2019] [Indexed: 01/16/2023] Open
Abstract
Background Previous US studies have indicated that haemodialysis with ≥6-h sessions [extended-hours haemodialysis (EHD)] may improve patient survival. However, patient characteristics and treatment practices vary between the USA and Europe. We therefore investigated the effect of EHD three times weekly on survival compared with conventional haemodialysis (CHD) among European patients. Methods We included patients who were treated with haemodialysis between 2010 and 2017 from eight countries providing data to the European Renal Association–European Dialysis and Transplant Association Registry. Haemodialysis session duration and frequency were recorded once every year or at every change of haemodialysis prescription and were categorized into three groups: CHD (three times weekly, 3.5–4 h/treatment), EHD (three times weekly, ≥6 h/treatment) or other. In the primary analyses we attributed death to the treatment at the time of death and in secondary analyses to EHD if ever initiated. We compared mortality risk for EHD to CHD with causal inference from marginal structural models, using Cox proportional hazards models weighted for the inverse probability of treatment and censoring and adjusted for potential confounders. Results From a total of 142 460 patients, 1338 patients were ever treated with EHD (three times, 7.1 ± 0.8 h/week) and 89 819 patients were treated exclusively with CHD (three times, 3.9 ± 0.2 h/week). Crude mortality rates were 6.0 and 13.5/100 person-years. In the primary analyses, patients treated with EHD had an adjusted hazard ratio (HR) of 0.73 [95% confidence interval (CI) 0.62–0.85] compared with patients treated with CHD. When we attributed all deaths to EHD after initiation, the HR for EHD was comparable to the primary analyses [HR 0.80 (95% CI 0.71–0.90)]. Conclusions EHD is associated with better survival in European patients treated with haemodialysis three times weekly.
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Affiliation(s)
- Thijs T Jansz
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.,Dianet Dialysis Centres, Utrecht, The Netherlands
| | - Marlies Noordzij
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anneke Kramer
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric Laruelle
- AUB Sante Dialyse, Rennes, France.,Service de Nephrologie, CHU Rennes, Rennes, France
| | - Cécile Couchoud
- REIN Registry, Agence de la biomédecine, Saint-Denis La Plaine, France
| | | | - Aleix Cases
- Nephrology Unit, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Registre de Malalts Renals de Catalunya, Barcelona, Spain
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Jaako Helve
- Finnish Registry for Kidney Diseases, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Helena Rydell
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Huddinge, Sweden.,Swedish Renal Registry, Department of Internal Medicine, Ryhov County Hospital, Jönköping, Sweden
| | - Jamie P Traynor
- Scottish Renal Registry Meridian Court, Information Services Division Scotland, Glasgow, UK
| | - Carmine Zoccali
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, CNR-Institute of Clinical Physiology, Reggio Calabria, Italy
| | - Ziad A Massy
- Division of Nephrology, Ambroise-Paré University Hospital, APHP, University of Paris Ouest-Versailles-St-Quentin-en-Yvelines, Boulogne-Billancourt/Paris, France.,Institut National de la Santé et de la Recherche Médicale U1018, Team 5, CESP UVSQ, University Paris Saclay, Villejuif, France
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Brigit C van Jaarsveld
- Dianet Dialysis Centres, Utrecht, The Netherlands.,Department of Nephrology and Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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23
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Haroon S, Griva K, Davenport A. Factors affecting uptake of home hemodialysis among self-care dialysis unit patients. Hemodial Int 2020; 24:460-469. [PMID: 32856399 DOI: 10.1111/hdi.12862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/02/2020] [Accepted: 07/15/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Superior outcomes have been reported among hemodialysis (HD) patients who take active control over their dialysis treatment either at self-care satellite dialysis units or home compared to the regular in-center hemodialysis patient. Although the differences between the home hemodialysis (HHD) and self-care in-center HD (SCHD) are not well described, the growing literature on the superior outcomes of HHD suggests that HHD is the better option. METHODS We performed a cross-sectional study in a stand-alone self-care unit to examine the differences in patients that are keen to consider HHD and those who are not. FINDINGS A cross-sectional sample of 44 patients completed a structured interview and the distress thermometer score used to assess psychological stress. Only 68% of patients reported to have heard about the benefits of HHD despite the long-established history and availability of the modality in the unit. One of the more critical findings in our study was that the cohort of patients who were keen to consider HHD believed that self-care and HHD would improve their quality of life (P < 0.05). Specifically, the perceived benefits stated by those willing to consider HHD were the lack of need to travel, association with better outcomes and the possibility of having the treatment in the comfort of home (P < 0.05). DISCUSSION We surmise that the answers expressed in this survey likely reflect a difference in perceptions of self-care and beliefs about HHD; hence, the importance of introducing HHD education earlier in the course of their chronic kidney disease journey.
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Affiliation(s)
| | - Konstadina Griva
- Center for Population Health Sciences, Nanyang Technological University, Singapore
| | - Andrew Davenport
- Division of Nephrology, Department of Medicine, UCL Center for Nephrology, Royal Free Hospital, University College London, London, UK
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24
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Abstract
Rationale & Objective Home dialysis has been underused in the United States, especially among minority groups. We investigated whether adjustment for socioeconomic factors would attenuate racial/ethnic differences in the initiation of home dialysis. Study Design Retrospective observational cohort study. Setting & Population Adult patients in the US Renal Data System who initiated dialysis on day 1 with either in-center hemodialysis (HD), home HD (HHD), or peritoneal dialysis (PD) from 2005 to 2013. Predictor Race/ethnicity: non-Hispanic white, Hispanic, black, or Asian. Outcome Initiating dialysis with PD versus in-center HD and HHD versus in-center HD for each minority group compared with non-Hispanic whites. Analytical Approach Odds ratios and 95% CIs estimated by logistic regression. Results Of 523,526 patients, 55% were white, 28% were black, 13% were Hispanic, and 4% were Asian; 8% started dialysis on PD, and 0.1%, on HHD. In unadjusted analyses, blacks and Hispanics were 30% and 19% less likely and Asians were 31% more likely to start on PD than whites. The differences narrowed when fully adjusted for demographic, medical, and socioeconomic factors. Adjustment for socioeconomic factors reduced these differences between white and black, Hispanic, and Asian patients by 13%, 28%, and 1%, respectively. Blacks were just as likely and Hispanics and Asians were less likely to start on HHD than whites. This did not change appreciably when fully adjusted for demographic, medical, and socioeconomic factors. Limitations No data for physician and patient preferences or modality education. Conclusions Black and Hispanic patients are less likely to start on PD than white patients, attributable partly, though not completely, to socioeconomic factors. Hispanics and Asians are less likely to start on HHD than whites. This was materially unaffected by socioeconomic factors. More research is needed to determine whether urgent-start PD programs and transitional care units in socioeconomically disadvantaged areas might reduce these disparities and increase home dialysis use among all groups.
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25
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Solimano RJ, Lineen J, Naimark DMJ. Preference for Alternate-Day Versus Conventional In-Center Dialysis: A Health Utility Elicitation. Can J Kidney Health Dis 2020; 7:2054358120914426. [PMID: 32426146 PMCID: PMC7218335 DOI: 10.1177/2054358120914426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Mortality rates for patients on hemodialysis (HD) continue to be high, in particular, following the long interdialytic period, yet thrice-weekly conventional HD (CHD) is still an almost universal regimen. Alternate-day dialysis (ADD) may have advantages over the current schedule because it would eliminate the long interdialytic break. A preliminary, as yet unpublished, patient simulation and cost-utility analysis compared CHD versus ADD and demonstrated that the economic attractiveness of ADD was sensitive, in particular, to patients’ preference for ADD versus CHD. To date, this preference has not been elicited. Objective: To elicit utilities for both CHD and ADD using 3 standard elicitation methods among a prevalent cohort of patients on CHD. Design: This study is a single-center survey of patient preferences (utilities). Setting: This study took place within the dialysis units of Sunnybrook Health Centre, a university-affiliated teaching hospital in Toronto, Ontario, Canada, which encompasses 174 patients on in-center HD. Patients: Those older than 18 years of age, on thrice-weekly HD, were included in this study. Measurements: Descriptive statistics were used to summarize patient characteristics and the utility values generated. A multiple linear regression was performed to determine an association between participant characteristics and the utility ratio. Methods: Via standardized face-to-face interviews by a single investigator, 3 utility elicitation methods, visual analogue scale (VAS), time trade-off (TTO), and standard gamble (SG), were administered to generate utilities for each patient for their current health state of CHD (thrice-weekly). After completing this task, we provided each patient with a concise summary regarding the current literature on how ADD may impact their health. Finally, patients were asked to envision their health while on an ADD regimen while repeating the VAS, TTO, and SG. Results: We recruited 65 participants. The mean utilities of CHD versus ADD were similar for all 3 methods. Visual analogue scale, TTO, and SG had utility values of 0.6 ± 0.2, 0.6 ± 0.3, and 0.7 ± 0.3, and 0.6 ± 0.2, 0.7 ± 0.3, and 0.7 ± 0.3 for CHD and ADD, respectively. The ratio for CHD to ADD was 1.1 ± 0.4, 1.1 ± 0.5, and 1.0 ± 0.2 for VAS, TTO, and SG, respectively. Limitations: Small sample size from a single center, where not all participants agreed to participate, wide variability in participant responses and requiring patients to conceptually imagine life on ADD may have affected our results. Conclusions: Compared with CHD, there was no difference in the preference toward ADD which demonstrates promise that adopting an alternate-day schedule may be acceptable to patients. Furthermore, with the generation of a utility for ADD, this will allow for more precise estimates in future simulation studies of the economic attractiveness of ADD. Trial registration: Not required as this article is not a systematic review nor does it report the results of a health care intervention.
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Affiliation(s)
| | | | - David M J Naimark
- Department of Medicine, University of Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
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26
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Abstract
The cost and health burden of ESRD continues to increase globally. Total Medicare expenditure on dialysis has increased from 229 million USD in 1973 to 35.4 billion USD in 2016. Dialysis access can represent almost a tenth of these costs. Central venous catheters have been recognized as a significant factor driving costs and mortality in this population. Home dialysis, which includes peritoneal dialysis and home hemodialysis, is an effective way of reducing costs related to renal replacement therapy, reducing central venous catheter usage and in many cases improving the clinical and psychosocial aspects of patients' health. Addressing access-related issues for peritoneal dialysis, urgent-start peritoneal dialysis and home hemodialysis can have impact on the success of home dialysis. This article reviews issues related to dialysis access for home therapies.
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27
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Hull KL, March DS, Churchward DR, Graham‐Brown MP, Burton JO. The effect of extended‐hours hemodialysis on outcomes: A systematic review and meta‐analysis. Hemodial Int 2020; 24:133-147. [DOI: 10.1111/hdi.12828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/05/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Katherine L. Hull
- Department of Cardiovascular SciencesUniversity of Leicester Leicester UK
- John Walls Renal UnitLeicester General Hospital Leicester UK
| | - Daniel S. March
- Department of Cardiovascular SciencesUniversity of Leicester Leicester UK
- John Walls Renal UnitLeicester General Hospital Leicester UK
| | - Darren R. Churchward
- Department of Cardiovascular SciencesUniversity of Leicester Leicester UK
- John Walls Renal UnitLeicester General Hospital Leicester UK
| | - Matthew P.M. Graham‐Brown
- Department of Cardiovascular SciencesUniversity of Leicester Leicester UK
- John Walls Renal UnitLeicester General Hospital Leicester UK
| | - James O. Burton
- Department of Cardiovascular SciencesUniversity of Leicester Leicester UK
- John Walls Renal UnitLeicester General Hospital Leicester UK
- School of Sport, Exercise and Health SciencesLoughborough University Loughborough UK
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28
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Luo J, Fan JB, Wang S. Recent Progress of Microfluidic Devices for Hemodialysis. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2020; 16:e1904076. [PMID: 31535786 DOI: 10.1002/smll.201904076] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/31/2019] [Indexed: 06/10/2023]
Abstract
Microfluidic hemodialysis techniques have recently attracted great attention in the treatment of kidney disease due to their advantages of portability and wearability as well as their great potential for replacing clinical hospital-centered blood purification with continuous in-home hemodialysis. This Review summarizes the recent progress in microfluidic devices for hemodialysis. First, the history of kidney-inspired hemodialysis is introduced. Then, recent achievements in the preparation of microfluidic devices and hemodialysis nanoporous membrane materials are presented and categorized. Subsequently, attention is drawn to the recent progress of nanoporous membrane-based microfluidic devices for hemodialysis. Finally, the challenges and opportunities of hemodialysis microfluidic devices in the future are also discussed. This Review is expected to provide a comprehensive guide for the design of hemodialysis microfluidic devices that are closely related to clinical applications.
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Affiliation(s)
- Jing Luo
- CAS Key Laboratory of Bio-inspired Materials and Interfacial Science, CAS Center for Excellence in Nanoscience, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing, 100049, P. R. China
| | - Jun-Bing Fan
- CAS Key Laboratory of Bio-inspired Materials and Interfacial Science, CAS Center for Excellence in Nanoscience, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, P. R. China
| | - Shutao Wang
- CAS Key Laboratory of Bio-inspired Materials and Interfacial Science, CAS Center for Excellence in Nanoscience, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing, 100049, P. R. China
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29
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Sarafidis P, Faitatzidou D, Papagianni A. Benefits and risks of frequent or longer haemodialysis: weighing the evidence. Nephrol Dial Transplant 2020; 36:gfaa023. [PMID: 32073626 DOI: 10.1093/ndt/gfaa023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Indexed: 12/28/2022] Open
Abstract
Although the ability of individuals with end-stage renal disease to maintain body homoeostasis is equally impaired during all weekdays, conventional haemodialysis (HD) treatment is scheduled thrice weekly, containing two short and one long interdialytic interval. This intermittent nature of HD and the consequent fluctuations in volume, metabolic parameters and electrolytes have long been hypothesized to predispose to complications. Large observational studies link the first weekday with an increased risk of cardiovascular morbidity and mortality. Several schemes of frequent and/or longer, home or in-centre HD have been introduced, aiming to alleviate the above risks by both increasing total dialysis duration and reducing the duration of interdialytic intervals. Observational studies in this field have non-uniform results, showing that enhanced frequency in home (but not in-centre) HD is associated with reduced mortality. Evidence from the randomized Daily and Nocturnal Trials of the Frequent HD Network suggest the opposite, showing mortality benefits with in-centre daily but not with home nocturnal dialysis. Secondary analyses of these trials indicate that daily and nocturnal schedules do not have equal effects on intermediate outcomes. Alternative schemes, such as thrice weekly in-centre nocturnal HD or every-other-day HD, seem to also offer improvements in several intermediate endpoints, but need further testing with randomized trials. This review summarizes the effects of frequent and/or longer HD methods on hard and intermediate outcomes, attempting to provide a balanced overview of the field.
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Affiliation(s)
- Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Danai Faitatzidou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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30
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Auguste BL, Girsberger M, Kennedy C, Srithongkul T, McGrath-Chong M, Bargman J, Chan CT. Are adverse events in newly trained home dialysis patients related to learning styles? A single-centre retrospective study from Toronto, Canada. BMJ Open 2020; 10:e033315. [PMID: 31964671 PMCID: PMC7045245 DOI: 10.1136/bmjopen-2019-033315] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Home haemodialysis (HD) and peritoneal dialysis (PD) have seen growth in utilisation around the globe over the last few years. However, home dialysis, with its attendant technical complexity and risk of adverse events continues to pose challenges for wider adoption. We examined whether differences in patients' learning styles are associated with differing risk of adverse events in both home HD and PD patients. DESIGN Retrospective cohort study. SETTING Tertiary care hospital in Toronto, Ontario, Canada. PARTICIPANTS One hundred and eighteen prevalent adult (≥18 years) home dialysis patients (40 PD and 78 home HD) were enrolled. Patients on home dialysis for less than 6 months or receiving home nursing assistance for dialysis were excluded from the study. INTERVENTIONS Enrolled patients completed (VARK) Visual, Aural, Reading-writing and Kinesthetic questionnaires to determine learning styles. PRIMARY AND SECONDARY OUTCOME MEASURES Home HD and PD adverse events were identified within 6 months of completing home dialysis training. Event rates were then stratified and compared according to learning styles. RESULTS Thirty patients had a total of 53 adverse events. We used logistic regression analysis to determine unadjusted and adjusted ORs for a single adverse event. Non-visual learners were 4.35 times more likely to have an adverse event (p=0.001). After adjusting for age, gender, dialysis modality, training duration, dialysis vintage, prior renal replacement therapy, visual impairment, education and literacy, an adverse event was still four times more likely among non-visual learners compared to visual learners (p=0.008). A subgroup analysis of home HD patients showed adverse events were more likely among non-visual learners (OR 11.1; p=0.003), whereas PD patients showed a trend for more adverse events in non-visual learners (OR: 1.60; p=0.694). CONCLUSIONS Different learning styles in home dialysis patients exist. Visual learning styles are associated with fewer adverse events in home dialysis patients within the first 6 months of completing training. Individualisation of home dialysis training by learning style is warranted.
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Affiliation(s)
- Bourne Lewis Auguste
- Medicine; Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Medicine; Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Michael Girsberger
- Medicine; Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Claire Kennedy
- Medicine; Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | | | | | - Joanne Bargman
- Medicine; Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
- Medicine; Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Christopher T Chan
- Medicine; Division of Nephrology, University Health Network, Toronto, Ontario, Canada
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Nishio-Lucar AG, Bose S, Lyons G, Awuah KT, Ma JZ, Lockridge RS. Intensive Home Hemodialysis Survival Comparable to Deceased Donor Kidney Transplantation. Kidney Int Rep 2020; 5:296-306. [PMID: 32154451 PMCID: PMC7056865 DOI: 10.1016/j.ekir.2019.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 12/18/2019] [Accepted: 12/31/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction Kidney transplantation (KT) remains the treatment of choice for end-stage kidney disease (ESKD), but access to transplantation is limited by a disparity between supply and demand for suitable organs. This organ shortfall has resulted in the use of a wider range of donor kidneys and, in parallel, a reexamination of potential alternative renal replacement therapies. Previous studies comparing Canadian intensive home hemodialysis (IHHD) with deceased donor (DD) KT in the United States reported similar survival, suggesting IHHD might be a plausible alternative. Methods Using data from the Scientific Registry of Transplant Recipients and an experienced US-based IHHD program in Lynchburg, VA, we retrospectively compared mortality outcomes of a cohort of IHHD patients with transplant recipients within the same geographic region between October 1997 and June 2014. Results We identified 3073 transplant recipients and 116 IHHD patients. Living donor KT (n = 1212) had the highest survival and 47% reduction in risk of death compared with IHHD (hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.34–0.83). Survival of IHHD patients did not statistically differ from that of DD transplant recipients (n = 1834) in adjusted analyses (HR: 0.96; 95% CI: 0.62–1.48) or when exclusively compared with marginal (Kidney Donor Profile Index >85%) transplant recipients (HR: 1.35; 95% CI: 0.84–2.16). Conclusion Our study showed comparable overall survival between IHHD and DD KT. For appropriate patients, IHHD could serve as bridging therapy to transplant and a tenable long-term renal replacement therapy.
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Affiliation(s)
- Angie G Nishio-Lucar
- Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Subhasish Bose
- Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA.,Lynchburg Nephrology Physicians, PLLC, Lynchburg, Virginia, USA
| | - Genevieve Lyons
- Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Kwabena T Awuah
- Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA.,Lynchburg Nephrology Physicians, PLLC, Lynchburg, Virginia, USA
| | - Jennie Z Ma
- Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Robert S Lockridge
- Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA.,Lynchburg Nephrology Physicians, PLLC, Lynchburg, Virginia, USA
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Dou P, Zhao S, Xu S, Li XM, He T. Feasibility of osmotic dilution for recycling spent dialysate: Process performance, scaling, and economic evaluation. WATER RESEARCH 2020; 168:115157. [PMID: 31614235 DOI: 10.1016/j.watres.2019.115157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/25/2019] [Accepted: 10/03/2019] [Indexed: 06/10/2023]
Abstract
Hemodialysis is one of the therapies for patients with kidney failure. Hemodialysis requires large amounts of pure water, and is one of the most water-hungry medical procedures, and thus represents a clear opportunity where improvements should be made concerning the consumption and wastage of water. In this paper, we explored the potential of forward osmosis (FO) membrane for recycling the spent dialysate using the dialysis concentrate as the draw solution. Partially diluted dialysis concentrate could be further diluted with pure water to form dialysate for further dialysis process. Using commercial cellulose triacetate (CTA) FO membranes, the water recovery of approximately 64% was achieved and the final volume of the partially diluted dialysis concentrate was about four times the initial volume. Flux decline of the FO process was observed, mainly due to concentration of synthetic spent dialysate and dilution of dialysis concentrate, while membrane scaling had little impact on the flux decline. The urea rejection was found to be relatively low owing to the small size and electroneutral nature of the urea molecule. Obvious membrane scaling was observed after three FO cycles. The energy dispersive spectroscopy analysis of the scaling layer indicated that the scalants were phosphates and carbonates. The scaling was removed via osmotic backwash and almost completely recovery of FO flux was obtained. Economic analysis showed that the centralized treatment of spent dialysate in a dialysis center using the proposed osmotic dilution process could greatly save water resources and cost. Improving the urea rejection of FO membrane was identified as an important research focus for future research on the potential application of FO technology for recycling the spent dialysate in hemodialysis.
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Affiliation(s)
- Pengjia Dou
- Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai, 201210, China; University of Chinese Academy of Sciences, Beijing, 100049, China; School of Physical Science and Technology, ShanghaiTech University, Shanghai, 201210, China
| | - Shuwei Zhao
- Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai, 201210, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Shanshan Xu
- Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai, 201210, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Xue-Mei Li
- Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai, 201210, China
| | - Tao He
- Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai, 201210, China; School of Physical Science and Technology, ShanghaiTech University, Shanghai, 201210, China.
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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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Plumb TJ, Alvarez L, Ross DL, Lee JJ, Mulhern JG, Bell JL, Abra G, Prichard SS, Chertow GM, Aragon MA. Safety and efficacy of the Tablo hemodialysis system for in-center and home hemodialysis. Hemodial Int 2019; 24:22-28. [PMID: 31697042 PMCID: PMC7027451 DOI: 10.1111/hdi.12795] [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: 07/19/2019] [Revised: 09/17/2019] [Accepted: 09/24/2019] [Indexed: 11/29/2022]
Abstract
Introduction: Home hemodialysis remains underutilized despite observational data indicating more favorable outcomes with home compared with in‐center hemodialysis. The Tablo Hemodialysis system is designed to be easy to learn and use and to facilitate adoption of home hemodialysis. The objective of the current investigational device exemption (IDE) study was to evaluate the safety and efficacy of Tablo managed in‐center by health care professionals and in‐home by patients and/or caregivers. Methods: A prospective, multicenter, open‐label, crossover trial comparing in‐center and in‐home hemodialysis using Tablo. There were 4 treatment periods during which hemodialysis was prescribed 4 times per week: 1‐week Run‐In, 8‐week In‐Center, 4‐week Transition, and 8‐week In‐Home. The primary efficacy endpoint was weekly standard Kt/Vurea ≥ 2.1. The secondary efficacy endpoint was delivery of ultrafiltration (UF) within 10% of prescribed UF. We collected safety and usability data. Findings: Thirty participants enrolled and 28 completed all trial periods. Adherence to the protocol requirement of 4 treatments per week was 96% in‐center and 99% in‐home. The average prescribed and delivered session lengths were 3.4 hours for both the In‐Center and the In‐Home periods. The primary efficacy endpoint for the intention‐to‐treat cohort was achieved in 199/200 (99.5%) of measurements during the In‐Center period and 168/171 (98.3%) In‐Home. The average weekly standard Kt/Vurea was 2.8 in both periods. The secondary efficacy UF endpoint was achieved in the ITT cohort in 94% in both in‐center and in‐home. Two prespecified adverse events (AEs) occurred during the In‐Center period and 6 in the In‐Home period. None of the AEs were deemed by investigators as related to Tablo. The median resolution time of alarms was 8 seconds in‐center and 5 seconds in‐home. Conclusion: Primary and secondary efficacy and safety endpoints were achieved during both In‐Center and In‐Home trial periods. This study confirms that Tablo is safe and effective for home hemodialysis use.
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Affiliation(s)
- Troy J Plumb
- University of Nebraska, Nebraska Medical Center, Omaha, Nebraska, USA
| | - Luis Alvarez
- Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Dennis L Ross
- Kansas Nephrology Research Institute, Wichita, Kansas, USA
| | - Joseph J Lee
- Nephrology Associates Medical Group, Riverside, California, USA
| | - Jeffrey G Mulhern
- Fresenius Kidney Care Pioneer Valley Dialysis, West Springfield, Massachusetts, USA
| | - Jeffrey L Bell
- Southwest Georgia Nephrology Clinic, Albany, Georgia, USA
| | - Graham Abra
- Satellite Healthcare, Mountain View, California, USA
| | | | - Glenn M Chertow
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Michael A Aragon
- Clinical Development, Outset Medical, San Jose, California, USA.,DaVita Grapevine at Home, Grapevine, Texas, USA
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Choo SZ, Polkinghorne KR, Kerr PG. Biochemical comparison of 8 h haemodialysis and 4 h haemodiafiltration, and two dialysis membranes, in a randomized cross-over trial. Nephrology (Carlton) 2019; 24:542-549. [PMID: 29722110 DOI: 10.1111/nep.13397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 11/28/2022]
Abstract
AIM Extended-hours haemodialysis has long been regarded as the optimal form of dialysis for solute clearance. With emerging benefits of haemodiafiltration, we wanted to compare these two head-to-head. METHODS In this randomized cross-over trial, we recruited existing nocturnal haemodialysis patients, who had not been hospitalized in the prior 3 months. After a baseline 8 h haemodialysis session, subjects were randomized to either 2 weeks of 8 h haemodialysis or 4 h haemodiafiltration with cross-over to the alternative treatment after a 2-week washout period. Subjects were additionally randomized to the Fresenius FX80 or Nipro Elisio in a parallel design. Blood and dialysate samples were collected at baseline and at the end of both study periods. RESULTS Twelve patients completed the study. Mean (SD) age and body mass index were 55.1 ± 11.5 years and 36.4 ± 10.8, respectively. Urea and creatinine reduction ratios were higher with extended-hours haemodialysis compared to haemodiafiltration (difference 14.0%, 95% CI = 10.6, 17.3; P < 0.001 and 9.1%, 95% CI = 11.0, 7.2; P < 0.001). Fibroblast growth factor 23 (FGF23) clearance was superior with haemodiafiltration (difference 20.1%, 95% CI = 8.7, 31.6; P = 0.001). No difference was seen in reduction ratios for phosphate, retinol binding protein, alpha-1-microglobulin, beta-2-microglobulin and fetuin with both modalities. Compared to Nipro Elisio, Fresenius FX80 dialyser achieved higher beta-2-microglobulin clearance (Period 1: difference 7.8%, 95% CI = 1.3, 14.4; P = 0.02, Period 2:7.5%, 95% CI = 1.0, 14.1; P = 0.02). CONCLUSIONS Small solute clearance was superior with extended-hours haemodialysis while haemodiafiltration enhanced FGF23 clearance. Beta-2-microglobulin clearance was improved with Fresenius FX80 dialyser, but this difference is unlikely to be clinically significant.
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Affiliation(s)
- Shi Z Choo
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Monash University, Clayton, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter G Kerr
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Monash University, Clayton, Victoria, Australia
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Abstract
There is a resurgence in clinical adoption of home hemodialysis globally driven by several demonstrated clinical and economic advantages. Yet, the overall adoption of home hemodialysis remains under-represented in most countries. The practicality of managing ESKD with home hemodialysis is a common concern among practicing nephrologists in the United States. The primary objective of this invited feature is to deliver a practical guide to managing ESKD with home hemodialysis. We have included common clinical scenarios, clinical and infrastructure management problems, and approaches to the day-to-day management of patients undergoing home hemodialysis.
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Affiliation(s)
- Ali Ibrahim
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Christopher T Chan
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
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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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Harasemiw O, Day C, Milad JE, Grainger J, Ferguson T, Komenda P. Human factors testing of the Quanta SC+ hemodialysis system: An innovative system for home and clinic use. Hemodial Int 2019; 23:306-313. [PMID: 30968548 PMCID: PMC6850132 DOI: 10.1111/hdi.12757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/27/2019] [Accepted: 03/15/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Uptake rates of home hemodialysis are the lowest among all modality types, despite providing patients with clinical and quality of life benefits at a lower cost to providers. Currently, there is a need to develop dialysis systems that are appealing to patients while also being suitable for use across the continuum of care. The SC+ hemodialysis system was developed by Quanta Dialysis Technologies Ltd. to provide patients with a dialysis system that is small, simple to use, and powerful enough to deliver acceptable dialysis adequacy. METHODS As part of the SC+ design validation, human factors testing was performed with 17 Healthcare Professionals (nephrology nurses and healthcare assistants) and 15 Home Users (patients and caregivers). To assess usability and safety, the human factors testing involved between 4.5 and 6 hours of training and, after a period of training decay, a subsequent test session in which participants independently performed tasks on SC+. FINDINGS Between the two user groups, there were only 29 errors observed out of 1216 opportunities for errors, despite minimal training. Errors that did occur were minor and attributed to an initial lack of familiarity with the device; none were safety related. DISCUSSION Among prevalent dialysis patients and healthcare professionals, the SC+ hemodialysis system was easy to use, even with minimal training and a learning decay period, and had a high level of use safety. By taking into account human factors to optimize the user experience, SC+ has the potential to address systemic and patient barriers, allowing for wider self-care and home hemodialysis adoption.
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Affiliation(s)
- Oksana Harasemiw
- Chronic Disease Innovation CentreSeven Oaks General HospitalWinnipegCanada
- Department of Internal MedicineUniversity of ManitobaWinnipegCanada
| | - Clara Day
- Department of Renal MedicineQueen Elizabeth HospitalBirminghamUK
| | | | | | - Thomas Ferguson
- Chronic Disease Innovation CentreSeven Oaks General HospitalWinnipegCanada
- Department of Internal MedicineUniversity of ManitobaWinnipegCanada
| | - Paul Komenda
- Chronic Disease Innovation CentreSeven Oaks General HospitalWinnipegCanada
- Department of Internal MedicineUniversity of ManitobaWinnipegCanada
- Quanta Dialysis Technologies Ltd.AlcesterUK
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Emmett CJ, Macintyre K, Kitsos A, McKercher CM, Jose M, Bettiol S. Independent effect of haemodialysis session frequency and duration on survival in non-indigenous Australians on haemodialysis. Nephrology (Carlton) 2019; 25:323-331. [PMID: 31112321 DOI: 10.1111/nep.13607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND End-stage kidney disease patients have increased mortality compared to the general population. Haemodialysis (HD) of more frequent and of longer duration has been proposed to improve survival but it remains unclear if this is attributed to increased frequency, duration, or both. We aimed to examine the independent effects of session frequency and duration on mortality in incident HD patients. METHODS A retrospective cohort study was performed using data from the Australian and New Zealand Dialysis and Transplant Registry examining non-Indigenous patients aged ≥18 years who initiated HD of ≥3 sessions/week in Australia from 2001 to 2015. Initial dialysis prescription was categorized as session duration >5 h/session compared to ≤5 h/session and session frequency as >3 sessions/week compared to 3 sessions/week. Survival analysis was performed using Cox regression analysis, with multivariable analysis controlling for available covariates. RESULTS We examined 16 944 patients of whom 757 (4.5%) received >3 sessions/week and 518 (3.1%) received >5 h/session. After controlling for frequency, patients initiated on HD sessions >5 h had a significantly reduced risk of mortality compared with patients with HD session ≤5 h (adjusted hazard ratio (HR) = 0.57; 95% confidence interval (CI) = 0.44-0.74). In contrast, patients initiated on >3 sessions/week of HD had a similar risk of death when compared with patients on 3 sessions/week of HD (adjusted HR = 0.97; 95% CI = 0.84-1.13), after controlling for duration. Limitations include potential residual confounding and changes in exposure over time. CONCLUSION Longer duration rather than increased frequency of treatment appears to reduce mortality in HD patients. This has implications for management and requires further study.
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Affiliation(s)
- Christopher J Emmett
- College of Health and Medicine, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Kate Macintyre
- College of Health and Medicine, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Alex Kitsos
- Health Services Innovation Tasmania, College of Health and Medicine, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Charlotte M McKercher
- Menzies Institute for Medical Research, University of Tasmania, Medical Science Precinct, Hobart, Tasmania, Australia
| | - Matthew Jose
- College of Health and Medicine, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.,Menzies Institute for Medical Research, University of Tasmania, Medical Science Precinct, Hobart, Tasmania, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, South Australia, Australia
| | - Silvana Bettiol
- College of Health and Medicine, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Pladys A, Bayat S, Couchoud C, Vigneau C, McDonald S. Daily hemodialysis practices in Australia/New Zealand and in France: a comparative cohort study. BMC Nephrol 2019; 20:156. [PMID: 31064344 PMCID: PMC6505110 DOI: 10.1186/s12882-019-1330-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 04/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background As patients on daily hemodialysis (DHD) have heterogeneous profiles, DHD benefit in terms of survival is still debated. The aim of this study was to compare DHD practices in France and in Australia and New Zealand. Methods This study was based on data from the French Renal Epidemiology and Information Network (REIN) and the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). All incident patients from both registries who underwent DHD (i.e., 5–6 sessions/week, including short daily hemodialysis and long nocturnal hemodialysis) at least once during their trajectories were included, and their characteristics and care trajectories were compared. For survival analyses, one French patient was matched to one Australian or New Zealand patient, based on age, sex and year of dialysis start. Survival was assessed using the Cox proportional hazards model, and access to renal transplantation was evaluated using the Fine & Gray model to take into account death as competing risk. Results Between 2003 and 2012, 523 patients from the AZNDATA and 753 from the REIN registry started DHD. ANZDATA patients were younger (54.8 vs 64.0 years, p < 0.001) and had comorbidities more frequently than French patients. In both registries, one third of patients were on early DHD (i.e., DHD started less than one year after dialysis initiation). Long nocturnal hemodialysis was more frequent in the ANZDATA than in the REIN cohort (20.8 and 3%, respectively). Comparison of the matched subgroups showed comparable survival rates between French and Australian/New Zealand patients (HRadjusted = 1.08; 95%CI: 0.78–1.50). Access to renal transplantation also was similar between matched groups (SHRadjusted = 1.30, 95%CI: 0.86–1.97). Conclusions Our study shows that, despite differences in terms of patients’ characteristics and DHD regimens, the mortality risk and access to renal transplantation are similar in France and Australia and New Zealand. Electronic supplementary material The online version of this article (10.1186/s12882-019-1330-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adélaïde Pladys
- EHESP Rennes, Sorbonne Paris Cité, EA 7449 Reperes, Rennes, France.
| | - Sahar Bayat
- EHESP Rennes, Sorbonne Paris Cité, EA 7449 Reperes, Rennes, France
| | - Cécile Couchoud
- Renal Epidemiology and Information Network (REIN), Biomedecine Agency, Saint Denis La Plaine, France
| | - Cécile Vigneau
- University of Rennes 1, INSERM U1085-IRSET, Rennes, France.,CHU Pontchaillou, Department of Nephrology, Rennes, France
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,University of Adelaide, Adelaide, Australia
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Choo SZ, See EJ, Simmonds RE, Somerville CA, Agar JWM. Nocturnal home haemodialysis: The 17 years experience of a single Australian dialysis service. Nephrology (Carlton) 2019; 24:1050-1055. [DOI: 10.1111/nep.13524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Shi Z Choo
- Department of Renal MedicineBarwon Health Geelong Victoria Australia
| | - Emily J See
- School of MedicineUniversity of Melbourne Melbourne Victoria Australia
- Department of Intensive CareAustin Health Melbourne Victoria Australia
| | | | | | - John W M Agar
- Department of Renal MedicineBarwon Health Geelong Victoria Australia
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Abstract
Conventional hemodialysis is associated with high morbidity and mortality rates, as well as a reduced quality of life. There is a growing interest in the provision of more intensive hemodialysis, due to associated benefits in terms of reduced cardiovascular morbidity, better regulation of mineral metabolism, as well as its impact on quality of life measures, fertility, and sleep. Nocturnal hemodialysis, both in center and at home, allows the delivery of more intensive hemodialysis. This review discusses the benefits of nocturnal hemodialysis and evaluates the evidence based on available literature.
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Huang SHS, MacRae J, Ross D, Imtiaz R, Hollingsworth B, Nesrallah GE, Copland MA, McFarlane PA, Chan CT, Zimmerman D. Buttonhole versus Stepladder Cannulation for Home Hemodialysis: A Multicenter, Randomized, Pilot Trial. Clin J Am Soc Nephrol 2019; 14:403-410. [PMID: 30659057 PMCID: PMC6419275 DOI: 10.2215/cjn.08310718] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/12/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Canadian home hemodialysis guidelines highlight the potential differences in complications associated with arteriovenous fistula (AVF) cannulation technique as a research priority. Our primary objective was to determine the feasibility of randomizing patients with ESKD training for home hemodialysis to buttonhole versus stepladder cannulation of the AVF. Secondary objectives included training time, pain with needling, complications, and cost by cannulation technique. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS All patients training for home hemodialysis at seven Canadian hospitals were assessed for eligibility, and demographic information and access type was collected on everyone. Patients who consented to participate were randomized to buttonhole or stepladder cannulation technique. Time to train for home hemodialysis, pain scores on cannulation, and complications over 12 months was recorded. For eligible but not randomized patients, reasons for not participating in the trial were documented. RESULTS Patient recruitment was November 2013 to November 2015. During this time, 158 patients began training for home hemodialysis, and 108 were ineligible for the trial. Diabetes mellitus as a cause of ESKD (31% versus 12%) and central venous catheter use (74% versus 6%) were more common in ineligible patients. Of the 50 eligible patients, 14 patients from four out of seven sites consented to participate in the study (28%). The most common reason for declining to participate was a strong preference for a particular cannulation technique (33%). Patients randomized to buttonhole versus stepladder cannulation required a shorter time to complete home hemodialysis training. We did not observe a reduction in cannulation pain or complications with the buttonhole method. Data linkages for a formal cost analysis were not conducted. CONCLUSIONS We were unable to demonstrate the feasibility of conducting a randomized, controlled trial of buttonhole versus stepladder cannulation in Canada with a sufficient number of patients on home hemodialysis to be able to draw meaningful conclusions.
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Affiliation(s)
- Shih-Han S. Huang
- Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Jennifer MacRae
- Department of Medicine, Division of Nephrology, Foothills Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Dana Ross
- Ottawa Hospital, Ottawa, Ontario, Canada
| | - Rameez Imtiaz
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Brittany Hollingsworth
- Kidney Research Centre of the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gihad E. Nesrallah
- Faculty of Medicine, Division of Nephrology, Humber River Hospital, Toronto, Ontario, Canada
| | - Michael A. Copland
- Department of Medicine, Division of Nephrology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada; and
| | | | - Christopher T. Chan
- Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Deborah Zimmerman
- Ottawa Hospital, Ottawa, Ontario, Canada
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
- Kidney Research Centre of the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Seshasai RK, Wong T, Glickman JD, Shea JA, Dember LM. The home hemodialysis patient experience: A qualitative assessment of modality use and discontinuation. Hemodial Int 2019; 23:139-150. [DOI: 10.1111/hdi.12713] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/19/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Rebecca Kurnik Seshasai
- Department of Medicine, Renal, Electrolyte and Hypertension DivisionPerelman School of Medicine Philadelphia Pennsylvania USA
| | - Tiffany Wong
- Department of Medicine, Renal, Electrolyte and Hypertension DivisionPerelman School of Medicine Philadelphia Pennsylvania USA
| | - Joel D. Glickman
- Department of Medicine, Renal, Electrolyte and Hypertension DivisionPerelman School of Medicine Philadelphia Pennsylvania USA
| | - Judy A. Shea
- Department of Medicine, Division of General Internal MedicinePerelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
| | - Laura M. Dember
- Department of Medicine, Renal, Electrolyte and Hypertension DivisionPerelman School of Medicine Philadelphia Pennsylvania USA
- Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and BiostatisticsPerelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
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Dhruve M, Faratro R, D'Gama C, Fung S, Arustei D, Wong E, Chan CT. The use of nurse-administered vascular access audit in home hemodialysis patients: A quality initiative. Hemodial Int 2019; 23:133-138. [PMID: 30734988 DOI: 10.1111/hdi.12708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/08/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Vascular access complications are associated with increased morbidity and mortality in home hemodialysis (HHD). Nurse-administered vascular access checklist is a feasible quality improvement strategy aimed to lower HHD access errors. METHODS We conducted a prospective quality improvement initiative for consecutive HHD patients between April 2013 and December 2016 at the Toronto General Hospital. Vascular access audits were administered every 6 months during clinic visits and during retraining sessions after an infection. We aimed to (1) determine whether prospective serial administration of vascular audit will decrease in the number of errors performed by the patient and (2) to determine whether there is an association between the number of errors and vascular access related infection. FINDINGS A total of 370 audits were performed on 122 patients with a mean HHD vintage of 6.7 (0.8-19.5) years. The mean number of errors per patient decreased from 1.24 ± 1.75 (baseline) to 0.33 ± 0.49 (last follow-up), P < 0.001. Among patients who had serial vascular access audits performed, there was a significant decrease in median number of errors (baseline median 1, [0-2] end of study median 0, [0-1] P = 0.01). Patients performing buttonhole cannulation made most proportion of errors as compared to CVC, 54% vs. 40% (P = 0.01) respectively; and as compared to rope ladder cannulation 54% vs. 37% (P = 0.008). We were unable to demonstrate an association between the change in patient reported errors and vascular access related infection. DISCUSSION Vascular access audit is a feasible quality initiative, which leads to a decrease in the number of patient reported errors in vascular access. The longitudinal clinical sequelae of this strategy warrants further examination.
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Affiliation(s)
- Miten Dhruve
- Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Rose Faratro
- Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Celine D'Gama
- Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Stella Fung
- Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Daniela Arustei
- Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Elizabeth Wong
- Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Christopher T Chan
- Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Reintjes F, Herian N, Shah N, Pauly RP. Prospective monitoring of after-hours nursing and technologist support calls to a regional Canadian home hemodialysis program. Hemodial Int 2018; 23:19-25. [PMID: 30289195 DOI: 10.1111/hdi.12677] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/26/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Increasing renal care providers offer home hemodialysis (HD) as a modality choice. There is considerable variation in the provision of after-hours on-call support for self-dialyzing patients and no literature describing the utility of this service. In this prospective, observational study we sought to monitor and classify the number and nature of interactions between home patients and our on-call nurses and technologists, and enumerate the number of adverse events averted by the availability of on-call staff. METHODS Our home HD unit provided 24-hour on-call patient support and during a 4-month period in 2012, we prospectively monitored all patient calls to this service. The nature of the calls was logged as nursing-related vs. technical. Call outcomes were classified according to whether patients were able to initiate/resume their treatments or whether additional interventions were required. FINDINGS During this period, our program cared for 58 home HD patients. Nurses fielded 172 calls and dealt with 239 issues. One hundred nine (46%) were clinical issues including 5 (2%) of a serious nature involving potential harm; 67 (28%) related to machine setup or alarms, 36 (15%) required a technologist to resolve, and 27 (11%) were deemed non-urgent. One hundred six issues were directed to technologists in 99 calls. Issues pertained to machine malfunction (45 calls-43%), machine set-up and alarms (25 calls-24%), or the water system (24 calls-23%). Only 12 calls (11.3%) were not of a technical nature. Nursing and technologist support allowed patients to initiate or continue their treatment 75% and 71% of the time, respectively. DISCUSSION Home HD on-call services provide patients support to successfully continue their dialysis treatments by troubleshooting clinical and technical aspects of dialysis and by averting potential adverse events.
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Affiliation(s)
- Frances Reintjes
- Northern Alberta Renal Program, Alberta Health Services, Edmonton, Alberta, Canada
| | - Nim Herian
- Northern Alberta Renal Program, Alberta Health Services, Edmonton, Alberta, Canada
| | - Nikhil Shah
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Robert P Pauly
- Northern Alberta Renal Program, Alberta Health Services, Edmonton, Alberta, Canada.,Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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47
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Pérez Alba A, Reque Santiváñez J, Segarra Pedro A, Torres Campos S, Sánchez Canel JJ, Fenollosa Segarra MÁ, Pons Prades R. Baja tasa de eventos adversos en hemodiálisis domiciliaria. Nefrologia 2018; 38:452-454. [DOI: 10.1016/j.nefro.2017.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/11/2017] [Accepted: 09/17/2017] [Indexed: 12/22/2022] Open
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48
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Auguste BL, Al-Muhaiteeb A, Chan CT. The Effect of Learning Styles on Adverse Events in Home Hemodialysis Patients. Clin J Am Soc Nephrol 2018; 13:782-783. [PMID: 29661768 PMCID: PMC5969485 DOI: 10.2215/cjn.12161017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Bourne L Auguste
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
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49
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Abstract
The use of frequent hemodialysis (HD) is growing, with the hope of improving outcomes in end-stage renal disease. We narratively review the three randomized trials, 15 comparative cohort studies, and several case series of frequent HD that empirically demonstrate the potential efficacy and adverse effects of these regimens. Taken together, the randomized studies suggest frequent HD may result in left ventricular mass regression. This effect is most pronounced when left ventricular mass is abnormal, but attenuated by significant residual urine output. Both frequent short and long HD consistently improved blood pressure control and reduced antihypertensive use, despite greater weekly interdialytic weight gains. Serum phosphate was lowered. Frequent short daytime HD improved health-related quality of life, while frequent long overnight HD did not. Regarding adverse effects, frequent HD patients underwent significantly more procedures to salvage arteriovenous vascular accesses. An absolute increase in hypotensive episodes was observed with frequent short HD, while frequent long HD accelerated residual renal function loss and increased perceived caregiver burden. The effect of frequent HD on mortality is controversial, due to conflicting results and limitations of published studies. Finally, pregnancy outcomes may be substantially better with frequent long HD. On the basis of these data, we suggest frequent HD is most likely to benefit patients with left ventricular hypertrophy particularly if there is minimal urine output, those unable to attain dry weight on a thrice weekly schedule, and pregnant women. All patients receiving frequent HD should be advised of and monitored for potential risks.
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Affiliation(s)
- Rita S Suri
- Department of Medicine, University of Montreal, Montreal, Canada
| | - Alan S Kliger
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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50
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Mitsides N, Cornelis T, Broers NJH, Diederen NMP, Brenchley P, van der Sande FM, Schalkwijk C, Kooman JP, Mitra S. Cardiovascular and Patient Phenotype of Extended Haemodialysis: A Critical Analysis of Studying a Unique Patient Population. Blood Purif 2018; 45:356-363. [PMID: 29455200 DOI: 10.1159/000485231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/13/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Extended haemodialysis (EHD) has been associated with better outcomes compared to conventional (CHD) regimes. The cardiovascular (CV) profile of these patients has not been assessed in detail. METHODS We report baseline demographic and CV phenotype of 36 CHD and 36 EHD participants to a longitudinal multicentre study. We measured pulse wave velocity (PWV), 24-h ambulatory blood pressure, sublingual dark-field capillaroscopy and vascular biomarkers. RESULTS EHD patients were younger (p < 0.01), with less CV comorbidity (p = 0.04) and higher dialysis vintage (p < 0.01). Higher PWV in CHD (p = 0.02) was not independent of demographic differences in the 2 groups. Biomarker profiles were similar in EHD and CHD but abnormal compared to healthy controls. CONCLUSION Although CV profiles in these 2 cohorts were similar, EHD patients were distinct from the CHD population in terms of age and dialysis vintage and appear to comprise a unique group. Direct comparison of outcomes in these groups is challenging due to clinical bias.
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Affiliation(s)
- Nicos Mitsides
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Department of Nephrology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.,NIHR Devices for Dignity Healthcare Technology Co-Operative, Royal Hallamshire Hospital, Sheffield, Sheffield, United Kingdom
| | | | - Natascha J H Broers
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, the Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Nanda M P Diederen
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paul Brenchley
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Department of Nephrology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Frank M van der Sande
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Casper Schalkwijk
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, the Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Jeroen P Kooman
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, the Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Sandip Mitra
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Department of Nephrology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.,NIHR Devices for Dignity Healthcare Technology Co-Operative, Royal Hallamshire Hospital, Sheffield, Sheffield, United Kingdom
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