1
|
Drewry K, Cummings JR, Patzer RE, Wilk AS. Characteristics of Nephrologists Participating in Medicare's Comprehensive ESRD Care Initiative. Am J Kidney Dis 2024; 83:836-839. [PMID: 38070589 DOI: 10.1053/j.ajkd.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 09/18/2023] [Accepted: 09/30/2023] [Indexed: 01/27/2024]
Affiliation(s)
- Kelsey Drewry
- Department of Health Policy and Management, Rollins School of Public Health at Emory University, Atlanta, Georgia; Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
| | - Janet R Cummings
- Department of Health Policy and Management, Rollins School of Public Health at Emory University, Atlanta, Georgia
| | - Rachel E Patzer
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia; Department of Epidemiology, Rollins School of Public Health at Emory University, Atlanta, Georgia; Department of General Internal Medicine, Emory University School of Medicine, Atlanta, Georgia; Regenstrief Institute, Indianapolis, Indiana
| | - Adam S Wilk
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
2
|
Desbiens LC, Bargman JM, Chan CT, Nadeau-Fredette AC. Integrated home dialysis model: facilitating home-to-home transition. Clin Kidney J 2024; 17:i21-i33. [PMID: 38846416 PMCID: PMC11151120 DOI: 10.1093/ckj/sfae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Indexed: 06/09/2024] Open
Abstract
Peritoneal dialysis (PD) and home hemodialysis (HHD) are the two home dialysis modalities offered to patients. They promote patient autonomy, enhance independence, and are generally associated with better quality of life compared to facility hemodialysis. PD offers some advantages (enhanced flexibility, ability to travel, preservation of residual kidney function, and vascular access sites) but few patients remain on PD indefinitely due to peritonitis and other complications. By contrast, HHD incurs longer and more intensive training combined with increased upfront health costs compared to PD, but is easier to sustain in the long term. As a result, the integrated home dialysis model was proposed to combine the advantages of both home-based dialysis modalities. In this paradigm, patients are encouraged to initiate dialysis on PD and transfer to HHD after PD termination. Available evidence demonstrates the feasibility and safety of this approach and some observational studies have shown that patients who undergo the PD-to-HHD transition have clinical outcomes comparable to patients who initiate dialysis directly on HHD. Nevertheless, the prevalence of PD-to-HHD transfers remains low, reflecting the multiple barriers that prevent the full uptake of home-to-home transitions, notably a lack of awareness about the model, home-care "burnout," clinical inertia after a transfer to facility HD, suboptimal integration of PD and HHD centers, and insufficient funding for home dialysis programs. In this review, we will examine the conceptual advantages and disadvantages of integrated home dialysis, present the evidence that underlies it, identify challenges that prevent its success and finally, propose solutions to increase its adoption.
Collapse
Affiliation(s)
- Louis-Charles Desbiens
- Department of Medicine, Université de Montréal, Montreal, Canada
- Department of Medicine, Hôpital Maisonneuve-Rosemont, Montreal, Canada
| | - Joanne M Bargman
- Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Christopher T Chan
- Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Annie-Claire Nadeau-Fredette
- Department of Medicine, Université de Montréal, Montreal, Canada
- Department of Medicine, Hôpital Maisonneuve-Rosemont, Montreal, Canada
| |
Collapse
|
3
|
Sarabu N, Dong W, Koroukian SM. Disparities in treatment patterns and mortality in prostate cancer: Interaction between Black race and end-stage kidney disease. Cancer Med 2024; 13:e7027. [PMID: 38770622 PMCID: PMC11106677 DOI: 10.1002/cam4.7027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 01/20/2024] [Accepted: 02/07/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Black men and men with end-stage kidney disease have lower rates of treatment and higher mortality for prostate cancer. We studied the interaction of end-stage kidney disease (ESKD) with Black race for treatment rates and mortality for men with prostate cancer. METHODS AND RESULTS We included 516 Black and 551 White men with ESKD before prostate cancer 22,299 Black men, and 141,821 White men without ESKD who were 40 years or older from the Surveillance, Epidemiology, and End-Results-Medicare data (2004-2016). All Black men with or without ESKD and White men with ESKD had higher prostate-specific antigen levels at diagnosis than White men without ESKD. Black men with ESKD had the lowest rates for treatment in both local and advanced stages of prostate cancer (age-adjusted risk ratio: 0.76, 95% Confidence Interval (CI): 0.71-0.82 for local stage and age-adjusted risk ratio: 0.82, 95% CI: 0.76-0.9 for advanced stages) compared to White men without ESKD. Compared to White men without ESKD, prostate cancer-specific mortality was higher in White men with ESKD for both local and advanced stages (age-adjusted hazard ratio: 1.8, 95% CI: 1.2-2.8 and HR: 1.6, 95% CI: 1.2-2.2) and it was higher for ESKD Black men only in advanced stage prostate cancer (age-adjusted hazard ratio: 2.4, 95% CI: 1.5-3.6). CONCLUSION Our findings suggest that having a comorbidity such as ESKD makes Black men more vulnerable to racial disparities in prostate cancer treatment and mortality.
Collapse
Affiliation(s)
- Nagaraju Sarabu
- Division of NephrologyDepartment of Medicine, The Metrohealth SystemClevelandOhioUSA
- Department of MedicineCase Western Reserve University School of MedicineClevelandOhioUSA
| | - Weichuan Dong
- Population and Quantitative Health Sciences, Population Cancer Analytics Shared Resource, and the Case Comprehensive Cancer CenterCase Western Reserve UniversityClevelandOhioUSA
| | - Siran M. Koroukian
- Population and Quantitative Health Sciences, Population Cancer Analytics Shared Resource, and the Case Comprehensive Cancer CenterCase Western Reserve UniversityClevelandOhioUSA
| |
Collapse
|
4
|
Tobada SB, Chatelet V, Bechade C, Lanot A, Boyer A, Couchoud C, Toure F, Boime S, Lobbedez T, Beaumier M. Is social deprivation associated with the peritoneal dialysis outcomes? A cohort study with REIN registry data. Perit Dial Int 2024:8968608241237685. [PMID: 38632672 DOI: 10.1177/08968608241237685] [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: 04/19/2024] Open
Abstract
BACKGROUND Social deprivation is associated with lower peritoneal dialysis (PD) uptake. This study was carried out to evaluate the role of social deprivation on the outcome of PD. METHODS This was a retrospective study of data extracted from the Renal Epidemiology and Information Network registry for patients older than 18 years who started PD in metropolitan France between 1 January 2017 and 30 June 2018. The end of the observation period was 31 December 2020. The exposure was the European Deprivation Index calculated using the patient's address. The events of interest were death, transfer to haemodialysis (HD), transplantation and the composite event of death or transfer to HD. A Cox model and Fine and Gray model were used for the analysis. RESULTS A total of 1581 patients were included, of whom 418 (26.5%) belonged to Quintile 5 of the European Deprivation Index (the most deprived patients). In the Cox model, the most deprived subjects did not have a greater risk of death (cause-specific hazard ratio (cs-HR): 0.76 [95% confidence interval (CI): 0.53-1.10], transfer to HD (cs-HR 1.37 [95% CI: 0.95-1.98]) or the composite event of death or transfer to HD (cs-HR: 1.08 [95% CI: 0.84-1.38]) or a lower risk of kidney transplantation (cs-HR: 0.73 [95% CI: 0.48-1.10]). In the competing risk analysis, the most deprived subjects had a higher risk of transfer to HD (subdistribution hazard ratio (sd-HR): 1.54 [95% CI: 1.08-2.19]) and lower access to kidney transplantation (sd-HR: 0.68 [0.46-0.99]). CONCLUSION In PD patients, social deprivation was not associated with death or the composite event of death or transfer to HD. Socially deprived individuals had a greater risk of transfer to HD and lower access to kidney transplantation in the competing risk analysis.
Collapse
Affiliation(s)
- Steve Biko Tobada
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen Cedex, France
| | - Valérie Chatelet
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen Cedex, France
- INSERM U1086 - ANTICIPE - Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen Cedex, France
| | - Clemence Bechade
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen Cedex, France
- INSERM U1086 - ANTICIPE - Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen Cedex, France
| | - Antoine Lanot
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen Cedex, France
- INSERM U1086 - ANTICIPE - Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen Cedex, France
| | - Annabel Boyer
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen Cedex, France
- INSERM U1086 - ANTICIPE - Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen Cedex, France
| | - Cécile Couchoud
- REIN Registry, Agence de la Biomédecine, Saint Denis La Plaine, France
| | - Fatouma Toure
- REIN Registry, Agence de la Biomédecine, Saint Denis La Plaine, France
- Service de Néphrologie, Dialyse et Transplantation, CHU de Limoges, Limousin, France
| | - Sabrina Boime
- REIN Registry, Agence de la Biomédecine, Saint Denis La Plaine, France
- Grand Est, Observatoire Régional de Santé (ORS), Alsace, France
| | - Thierry Lobbedez
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen Cedex, France
- INSERM U1086 - ANTICIPE - Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen Cedex, France
| | - Mathilde Beaumier
- Néphrologie, Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin, Basse-Normandie, France
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Johansen KL, Gilbertson DT, Li S, Li S, Liu J, Roetker NS, Ku E, Schulman IH, Greer RC, Chan K, Abbott KC, Butler CR, O'Hare AM, Powe NR, Reddy YNV, Snyder J, St Peter W, Taylor JS, Weinhandl ED, Wetmore JB. US Renal Data System 2023 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis 2024; 83:A8-A13. [PMID: 38519262 DOI: 10.1053/j.ajkd.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
|
7
|
Koukounas KG, Thorsness R, Patzer RE, Wilk AS, Drewry KM, Mehrotra R, Rivera-Hernandez M, Meyers DJ, Kim D, Trivedi AN. Social Risk and Dialysis Facility Performance in the First Year of the ESRD Treatment Choices Model. JAMA 2024; 331:124-131. [PMID: 38193961 PMCID: PMC10777251 DOI: 10.1001/jama.2023.23649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/22/2023] [Indexed: 01/10/2024]
Abstract
Importance The End-Stage Renal Disease Treatment Choices (ETC) model randomly selected 30% of US dialysis facilities to receive financial incentives based on their use of home dialysis, kidney transplant waitlisting, or transplant receipt. Facilities that disproportionately serve populations with high social risk have a lower use of home dialysis and kidney transplant raising concerns that these sites may fare poorly in the payment model. Objective To examine first-year ETC model performance scores and financial penalties across dialysis facilities, stratified by their incident patients' social risk. Design, Setting, and Participants A cross-sectional study of 2191 US dialysis facilities that participated in the ETC model from January 1 through December 31, 2021. Exposure Composition of incident patient population, characterized by the proportion of patients who were non-Hispanic Black, Hispanic, living in a highly disadvantaged neighborhood, uninsured, or covered by Medicaid at dialysis initiation. A facility-level composite social risk score assessed whether each facility was in the highest quintile of having 0, 1, or at least 2 of these characteristics. Main Outcomes and Measures Use of home dialysis, waitlisting, or transplant; model performance score; and financial penalization. Results Using data from 125 984 incident patients (median age, 65 years [IQR, 54-74]; 41.8% female; 28.6% Black; 11.7% Hispanic), 1071 dialysis facilities (48.9%) had no social risk features, and 491 (22.4%) had 2 or more. In the first year of the ETC model, compared with those with no social risk features, dialysis facilities with 2 or more had lower mean performance scores (3.4 vs 3.6, P = .002) and lower use of home dialysis (14.1% vs 16.0%, P < .001). These facilities had higher receipt of financial penalties (18.5% vs 11.5%, P < .001), more frequently had the highest payment cut of 5% (2.4% vs 0.7%; P = .003), and were less likely to achieve the highest bonus of 4% (0% vs 2.7%; P < .001). Compared with all other facilities, those in the highest quintile of treating uninsured patients or those covered by Medicaid experienced more financial penalties (17.4% vs 12.9%, P = .01) as did those in the highest quintile in the proportion of patients who were Black (18.5% vs 12.6%, P = .001). Conclusions In the first year of the Centers for Medicare & Medicaid Services' ETC model, dialysis facilities serving higher proportions of patients with social risk features had lower performance scores and experienced markedly higher receipt of financial penalties.
Collapse
Affiliation(s)
- Kalli G. Koukounas
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | | | - Rachel E. Patzer
- Regenstrief Institute, Indianapolis, Indiana
- Department of Surgery, Division of Transplant Surgery, Indiana University School of Medicine, Indianapolis
| | - Adam S. Wilk
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kelsey M. Drewry
- Regenstrief Institute, Indianapolis, Indiana
- Department of Surgery, Division of Transplant Surgery, Indiana University School of Medicine, Indianapolis
| | - Rajnish Mehrotra
- Division of Nephrology, Department of Medicine, University of Washington School of Medicine, Seattle
| | - Maricruz Rivera-Hernandez
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - David J. Meyers
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Daeho Kim
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Amal N. Trivedi
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
- Providence VA Medical Center, Providence, Rhode Island
| |
Collapse
|
8
|
Zhu Y. Usage and Health Outcomes of Home Hemodialysis vs Center Hemodialysis in Racial/Ethnic Minority Groups in the United States a Quantitative Research in 2016-2019 USRDS Using Aday-Anderson Framework and Multiple Regression Models. Patient Relat Outcome Meas 2024; 15:1-16. [PMID: 38222923 PMCID: PMC10787550 DOI: 10.2147/prom.s416279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 12/15/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Home hemodialysis (HHD) offers patients with end-stage kidney disease (ESKD) greater flexibility and advantages of health outcomes over center hemodialysis (CHD). This study aims to investigate the differences between home and center hemodialysis with a focus on racial/ethnic minorities. Methods The US Renal Disease System (USRDS) 2019 patient core data containing mortality and hospitalization which are cumulative since 2010 were merged with 2016-2019 Medicare clinical claims. To assess demographic and medical factors adjusted utilization and mortality of HHD vs CHD within every racial/ethnic cohort, logistic regression was used, and negative binomial regression was conducted to analyze the number of hospitalizations. Results Evaluating 548,453 (97.48%) CHD patients and 14,202 (2.52%) HHD patients with Whites 47%, Blacks 32%, Hispanics 15%, Asians 4%, and other minorities 2%, the outcomes from adjusted regressions showed that: 1) minorities were significantly less likely to use HHD than Whites (Blacks: OR, 0.568, 95% CI, 0.546-0.592; Hispanics: OR, 0.510, 95% CI, 0.477-0.544; Asians: OR, 0.689, 95% CI, 0.619-0.766; Others: OR, 0.453, 95% CI, 0.390-0.525; p < 0.001); 2) most minority patients were younger and had fewer comorbidities than Whites, and all minority groups displayed significantly lower mortality and hospitalization incidences than the White group with adjustment on multiple covariates; 3) in the overall and main racial/ethnic cohorts, HHD showed a significantly lower risk of death than CHD after confounding for major risk factors (overall cohort: OR, 0.686, 95% CI, 0.641-0.734; White: OR, 0.670, 95% CI, 0.612-0.734; Blacks: OR, 0.717, 95% CI, 0.644-0.799; Hispanics: OR, 0.715, 95% CI, 0.575-0.889; Others: OR, 0.473, 95% CI, 0.265-0.844). Conclusion There are substantial racial/ethnic variations in home hemodialysis use and health outcomes in the United States.
Collapse
Affiliation(s)
- Ying Zhu
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, USA
| |
Collapse
|
9
|
Rizzolo K, Cervantes L, Wilhalme H, Vasilyev A, Shen JI. Differences in Outcomes by Place of Origin among Hispanic Patients with Kidney Failure. J Am Soc Nephrol 2023; 34:2013-2023. [PMID: 37755821 PMCID: PMC10703086 DOI: 10.1681/asn.0000000000000239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
SIGNIFICANCE STATEMENT Hispanic patients are known to have a higher risk of kidney failure and lower rates of home dialysis use and kidney transplantation than non-Hispanic White patients. However, it is unknown whether these outcomes differ within the Hispanic community, which is heterogeneous in its members' places of origins. Using United States Renal Data System data, the authors found similar adjusted rates of home dialysis use for patients originating from places outside the United States and US-born Hispanic patients, whereas the adjusted risk of mortality and likelihood of transplantation differed depending on place (country or territory) of origin. Understanding the heterogeneity in kidney disease outcomes and treatment within the Hispanic community is crucial in designing interventions and implementation strategies to ensure that Hispanic individuals with kidney failure have equitable access to care. BACKGROUND Compared with non-Hispanic White groups, Hispanic individuals have a higher risk of kidney failure yet lower rates of living donor transplantation and home dialysis. However, how home dialysis, mortality, and transplantation vary within the Hispanic community depending on patients' place of origin is unclear. METHODS We identified adult Hispanic patients from the United States Renal Data System who initiated dialysis in 2009-2017. Primary exposure was country or territory of origin (the United States, Mexico, US-Puerto Rico, and other countries). We used logistic regression to estimate differences in odds of initiating home dialysis and competing risk models to estimate subdistribution hazard ratios (SHR) of mortality and kidney transplantation. RESULTS Of 137,039 patients, 44.4% were US-born, 30.9% were from Mexico, 12.9% were from US-Puerto Rico, and 11.8% were from other countries. Home dialysis rates were higher among US-born patients, but not significantly different after adjusting for demographic, medical, socioeconomic, and facility-level factors. Adjusted mortality risk was higher for individuals from US-Puerto Rico (SHR, 1.04; 95% confidence interval [CI], 1.01 to 1.08) and lower for Mexico (SHR, 0.80; 95% CI, 0.78 to 0.81) and other countries (SHR, 0.83; 95% CI, 0.81 to 0.86) compared with US-born patients. The adjusted rate of transplantation for Mexican or US-Puerto Rican patients was similar to that of US-born patients but higher for those from other countries (SHR, 1.22; 95% CI, 1.15 to 1.30). CONCLUSIONS Hispanic people from different places of origin have similar adjusted rates of home dialysis but different adjusted rates of mortality and kidney transplantation. Further research is needed to understand the mechanisms underlying these observed differences in outcomes.
Collapse
Affiliation(s)
- Katherine Rizzolo
- Section of Nephrology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Lilia Cervantes
- Department of Medicine, University of Colorado Anschutz Campus, Denver, Colorado
| | - Holly Wilhalme
- David Geffen School of Medicine at University of California, Los Angeles, California, Los Angeles, California
| | - Arseniy Vasilyev
- David Geffen School of Medicine at University of California, Los Angeles, California, Los Angeles, California
| | - Jenny I. Shen
- David Geffen School of Medicine at University of California, Los Angeles, California, Los Angeles, California
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| |
Collapse
|
10
|
Vanholder R, Annemans L, Braks M, Brown EA, Pais P, Purnell TS, Sawhney S, Scholes-Robertson N, Stengel B, Tannor EK, Tesar V, van der Tol A, Luyckx VA. Inequities in kidney health and kidney care. Nat Rev Nephrol 2023; 19:694-708. [PMID: 37580571 DOI: 10.1038/s41581-023-00745-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/16/2023]
Abstract
Health inequity refers to the existence of unnecessary and unfair differences in the ability of an individual or community to achieve optimal health and access appropriate care. Kidney diseases, including acute kidney injury and chronic kidney disease, are the epitome of health inequity. Kidney disease risk and outcomes are strongly associated with inequities that occur across the entire clinical course of disease. Insufficient investment across the spectrum of kidney health and kidney care is a fundamental source of inequity. In addition, social and structural inequities, including inequities in access to primary health care, education and preventative strategies, are major risk factors for, and contribute to, poorer outcomes for individuals living with kidney diseases. Access to affordable kidney care is also highly inequitable, resulting in financial hardship and catastrophic health expenditure for the most vulnerable. Solutions to these injustices require leadership and political will. The nephrology community has an important role in advocacy and in identifying and implementing solutions to dismantle inequities that affect kidney health.
Collapse
Affiliation(s)
- Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium.
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium.
| | - Lieven Annemans
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marion Braks
- European Kidney Health Alliance, Brussels, Belgium
- Association Renaloo, Paris, France
| | - Edwina A Brown
- Imperial College Healthcare NHS Trust, Imperial College Renal and Transplant Center, London, UK
| | - Priya Pais
- Department of Paediatric Nephrology, St John's Medical College, Bengaluru, India
| | - Tanjala S Purnell
- Departments of Epidemiology and Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Simon Sawhney
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
| | | | - Bénédicte Stengel
- Clinical Epidemiology Team, Center for Research in Epidemiology and Population Health (CESP), University Paris-Saclay, UVSQ, Inserm, Villejuif, France
| | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Renal Unit, Directorate of Medicine, Komfo Anokye, Teaching Hospital, Kumasi, Ghana
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Arjan van der Tol
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium
| | - Valérie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| |
Collapse
|
11
|
Shohet M, Nguyen NH, Stern LD, Waikar SS, Schmidt IM. Structural and Psychosocial Challenges Among Underserved Patients Receiving Hemodialysis During and Beyond the COVID-19 Pandemic: A Qualitative Study. Kidney Med 2023; 5:100717. [PMID: 37817797 PMCID: PMC10561110 DOI: 10.1016/j.xkme.2023.100717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
Rationale & Objective Racial and ethnic minority groups in the United States are disproportionately affected by chronic kidney disease and progressive kidney failure and face significantly more socioeconomic and psychosocial challenges. However, how such patients' social environment and stigmatization shape their illness experiences and abilities to cope before and during the coronavirus disease 2019 (COVID-19) pandemic has not been well documented, even as social scientific research predicts these groups' exponential vulnerability. Study Design Qualitative study using semistructured interviews to elicit individual patient narratives about their personal illness experiences before and during the COVID-19 pandemic, any challenges they faced, and their sources of support. Setting & Participants Using purposive sampling, we recruited 20 adult patients receiving maintenance hemodialysis from centers affiliated with a safety-net hospital in Boston, Massachusetts. Analytical Approach Interviews were audiotaped, transcribed, and analyzed using thematic content analysis to identify patients' challenges and supports before and during the pandemic. Results Of the 20 patients in the study, 9 were women, and 18 self-identified as Black or African American. Three main themes emerged, whereby most patients described: (1) stigma and stigmatization as a central element of their life experience; (2) the pandemic as a difficult experience but not a complete rupture from their prepandemic life; and (3) social networks, particularly family, friends, and religious communities, as sources of support crucial to coping with their debilitating illness. Limitations Whether the findings apply to other settings is unknown, as participants were recruited from centers in a single safety-net urban hospital setting. Conclusions Psychosocial and environmental factors, including institutional racism and stigmatization, play significant roles in amplifying the burdens shouldered by racial and ethnic minority individuals with kidney disease who now also face the COVID-19 pandemic that has since turned endemic. The results of this study can inform the development of policy interventions aimed at alleviating tensions and structural conditions that impinge on kidney disease patients' wellbeing and health outcomes. Plain-Language Summary Members of racial and ethnic minority groups in the United States experience the highest rates of progressive kidney failure and face significantly more socioeconomic and psychosocial challenges. We interviewed 20 patients who receive maintenance hemodialysis treatment from centers affiliated with a safety-net hospital. Patients described stigmatization as a central element of their life experience and the pandemic as a difficult challenge (but not a complete rupture) that added to their struggles with illness-related, race-related, and class-related stigmas. Social networks, particularly family, friends, and religious communities, are key sources of support crucial to coping with illness. Findings from this study can inform health care providers and community workers and guide the development of policy interventions to provide better support for these patients.
Collapse
Affiliation(s)
- Merav Shohet
- Boston University College & Graduate School of Arts and Sciences, Department of Anthropology, Boston, MA
| | - Nicole H. Nguyen
- Boston University College & Graduate School of Arts and Sciences, Department of Anthropology, Boston, MA
- Boston University Sargent College of Health and Rehabilitation Sciences, Boston, MA
| | - Lauren D. Stern
- Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Section of Nephrology, Boston, MA
| | - Sushrut S. Waikar
- Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Section of Nephrology, Boston, MA
| | - Insa M. Schmidt
- Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Section of Nephrology, Boston, MA
- Hamburg Center for Kidney Health, University Medical Center Hamburg, Hamburg, Germany
| |
Collapse
|
12
|
Purcell LK, Schnitker JW, Moore TM, Peña AM, Love MF, Ford AI, Vassar BM. Health inequities in dialysis care: A scoping review. Semin Dial 2023; 36:430-447. [PMID: 37734842 DOI: 10.1111/sdi.13176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 08/14/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023]
Abstract
MAIN PROBLEM We aim to look at potential gaps in current dialysis literature on inequities and explore future research that could contribute to more equitable care. METHODS Following guidelines from the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic reviews and Meta Analyses extension for Scoping Reviews (PRISMA-ScR), we conducted a scoping review of health inequities in dialysis. PubMed and Ovid Embase were searched in July 2022 for articles published between 2016 and 2022 that examined at least one of the following NIH defined health inequities: race/ethnicity, sex/gender, LGBTQ+ identity, underserved rural populations, education level, income, and occupation status. Frequencies of each health inequity as well as trends over time of the four most examined inequities were analyzed. RESULTS In our sample of 69 included studies, gaps were identified in LGBTQ+ identity and patient education. Inequities pertaining to race/ethnicity, sex/gender, underserved rural populations, and income were sufficiently reported. No trends between inequities investigated over time were identified. CONCLUSIONS Our scoping review examined current literature on health inequities pertaining to dialysis and found gaps concerning LGBTQ+ and patients with lower levels of education. To help fill these gaps, and possibly alleviate additional burden to these patients, we recommend cultural competency training for providers and dialysis center staff as well as community-based educational programs to improve dialysis patients' health literacy.
Collapse
Affiliation(s)
- Lindsey Kay Purcell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Joseph William Schnitker
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Ty Michael Moore
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Andriana Mercedes Peña
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Mitchell Faris Love
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Alicia Ito Ford
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Benjamin Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| |
Collapse
|
13
|
Shukla AM, Cavanaugh KL, Jia H, Hale-Gallardo J, Wadhwa A, Fischer MJ, Reule S, Palevsky PM, Fried LF, Crowley ST. Needs and Considerations for Standardization of Kidney Disease Education in Patients with Advanced CKD. Clin J Am Soc Nephrol 2023; 18:1234-1243. [PMID: 37150877 PMCID: PMC10564354 DOI: 10.2215/cjn.0000000000000170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/04/2023] [Indexed: 05/09/2023]
Abstract
Kidney health advocacy organizations and leaders in the nephrology community have repeatedly emphasized the need to increase home dialysis utilization in the United States. Limited awareness and understanding of options for the management of kidney failure among patients living with advanced CKD is a significant barrier to increasing the selection and use of home dialysis. Studies have shown that providing targeted comprehensive patient education before the onset of kidney failure can improve patients' awareness of kidney disease and substantially increase the informed utilization of home dialysis. Unfortunately, in the absence of validated evidence-based education protocols, outcomes associated with home dialysis use vary widely among published studies, potentially affecting the routine implementation and reporting of these services among patients with advanced CKD. This review provides pragmatic guidance on establishing effective patient-centered education programs to empower patients to make informed decisions about their KRT and, in turn, increase home dialysis use.
Collapse
Affiliation(s)
- Ashutosh M. Shukla
- North Florida/South Georgia Veterans Health System, Gainesville, Florida
- Division of Nephrology, Hypertension, and Transplantation, Department of Medicine, University of Florida, Gainesville, Florida
| | - Kerri L. Cavanaugh
- Tennessee Valley Health System (THVS), Veterans Health Administration, Nashville, Tennessee
- Division of Nephrology & Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Huanguang Jia
- North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | | | - Anuradha Wadhwa
- Hines Veterans Health Administration, Chicago, Illinois
- Loyola University Medical Center, Chicago, Illinois
| | - Michael J. Fischer
- Medical Service, Jesse Brown VA Medical Center, Chicago, Illinois
- Medicine/Nephrology, University of Illinois at Chicago, Chicago, Illinois
| | - Scott Reule
- University of Minnesota Medical Center, Minneapolis, Minnesota
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Paul M. Palevsky
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Linda F. Fried
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Susan T. Crowley
- VA Connecticut Healthcare System, New Haven, Connecticut
- Department of Medicine (Nephrology), Yale University, New Haven, Connecticut
| |
Collapse
|
14
|
Rizzolo K, Gonzalez Jauregui R, Barrientos I, Teakell J, Camacho C, Chonchol M, Waikar SS, Cervantes L. Barriers and Facilitators to Home Dialysis Among Latinx Patients with Kidney Disease. JAMA Netw Open 2023; 6:e2328944. [PMID: 37581885 PMCID: PMC10427944 DOI: 10.1001/jamanetworkopen.2023.28944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/02/2023] [Indexed: 08/16/2023] Open
Abstract
Importance Latinx people have a high burden of kidney disease but are less likely to receive home dialysis compared to non-Latinx White people. The disparity in home dialysis therapy has not been completely explained by demographic, medical, or social factors. Objective To understand the barriers and facilitators to home dialysis therapy experienced by Latinx individuals with kidney failure receiving home dialysis. Design, Setting, and Participants This qualitative study used semistructured interviews with Latinx adults with kidney failure receiving home dialysis therapy in Denver, Colorado, and Houston, Texas, between November 2021 and March 2023. Patients were recruited from home dialysis clinics affiliated with academic medical centers. Of 39 individuals approached, 27 were included in the study. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Main Outcomes and Measures Themes and subthemes regarding barriers and facilitators to home dialysis therapy. Results A total of 27 Latinx adults (17 [63%] female and 10 [37%] male) with kidney failure who were receiving home dialysis participated. Themes and subthemes were identified, 3 related to challenges with home dialysis and 2 related to facilitators. Challenges to home dialysis included misinformation and immigration-related barriers to care (including cultural stigma of dialysis, misinformation regarding chronic disease care, and lack of health insurance due to immigration status), limited dialysis education (including lack of predialysis care, no-nephrologist education, and shared decision-making), and maintenance of home dialysis (including equipment issues, lifestyle restrictions, and anxiety about complications). Facilitators to home dialysis included improved lifestyle (including convenience, autonomy, physical symptoms, and dietary flexibility) and support (including family involvement, relationships with staff, self-efficacy, and language concordance). Conclusions and Relevance Latinx participants in this study who were receiving home dialysis received misinformation and limited education regarding home dialysis, yet were engaged in self-advocacy and reported strong family and clinic support. These findings may inform new strategies aimed at improving access to home dialysis education and uptake for Latinx individuals with kidney disease.
Collapse
Affiliation(s)
- Katherine Rizzolo
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | | | - Ileana Barrientos
- Division of Renal Diseases and Hypertension, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Jade Teakell
- Division of Renal Diseases and Hypertension, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Claudia Camacho
- Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora
| | - Michel Chonchol
- Division of Nephrology, University of Colorado-Anschutz Medical Campus, Aurora
| | - Sushrut S. Waikar
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Lilia Cervantes
- Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora
| |
Collapse
|
15
|
Tran E, Karadjian O, Chan CT, Trinh E. Home hemodialysis technique survival: insights and challenges. BMC Nephrol 2023; 24:205. [PMID: 37434110 PMCID: PMC10337160 DOI: 10.1186/s12882-023-03264-5] [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: 10/02/2022] [Accepted: 07/06/2023] [Indexed: 07/13/2023] Open
Abstract
Home hemodialysis (HHD) offers several clinical, quality of life and cost-saving benefits for patients with end-stage kidney disease. While uptake of this modality has increased in recent years, its prevalence remains low and high rates of discontinuation remain a challenge. This comprehensive narrative review aims to better understand what is currently known about technique survival in HHD patients, elucidate the clinical factors that contribute to attrition and expand on possible strategies to prevent discontinuation. With increasing efforts to encourage home modalities, it is imperative to better understand technique survival and find strategies to help maintain patients on the home therapy of their choosing. It is crucial to better target high-risk patients, examine ideal training practices and identify practices that are potentially modifiable to improve technique survival.
Collapse
Affiliation(s)
- Estelle Tran
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Oliver Karadjian
- Division of Nephrology, Department of Medicine, McGill University Health Center, 1650 Av Cedar, L4-510, Montreal, QC, H3G 1A4, Canada
| | | | - Emilie Trinh
- Division of Nephrology, Department of Medicine, McGill University Health Center, 1650 Av Cedar, L4-510, Montreal, QC, H3G 1A4, Canada.
| |
Collapse
|
16
|
Wahood W, Takahashi E, Rajan D, Misra S. National Trends in Complications of Vascular Access for Hemodialysis and Analysis of Racial Disparities Among Patients With End-Stage Renal Disease in the Inpatient Setting. Kidney Int Rep 2023; 8:1162-1169. [PMID: 37284686 PMCID: PMC10239770 DOI: 10.1016/j.ekir.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/31/2023] [Accepted: 03/06/2023] [Indexed: 04/04/2023] Open
Abstract
Introduction The aim of this study is to assess the trends in access-related complications, as well as the impact of race on these complications, among admitted patients with end-stage kidney disease (ESKD) receiving hemodialysis. Methods A retrospective cohort study between 2005 and 2018 was performed using the National Inpatient Sample (NIS). Hospitalizations involving ESKD and hemodialysis were identified. There were 9,246,553 total admissions involving ESKD and hemodialysis, of which 1,167,886 (12.6%) had complications. Trends in complications were assessed and compared among races. Results There was a decreasing trend in rates of mechanical (trend: -0.05% per year; P < 0.001), inflammatory or infectious (-0.48%; P < 0.001), and other (-0.19%; P < 0.001) complications from 2005 to 2018. Non-White patients had a greater magnitude in the decrease in trends in rates of complications compared to White patients (-0.69% per year vs. -0.57%; P < 0.001). Compared to the White patients, Black patients (odds ratio [OR]: 1.26; P < 0.001) and those of the other races (OR: 1.11; P < 0.001) had higher odds of complications. These differences were also statistically significant among lower socioeconomic classes (75 percentile vs. 0-25 percentile: P = 0.009) and within southern states (vs. Northeast: P < 0.001). Conclusion Although there was an overall decrease in the trends of dialysis-associated complications requiring hospitalization among ESKD patients receiving hemodialysis, non-White patients have higher odds of complications compared to White patients. The findings in this study emphasize the need for more equitable care for hemodialysis patients.
Collapse
Affiliation(s)
- Waseem Wahood
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida, USA
| | - Edwin Takahashi
- Department of Interventional Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dheeraj Rajan
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Sanjay Misra
- Department of Interventional Radiology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
17
|
Shah S, Gupta N, Christianson AL, Meganathan K, Leonard AC, Thakar CV. Sex and Racial/Ethnic Differences in Home Hemodialysis Mortality. KIDNEY360 2023; 4:206-216. [PMID: 36821612 PMCID: PMC10103461 DOI: 10.34067/kid.0005712022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Key Points Women on home hemodialysis have higher 1-year mortality than men, and women and men have comparable survival on long-term follow-up. Compared with White patients on home hemodialysis, there was no difference in all-cause mortality for Black patients, Hispanics, or Native Americans. Among patients undergoing home hemodialysis, Asians had a lower risk of all-cause mortality than White patients. Background Women and minorities constitute substantial portions of the prevalent population of patients with kidney failure. Little is known about sex and racial/ethnic differences in mortality among patients with kidney failure on home hemodialysis in the United States. Methods Using the United States Renal Data System, we retrospectively evaluated a cohort of 42,849 patients who started home hemodialysis between January 1, 2005, and December 31, 2015. We examined the association of sex and race/ethnicity with the outcome of all-cause mortality using adjusted Cox proportional hazard models and logistic regression models. Results In the study cohort, 40.4% were women, and 57.4% were White. Women on home hemodialysis had higher unadjusted death rates (26.9 versus 22.4 per 100 person-years) compared with men. There was no difference in adjusted all-cause mortality between men and women, but women had an 8% higher adjusted risk of all-cause mortality at 1 year after initiating home hemodialysis (odds ratio 1.08, 95% confidence interval [CI], 1.01 to 1.15). Regarding race/ethnicity, Hispanic, White, and Black patients had higher unadjusted death rates compared with Asians and Native Americans (25.1 versus 24.8 versus 23.2 versus 17.4 versus 16.6 per 100 person-years). There was no difference in adjusted all-cause mortality in Black, Hispanic, and Native Americans compared with White patients, while Asians had a lower risk of all-cause mortality than did White patients (hazard ratio, 0.81; 95% CI, 0.72 to 0.92). There was no difference in adjusted 1-year mortality for Asian, Black, Hispanic, and Native American patients compared with White patients. Conclusions Among patients undergoing home hemodialysis, women have higher 1-year mortality than men, and women and men have comparable survival on long-term follow-up after adjusting for other covariates. Compared with White patients, there was no difference in adjusted survival on long-term follow-up for Black patients, Hispanics, or Native Americans, while Asians had better survival. Our results suggest the need for population-wide strategies to overcome differences in home hemodialysis care.
Collapse
Affiliation(s)
- Silvi Shah
- Division of Nephrology Kidney CARE Program, University of Cincinnati, Cincinnati, Ohio
| | - Nupur Gupta
- Division of Nephrology, Indiana University, Indianapolis, Indiana
| | | | | | - Anthony C. Leonard
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio
| | - Charuhas V. Thakar
- Division of Nephrology Kidney CARE Program, University of Cincinnati, Cincinnati, Ohio
- Cincinnati VA Medical Center, Cincinnati, Ohio
| |
Collapse
|
18
|
Mohottige D, Olabisi O, Boulware LE. Use of Race in Kidney Function Estimation: Lessons Learned and the Path Toward Health Justice. Annu Rev Med 2023; 74:385-400. [PMID: 36706748 DOI: 10.1146/annurev-med-042921-124419] [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: 01/28/2023]
Abstract
In 2020, the nephrology community formally interrogated long-standing race-based clinical algorithms used in the field, including the kidney function estimation equations. A comprehensive understanding of the history of kidney function estimation and racial essentialism is necessary to understand underpinnings of the incorporation of a Black race coefficient into prior equations. We provide a review of this history, as well as the considerations used to develop race-free equations that are a guidepost for a more equity-oriented, scientifically rigorous future for kidney function estimation and other clinical algorithms and processes in which race may be embedded as a variable.
Collapse
Affiliation(s)
- Dinushika Mohottige
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; .,Center for Community and Population Health Improvement, Clinical and Translational Science Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Opeyemi Olabisi
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; .,Duke Molecular Physiology Institute, Duke University, Durham, North Carolina, USA
| | - L Ebony Boulware
- Center for Community and Population Health Improvement, Clinical and Translational Science Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
19
|
Shukla AM, Cavanaugh KL, Wadhwa A, Crowley ST, Fried L. Basic Requirements for Improving Home Dialysis Utilization: Universal Access to Specialty Nephrology Care and Comprehensive Pre-ESKD Education. J Am Soc Nephrol 2023; 34:21-25. [PMID: 36283810 PMCID: PMC10101569 DOI: 10.1681/asn.2022060685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 01/16/2023] Open
Affiliation(s)
- A M Shukla
- North Florida/South Georgia Veteran Healthcare System, Gainesville, Florida
- University of Florida, Gainesville, Florida
| | - Kerri L Cavanaugh
- Tennessee Valley Healthcare System, Nashville, Tennessee
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anuradha Wadhwa
- Hines Veterans Health Administration, Chicago, Illinois
- Loyola University Medical Center, Chicago, Illinois
| | - Susan T Crowley
- Veterans Affairs Connecticut Healthcare System, New Haven, Connecticut
- Yale University, New Haven, Connecticut
| | - Linda Fried
- Pittsburgh Veterans Healthcare System, Pittsburgh, Pennsylvania
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
20
|
Walker R, Palmer S. Community Houses to Increase Access to Home Dialysis. Clin J Am Soc Nephrol 2022; 17:1820-1822. [PMID: 36241370 PMCID: PMC9718007 DOI: 10.2215/cjn.09090822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Rachael Walker
- Eastern Institute of Technology, Taradale, Hawke’s Bay, New Zealand
| | | |
Collapse
|
21
|
Sarnak MJ, Auguste BL, Brown E, Chang AR, Chertow GM, Hannan M, Herzog CA, Nadeau-Fredette AC, Tang WHW, Wang AYM, Weiner DE, Chan CT. Cardiovascular Effects of Home Dialysis Therapies: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e146-e164. [PMID: 35968722 DOI: 10.1161/cir.0000000000001088] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage kidney disease. Currently, thrice-weekly in-center hemodialysis for 3 to 5 hours per session is the most common therapy worldwide for patients with treated kidney failure. Outcomes with thrice-weekly in-center hemodialysis are poor. Emerging evidence supports the overarching hypothesis that a more physiological approach to administering dialysis therapy, including in the home through home hemodialysis or peritoneal dialysis, may lead to improvement in several cardiovascular risk factors and cardiovascular outcomes compared with thrice-weekly in-center hemodialysis. The Advancing American Kidney Health Initiative, which has a goal of increasing the use of home dialysis, is aligned with the American Heart Association's 2024 mission to champion a full and healthy life and health equity. We conclude that incorporation of interdisciplinary care models to increase the use of home dialysis therapies in an equitable manner will contribute to the ultimate goal of improving outcomes for patients with kidney failure and cardiovascular disease.
Collapse
|
22
|
Campbell-Montalvo R, Jia H, Shukla AM. Supporting Shared Decision-Making and Home Dialysis in End-Stage Kidney Disease. Int J Nephrol Renovasc Dis 2022; 15:229-237. [PMID: 36105650 PMCID: PMC9467687 DOI: 10.2147/ijnrd.s375347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/30/2022] [Indexed: 01/16/2023] Open
Abstract
It has been widely demonstrated that patient education and empowerment, especially involving shared treatment decisions, improve patient outcomes in chronic medical conditions, including chronic kidney disease requiring kidney replacement therapies. Accordingly, regulatory agencies in the US and worldwide recommend shared decision-making for finalizing one's choice of kidney replacement therapy. It is also recognized that the US needs to substantially increase home dialysis utilization to leverage its positive impacts on patient and healthcare cost-related outcomes. This perspective highlights how the routine clinical use of the recommended practice of shared decision-making can exist in synergy with the system's goal for increased home dialysis use. It introduces a pragmatic provider checklist, The Nephrologist's Shared Decision-Making Checklist, grounded in the relevant theories of shared decision-making, and, unlike some research assessments and extant tools, is easy to understand and implement in clinical practice. This qualitative Checklist can help providers ensure that they have co-constructed an SDM experience with the patient and involved caretakers, helping them benefit from the improved outcomes associated with SDM.
Collapse
Affiliation(s)
- Rebecca Campbell-Montalvo
- Department of Curriculum and Instruction, Neag School of Education, University of Connecticut, Storrs, CT, USA
- Department of Medicine, North Florida/South Georgia Veteran Healthcare System, Gainesville, FL, USA
| | - Huanguang Jia
- Department of Medicine, North Florida/South Georgia Veteran Healthcare System, Gainesville, FL, USA
| | - Ashutosh M Shukla
- Department of Medicine, North Florida/South Georgia Veteran Healthcare System, Gainesville, FL, USA
- Division of Nephrology, Hypertension and Transplantation, Department of Medicine, University of Florida, Gainesville, FL, USA
| |
Collapse
|
23
|
Abstract
Patients with kidney disease represent a medically complex group of patients with high medication burdens that could benefit from clinical pharmacy services as part of the interdisciplinary care team to optimize medication use. The “Advancing American Kidney Health” executive order includes new value-based reimbursement models to be tested by the Center for Medicare and Medicaid Innovation beginning January 2021 and January 2022. Advancing American Kidney Health executive order poses opportunities for the inclusion of comprehensive medication management. Following an iterative process integrating input from a diverse expert panel, published standards, clinical practice guidelines, peer review, and stakeholder feedback, our group developed practice standards for pharmacists caring for patients with kidney disease in health care settings. The standards focus on activities that are part of direct patient care and also include activities related to public health and advocacy, population health, leadership and management, and teaching, education and dissemination of knowledge. These standards are intended to be used by a variety of professionals, from pharmacists starting new practices to practice managers looking to add a pharmacist to the clinical team, to create standardization in services provided.
Collapse
|
24
|
Wilk AS, Drewry KM, Zhang R, Pastan SO, Thorsness R, Trivedi AN, Patzer RE. Treatment Patterns and Characteristics of Dialysis Facilities Randomly Assigned to the Medicare End-Stage Renal Disease Treatment Choices Model. JAMA Netw Open 2022; 5:e2225516. [PMID: 35930284 PMCID: PMC9356315 DOI: 10.1001/jamanetworkopen.2022.25516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE In 2021, Medicare launched the End-Stage Renal Disease Treatment Choices (ETC) model, which randomly assigned approximately 30% of dialysis facilities to new financial incentives to increase use of transplantation and home dialysis; these financial bonuses and penalties are calculated by comparing living-donor transplantation, transplant wait-listing, and home dialysis use in ETC-assigned facilities vs benchmarks from non-ETC-assigned (ie, control) facilities. Because model participation is randomly assigned, evaluators may attribute any downstream differences in outcomes to facility performance rather than any imbalance in baseline characteristics. OBJECTIVE To identify preintervention imbalances in dialysis facility characteristics that should be recognized in any ETC model evaluations. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study compared ETC-assigned and control dialysis facility characteristics in the United States from 2017 to 2018. A total of 6062 facilities were included. Data were analyzed from February 2021 to May 2022. EXPOSURES Assignment to the ETC model. MAIN OUTCOMES AND MEASURES Dialysis facilities' preintervention transplantations and home dialysis use, facility characteristics (notably, profit and chain status), patient demographic characteristics, and community socioeconomic characteristics. RESULTS Among 316 927 patients, with 6 178 855 attributed patient-months, the mean (SD) age in January 2017 was 59 (11) years, and 132 462 (42%) were female. Patients in ETC-assigned facilities had 9% (0.2 [95% CI, 0.1-0.2] percentage points) lower prevalence of living donor transplantation, 12% (3.2 [95% CI, 3.0-3.3] percentage points) lower prevalence of transplantation wait-listing, and 4% (0.4 [95% CI, 0.3-0.4] percentage points) lower prevalence of peritoneal dialysis use compared with control facilities. ETC-assigned facilities were 14% (5.1 [95% CI, 0.9-9.4] percentage points) more likely than control facilities to be owned by the second largest dialysis organization. Relative to control facilities, ETC-assigned facilities also treated 34% (6.6 [95% CI, 6.5-6.7] percentage point) fewer patients with Hispanic ethnicity and were located in communities with median household incomes that were 4% ($2500; 95% CI, $500-$4500) lower on average. CONCLUSIONS AND RELEVANCE In this study, dialysis facilities in ETC-assigned regions had lower preintervention prevalence of transplantation wait-listing, living donor transplantation, and peritoneal dialysis use, relative to control facilities. ETC-assigned and control facilities also differed with respect to other facility, patient, and community characteristics. Evaluators should account for these preintervention imbalances to minimize bias in their inferences about the model's association with postintervention outcomes.
Collapse
Affiliation(s)
- Adam S. Wilk
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kelsey M. Drewry
- Rollins School of Public Health, Emory University, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Rebecca Zhang
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Stephen O. Pastan
- Emory University School of Medicine, Atlanta, Georgia
- Emory Transplant Center, Atlanta, Georgia
| | - Rebecca Thorsness
- Brown University School of Public Health, Providence, Rhode Island
- Providence VA Medical Center, Providence, Rhode Island
| | - Amal N. Trivedi
- Brown University School of Public Health, Providence, Rhode Island
- Providence VA Medical Center, Providence, Rhode Island
| | - Rachel E. Patzer
- Rollins School of Public Health, Emory University, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
- Emory Transplant Center, Atlanta, Georgia
| |
Collapse
|
25
|
Glyde M, Sutherland E, Dye L, Mitra S, Keane D. Patients' perspectives of fluid management: A multicentre comparative study of home and incentre haemodialysis. J Ren Care 2022; 49:84-92. [PMID: 35637608 DOI: 10.1111/jorc.12426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/15/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is increasing worldwide interest in person-centred care in haemodialysis and home haemodialysis (HHD). Intradialytic fluid management is a vital component of haemodialysis, and often a shared decision, yet patients' perspectives and experience of related decisions are largely unexplored. OBJECTIVES To explore the perspectives of patients receiving home or incentre haemodialysis (IHD), in relation to intradialytic fluid management. DESIGN A multicentre cross-sectional survey. PARTICIPANTS Eight hundred and thirty-nine patients receiving IHD and 99 patients receiving HHD, across six English renal units. MEASUREMENTS Self-reported measures of understanding, experiences and control of fluid management, and willingness to achieve target weight. An objective test of patients' ability to relate common signs and symptoms to fluid overload or excessive ultrafiltration. RESULTS Patients receiving HHD had greater knowledge than those receiving IHD (66.1% vs. 42.3%, p < 0.001) about causes of common signs and symptoms which remained when controlling for age, education and years since beginning haemodialysis. Patients receiving HHD felt more in control of and had greater self-reported adherence to fluid management (p < 0.01), yet knowledge gaps existed in both cohorts. CONCLUSIONS Greater patient knowledge and its practice in HHD may contribute to improved fluid balance and outcomes. Whilst patient selection may contribute towards these differences, the training patients receive when opting for HHD and subsequent experience are likely to be key contributing factors. Integrating aspects of education on fluid management from HHD training programmes should be considered in IHD, and further targeted, robust education remains an unmet need.
Collapse
Affiliation(s)
- Megan Glyde
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Ed Sutherland
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Louise Dye
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Sandip Mitra
- Department of Renal Medicine, Manchester Royal Infirmary, Manchester, UK.,Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - David Keane
- Department of Renal Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Manchester, UK
| |
Collapse
|
26
|
El Shamy O. Utilization of Peritoneal Dialysis in the United States: Progress in Tackling Obstacles to Expansion. KIDNEY360 2022; 3:1112-1117. [PMID: 35845335 PMCID: PMC9255889 DOI: 10.34067/kid.0001872022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/15/2022] [Indexed: 01/10/2023]
Abstract
To facilitate the desired increase in home dialysis utilization in the United States, multiple factors need to be taken into consideration in order to achieve this complex task. Through policy-level facilitators such as the Advancing American Kidney Health Initiative and the expansion of telehealth utilization, adjustments to the existing payment models, providing health equity incentives, increasing number of provider education materials on home therapies, and allaying patient fears with the expansion of home dialysis education nationwide, we have taken several steps in the right direction. There is still a long way to go, and further improvements can be made while utilizing lessons learned from some of our international peers who have been successful in their implementation of large-scale home dialysis programs.
Collapse
Affiliation(s)
- Osama El Shamy
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
27
|
Shukla AM, Hale-Gallardo J, Orozco T, Freytes I, Purvis Z, Romero S, Jia H. A randomized controlled trial to evaluate and assess the effect of comprehensive pre-end stage kidney disease education on home dialysis use in veterans, rationale and design. BMC Nephrol 2022; 23:121. [PMID: 35354430 PMCID: PMC8966272 DOI: 10.1186/s12882-022-02740-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 03/14/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Informed dialysis selection and greater home dialysis use are the two long-desired, underachieved targets of advanced chronic kidney disease (CKD) care in the US healthcare system. Observational institutional studies have shown that comprehensive pre-kidney failure, conventionally referred to as end stage kidney disease education (CPE) can improve both these outcomes. However, lack of validated protocols, well-controlled studies, and systemic models have limited wide-spread adoption of CPE in the US. We hypothesized that a universal CPE and patient-centered initiation of kidney replacement therapy can improve multiple clinical, patient-centered and health service outcomes in advanced CKD and kidney failure requiring dialysis therapy. METHODS Trial to Evaluate and Assess the effects of CPE on Home dialysis in Veterans (TEACH-VET) is a multi-method randomized controlled trial aimed to evaluate the effects of a system-based approach for providing CPE to all Veterans with advanced CKD across a regional healthcare System. The study will randomize 544 Veterans with non-dialysis stage 4 and 5 CKD in a 1:1 allocation stratified by their annual family income and the stage of CKD to an intervention (CPE) arm or control arm. Intervention arm will receive a two-phase CPE in an intent-to-teach manner. Control arm will receive usual clinical care supplemented by resources for the freely-available kidney disease information. Participants will be followed after intervention/control for the duration of the study or until 90-days post-kidney failure, whichever occurs earlier. RESULTS The primary outcome will assess the proportion of Veterans using home dialysis at 90-days post-kidney failure, and secondary outcomes will include post-intervention/control CKD knowledge, confidence in dialysis decision and home dialysis selection. Qualitative arm of the study will use semi-structured interviews to in-depth assess Veterans' satisfaction with the intervention, preference for delivery, and barriers and facilitators to home dialysis selection and use. Several post-kidney failure clinical, patient-centered and health services outcomes will be assessed 90-days post-kidney failure as additional secondary outcomes. CONCLUSION The results will provide evidence regarding the need and efficacy of a system-based, patient-centered approach towards universal CPE for all patients with advanced CKD. If successful, this may provide a blueprint for developing such programs across the similar healthcare infrastructures throughout the country. TRIAL REGISTRATION NCT04064086 .
Collapse
Affiliation(s)
- Ashutosh M Shukla
- North Florida / South Georgia Veteran Healthcare System, Gainesville, FL, USA.
- Division of Nephrology, Hypertension and Transplantation, University of Florida, 1600 Archer Road, Gainesville, FL, 32610, USA.
| | | | - Tatiana Orozco
- North Florida / South Georgia Veteran Healthcare System, Gainesville, FL, USA
| | - Ivette Freytes
- North Florida / South Georgia Veteran Healthcare System, Gainesville, FL, USA
| | - Zachary Purvis
- North Florida / South Georgia Veteran Healthcare System, Gainesville, FL, USA
| | - Sergio Romero
- North Florida / South Georgia Veteran Healthcare System, Gainesville, FL, USA
| | - Huanguang Jia
- North Florida / South Georgia Veteran Healthcare System, Gainesville, FL, USA
| |
Collapse
|
28
|
Shrestha S, Zaidi R, Schuerch C, Singh G. Pandemic affects the uninfected: hypercalcemia in a peritoneal dialysis patient due to protective equipment shortage. J Nephrol 2022; 35:1509-1513. [PMID: 35212969 PMCID: PMC8876073 DOI: 10.1007/s40620-022-01272-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/01/2022] [Indexed: 12/02/2022]
Affiliation(s)
| | - Raza Zaidi
- Department of Medicine, Geisinger Health, Danville, PA, USA
| | - Conrad Schuerch
- Department of Pathology, Geisinger Health, Danville, PA, USA
| | - Gurmukteshwar Singh
- Department of Nephrology, Geisinger Health, 100 N. Academy Blvd, Danville, PA, 17822, USA.
| |
Collapse
|
29
|
Bassuner J, Kowalczyk B, Abdel-Aal AK. Why Peritoneal Dialysis is Underutilized in the United States: A Review of Inequities. Semin Intervent Radiol 2022; 39:47-50. [PMID: 35210732 PMCID: PMC8856784 DOI: 10.1055/s-0041-1741080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Given a choice, most patients with end-stage renal disease prefer home dialysis over in-center hemodialysis (HD). Peritoneal dialysis (PD) is a home dialysis method and offers benefits such as absence of central venous access and therefore preservation of veins, low cost, and decreased time per dialysis session, as well as convenience. Survival rate for patients on PD has increased to levels comparable to in-center HD. Despite endorsement by leaders in the medical field, professional societies, and those in government, PD has reached only 11% adoption among incident patients according to the 2019 United States Renal Data System Annual Data Report. This figure is dwarfed in comparison to rates as high as 79% in other countries. In addition, research has shown that inequities exist in PD access, which are most pronounced in rural, minority, and low-income regions as demonstrated by trends in regional PD supplies. To complicate things further, technique failure has been implicated as a major determinant of poor PD retention rates. The low initiation and retention rates of PD in the United States points to barriers within the healthcare system, many of which are in the early phases of being addressed.
Collapse
Affiliation(s)
- Juri Bassuner
- Department of Diagnostic and Interventional Imaging, Section of Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Texas,Address for correspondence Juri Bassuner, MD 6431 Fannin Street, MSB 2.130B, Houston, TX 77030
| | | | - Ahmed Kamel Abdel-Aal
- Department of Diagnostic and Interventional Imaging, Section of Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Texas
| |
Collapse
|
30
|
Wilk AS, Cummings JR, Plantinga LC, Franch HA, Lea JP, Patzer RE. Racial and Ethnic Disparities in Kidney Replacement Therapies Among Adults With Kidney Failure: An Observational Study of Variation by Patient Age. AMERICAN JOURNAL OF KIDNEY DISEASES 2022; 80:9-19. [DOI: 10.1053/j.ajkd.2021.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/07/2021] [Indexed: 12/13/2022]
|
31
|
Eneanya ND, Boulware LE, Tsai J, Bruce MA, Ford CL, Harris C, Morales LS, Ryan MJ, Reese PP, Thorpe RJ, Morse M, Walker V, Arogundade FA, Lopes AA, Norris KC. Health inequities and the inappropriate use of race in nephrology. Nat Rev Nephrol 2022; 18:84-94. [PMID: 34750551 PMCID: PMC8574929 DOI: 10.1038/s41581-021-00501-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 12/13/2022]
Abstract
Chronic kidney disease is an important clinical condition beset with racial and ethnic disparities that are associated with social inequities. Many medical schools and health centres across the USA have raised concerns about the use of race - a socio-political construct that mediates the effect of structural racism - as a fixed, measurable biological variable in the assessment of kidney disease. We discuss the role of race and racism in medicine and outline many of the concerns that have been raised by the medical and social justice communities regarding the use of race in estimated glomerular filtration rate equations, including its relationship with structural racism and racial inequities. Although race can be used to identify populations who experience racism and subsequent differential treatment, ignoring the biological and social heterogeneity within any racial group and inferring innate individual-level attributes is methodologically flawed. Therefore, although more accurate measures for estimating kidney function are under investigation, we support the use of biomarkers for determining estimated glomerular filtration rate without adjustments for race. Clinicians have a duty to recognize and elucidate the nuances of racism and its effects on health and disease. Otherwise, we risk perpetuating historical racist concepts in medicine that exacerbate health inequities and impact marginalized patient populations.
Collapse
Affiliation(s)
- Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - L Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer Tsai
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Marino A Bruce
- Program for Research on Faith, Justice, and Health, Department of Behavioral and Social Sciences, University of Houston College of Medicine, Houston, TX, USA
| | - Chandra L Ford
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Christina Harris
- VA Greater Los Angeles Healthcare System, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Leo S Morales
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Michael J Ryan
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Peter P Reese
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Roland J Thorpe
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michelle Morse
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Valencia Walker
- Department of Paediatrics, Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Antonio A Lopes
- Clinical Epidemiology and Evidence-Based Medicine Unit of the Edgard Santos University Hospital and Department of Internal Medicine, Federal University of Bahia, Salvador, Brazil
| | - Keith C Norris
- VA Greater Los Angeles Healthcare System, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| |
Collapse
|
32
|
Delgado C, Powe NR. Resolving the Debate: The Future of Using Race in Estimating Kidney Function. Adv Chronic Kidney Dis 2022; 29:5-16. [PMID: 35690404 DOI: 10.1053/j.ackd.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/27/2022] [Accepted: 02/10/2022] [Indexed: 11/11/2022]
Abstract
Racial and social unrest witnessed during 2020 ignited a national conversation about the appropriateness of the use of race in health care algorithms and in the estimation of kidney function in particular. The growing concerns over the use of race in kidney function-estimating equations prompted the National Kidney Foundation (NKF) and American Society of Nephrology to launch an effort for change by establishing a task force on reassessing the use of race in diagnosing kidney disease. After nearly a year examining the evidence and obtaining testimony from experts and stakeholders, the task force recommended the immediate implementation of the 2020 Chronic Kidney Disease-Epidemiology creatinine equation refit without race in all US laboratories; increased routine use of cystatin C for confirmation of estimated glomerular filtration rate in clinical decision-making and a call for research on glomerular filtration rate estimation with new endogenous filtration markers and on addressing disparities in health and health care. The NKF and American Society of Nephrology strongly encouraged rapid adoption of these new recommendations. Leadership efforts of the NKF have begun to lay the foundation for national implementation through laboratory engagement, clinician awareness, and patient education.
Collapse
Affiliation(s)
- Cynthia Delgado
- Nephrology Section, San Francisco VA Medical Center, San Francisco, CA; Department of Medicine, University of California, San Francisco, San Francisco, CA.
| | - Neil R Powe
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, San Francisco, CA; Department of Medicine, University of California, San Francisco, San Francisco, CA
| |
Collapse
|
33
|
Weinhandl ED, Forfang D. From Home Dialysis Access to Home Dialysis Quality. Adv Chronic Kidney Dis 2022; 29:52-58. [PMID: 35690405 DOI: 10.1053/j.ackd.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/14/2022] [Accepted: 02/28/2022] [Indexed: 11/11/2022]
Abstract
The number and percentage of patients dialyzing at home has steadily increased during the past decade, and federal policy initiatives have driven interest to a new high. However, the mere utilization of home dialysis does not ensure better outcomes for patients and care partners. Although public reporting systems for dialysis quality are mature and robust, the incorporation of home dialysis quality in those systems is immature; the advent of the End-Stage Renal Disease Treatment Choices payment model brings this problem into sharp relief. The home dialysis modalities present both common and unique targets for quality measurement. For both modalities, therapy duration (or its inverse, technique failure) is a potential target. For peritoneal dialysis, peritonitis, catheter complications, and residual kidney function are additional targets; for home hemodialysis, vascular access infections, dialysis adequacy, and treatment adherence are targets. Patient-reported experience measures are also important; this domain is a long-standing disparity, as in-facility hemodialysis patients have been routinely surveyed for several years. The statistical aspect of quality measurement in home dialysis requires some adaptation, as the typical home dialysis program is small, thus presenting a threat to reliability; pooling programs may be necessary. Ultimately, promoting high-quality home dialysis will likely increase utilization of home dialysis.
Collapse
Affiliation(s)
- Eric D Weinhandl
- Satellite Healthcare, San Jose, CA; Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, MN.
| | | |
Collapse
|
34
|
Lynch MR, Shah AD. The In-Center Hemodialysis Unit, Yet Another Obstacle to Home Dialysis. KIDNEY360 2021; 2:1871-1872. [PMID: 35419535 PMCID: PMC8986047 DOI: 10.34067/kid.0007372021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Matthew R. Lynch
- Division of Kidney Disease and Hypertension, Department of Medicine, Rhode Island Hospital, Rhode Island,Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ankur D. Shah
- Division of Kidney Disease and Hypertension, Department of Medicine, Rhode Island Hospital, Rhode Island,Warren Alpert Medical School of Brown University, Providence, Rhode Island
| |
Collapse
|
35
|
Ladin K, Porteny T, Perugini JM, Gonzales KM, Aufort KE, Levine SK, Wong JB, Isakova T, Rifkin D, Gordon EJ, Rossi A, Koch-Weser S, Weiner DE. Perceptions of Telehealth vs In-Person Visits Among Older Adults With Advanced Kidney Disease, Care Partners, and Clinicians. JAMA Netw Open 2021; 4:e2137193. [PMID: 34870680 PMCID: PMC8649833 DOI: 10.1001/jamanetworkopen.2021.37193] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/04/2021] [Indexed: 12/11/2022] Open
Abstract
Importance Telehealth has been posited as a cost-effective means for improving access to care for persons with chronic conditions, including kidney disease. Perceptions of telehealth among older patients with chronic illness, their care partners, and clinicians are largely unknown but are critical to successful telehealth use and expansion efforts. Objective To identify patient, care partner, and nephrologists' perceptions of the patient-centeredness, benefits, drawbacks of telehealth compared to in-person visits. Design, Setting, and Participants This qualitative study used semistructured interviews conducted from August to December 2020 with purposively sampled patients (aged 70 years or older, chronic kidney disease stages 4 to 5), care partners, and clinicians in Boston, Massachusetts; Chicago, Illinois; Portland, Maine; and San Diego, California. Main Outcomes and Measures Participants described telehealth experiences, including factors contributing to and impeding engagement, satisfaction, and quality of care. Thematic analysis was used to analyze data. Results Of 60 interviews, 19 (32%) were with clinicians, 30 (50%) with patients, and 11 (18%) with care partners; 16 clinicians (84%) were nephrologists; 17 patient participants (43%) were non-Hispanic Black, and 38 (67%) were women. Four overarching themes characterized telehealth's benefits and drawbacks for patient-centered care among older, chronically ill adults: inconsistent quality of care, patient experience and engagement, loss of connection and mistrust (eg, challenges discussing bad news), and disparities with accessing telehealth. Although telehealth improved convenience and care partner engagement, participants expressed concerns about clinical effectiveness and limitations of virtual physical examinations and potentially widening disparities in access. Many participants shared concerns about harms to the patient-clinician relationship, limited ability to comfort patients in virtual settings, and reduced patient trust. Conclusions and Relevance Older patients, care partners, and kidney clinicians (ie, nephrologists and physician assistants) shared divergent views of patient-centered telehealth care, especially its clinical effectiveness, patient experience, access to care, and clinician-patient relationship. Understanding older patients' and kidney clinicians' perceptions of telehealth elucidate barriers that should be addressed to promote high-quality care and telehealth use.
Collapse
Affiliation(s)
- Keren Ladin
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts
- Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts
| | - Thalia Porteny
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts
- Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts
| | - Julia M. Perugini
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts
| | - Kristina M. Gonzales
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts
- Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts
| | - Kate E. Aufort
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts
- Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts
| | - Sarah K. Levine
- William B. Schwartz MD Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - John B. Wong
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Tamara Isakova
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dena Rifkin
- Division of Nephrology, Veterans’ Affairs Healthcare System, San Diego, California
- University of California, San Diego
| | - Elisa J. Gordon
- Department of Surgery-Division of Transplantation, and Center for Health Services and Outcomes Research, and Center for Bioethics and Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ana Rossi
- Piedmont Transplant Institute, Atlanta, Georgia
| | - Susan Koch-Weser
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Massachusetts
| | - Daniel E. Weiner
- William B. Schwartz MD Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| |
Collapse
|
36
|
Abra G, Weinhandl ED. Pulling the goalie: What the United States and the world can learn from Canada about growing home dialysis. Perit Dial Int 2021; 41:437-440. [PMID: 34323152 DOI: 10.1177/08968608211034696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Graham Abra
- Satellite Healthcare, San Jose, CA, USA.,Department of Medicine, Division of Nephrology, 6429Stanford University, Palo Alto, CA, USA
| | - Eric D Weinhandl
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA.,Department of Pharmaceutical Care and Health Systems, 5635University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
37
|
Delgado C, Baweja M, Burrows NR, Crews DC, Eneanya ND, Gadegbeku CA, Inker LA, Mendu ML, Miller WG, Moxey-Mims MM, Roberts GV, St Peter WL, Warfield C, Powe NR. Reassessing the Inclusion of Race in Diagnosing Kidney Diseases: An Interim Report From the NKF-ASN Task Force. Am J Kidney Dis 2021; 78:103-115. [PMID: 33845065 PMCID: PMC8238889 DOI: 10.1053/j.ajkd.2021.03.008] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
For almost 2 decades, equations that use serum creatinine, age, sex, and race to estimate glomerular filtration rate (GFR) have included "race" as Black or non-Black. Given considerable evidence of disparities in health and health care delivery in African American communities, some regard keeping a race term in GFR equations as a practice that differentially influences access to care and kidney transplantation. Others assert that race captures important non-GFR determinants of serum creatinine and its removal from the calculation may perpetuate other disparities. The National Kidney Foundation (NKF) and American Society of Nephrology (ASN) established a task force in 2020 to reassess the inclusion of race in the estimation of GFR in the United States and its implications for diagnosis and subsequent management of patients with, or at risk for, kidney diseases. This interim report details the process, initial assessment of evidence, and values defined regarding the use of race to estimate GFR. We organized activities in phases: (1) clarify the problem and examine evidence, (2) evaluate different approaches to address use of race in GFR estimation, and (3) make recommendations. In phase 1, we constructed statements about the evidence and defined values regarding equity and disparities; race and racism; GFR measurement, estimation, and equation performance; laboratory standardization; and patient perspectives. We also identified several approaches to estimate GFR and a set of attributes to evaluate these approaches. Building on evidence and values, the attributes of alternative approaches to estimate GFR will be evaluated in the next phases and recommendations will be made.
Collapse
Affiliation(s)
- Cynthia Delgado
- Nephrology Section, San Francisco Veterans Affairs Medical Center, Division of Nephrology, University of California San Francisco, San Francisco, CA.
| | - Mukta Baweja
- Nephrology Division, Department of Medicine, Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nilka Ríos Burrows
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Crystal A Gadegbeku
- Department of Medicine, Section of Nephrology, Hypertension and Kidney Transplantation, Temple University, Philadelphia, PA
| | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, MA
| | - Mallika L Mendu
- Division of Renal Medicine and Office of the Chief Medical Officer, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - W Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, VA
| | - Marva M Moxey-Mims
- Division of Nephrology, Children's National Hospital, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Glenda V Roberts
- External Relations and Patient Engagement, Kidney Research Institute, Center for Dialysis Innovation, University of Washington, Seattle, WA
| | | | | | - Neil R Powe
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA.
| |
Collapse
|
38
|
Beaumier M, Calvar E, Launay L, Béchade C, Lanot A, Schauder N, Touré F, Lassalle M, Couchoud C, Châtelet V, Lobbedez T. Effect of social deprivation on peritoneal dialysis uptake: A mediation analysis with the data of the REIN registry. Perit Dial Int 2021; 42:361-369. [PMID: 34196237 DOI: 10.1177/08968608211023268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Social deprivation could act as a barrier to peritoneal dialysis (PD). The objective of this study was to assess the association between social deprivation estimated by the European deprivation index (EDI) and PD uptake and to explore the potential mediators of this association. METHODS From the Renal Epidemiology and Information Network registry, patients who started dialysis in 2017 were included. The EDI was calculated based on the patient's address. The event of interest was the proportion of PD 3 months after dialysis initiation. A mediation analysis with a counterfactual approach was carried out to evaluate the direct and indirect effect of the EDI on the proportion of PD. RESULTS Among the 9588 patients included, 1116 patients were on PD; 2894 (30.2%) patients belonged to the most deprived quintile (Q5). PD was associated with age >70 years (odds ratio (OR) 0.79 [95% confidence interval (CI): 0.69-0.91]), male gender (0.85 [95% CI: 0.74-0.97]), cardiovascular disease (OR 0.86 [95% CI: 0.86-1.00]), chronic heart failure (OR 1.34 [95% CI: 1.13-1.58]), active cancer (OR 0.67 [95% CI: 0.53-0.85]) and obesity (OR 0.75 [95% CI: 0.63-0.89]). In the mediation analysis, Q5 had a direct effect on PD proportion OR 0.84 [95% CI: 0.73-0.96]. The effect of Q5 on the proportion of PD was mediated by haemoglobin level at dialysis initiation (OR 0.96 [95% CI: 0.94-0.98]) and emergency start (OR 0.98 [95% CI: 0.96-0.99]). CONCLUSION Social deprivation, estimated by the EDI, was associated with a lower PD uptake. The effect of social deprivation was mediated by haemoglobin level, a proxy of predialysis care and emergency start.
Collapse
Affiliation(s)
- Mathilde Beaumier
- Service de Néphrologie, Centre Hospitalier Public du Cotentin, rue du Val de Saire, Cherbourg, France
| | - Eve Calvar
- Centre Universitaire des Maladies Rénales, CHU de Caen Avenue Côte de Nacre, Caen, France
| | - Ludivine Launay
- U1086 Inserm, ANTICIPE, Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Clémence Béchade
- Centre Universitaire des Maladies Rénales, CHU de Caen Avenue Côte de Nacre, Caen, France.,U1086 Inserm, ANTICIPE, Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Antoine Lanot
- Centre Universitaire des Maladies Rénales, CHU de Caen Avenue Côte de Nacre, Caen, France
| | - Nicole Schauder
- REIN Registry, Biomedecine Agency, France.,Observatoire Régional de la Santé Grand Est, Strasbourg, France
| | - Fatouma Touré
- REIN Registry, Biomedecine Agency, France.,Service de Néphrologie, dialyse, transplantations, CHU de Limoges, Caen, France
| | | | | | - Valérie Châtelet
- Centre Universitaire des Maladies Rénales, CHU de Caen Avenue Côte de Nacre, Caen, France.,U1086 Inserm, ANTICIPE, Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Thierry Lobbedez
- Centre Universitaire des Maladies Rénales, CHU de Caen Avenue Côte de Nacre, Caen, France.,U1086 Inserm, ANTICIPE, Centre de Lutte Contre le Cancer François Baclesse, Caen, France.,RDPLF, Pontoise, Caen, France
| | | |
Collapse
|
39
|
Wu HHL, Nixon AC, Dhaygude AP, Jayanti A, Mitra S. Is home hemodialysis a practical option for older people? Hemodial Int 2021; 25:416-423. [PMID: 34133069 DOI: 10.1111/hdi.12949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/23/2021] [Accepted: 05/23/2021] [Indexed: 11/30/2022]
Abstract
An increasing demand for in-center dialysis services has been largely driven by a rapid growth of the older population progressing to end-stage kidney disease. Since the onset of the COVID-19 pandemic, efforts to encourage home-based dialysis options have increased due to risks of infective transmission for patients receiving hemodialysis in center-based units. There are various practical and clinical advantages for patients receiving hemodialysis at home. However, the lack of caregiver support, cognitive and physical impairment, challenges of vascular access, and preparation and training for home hemodialysis (HHD) initiation may present as barriers to successful implementation of HHD in the older dialysis population. Assessment of an older patient's frailty status may help clinicians guide patients when making decisions about HHD. The development of an assisted HHD care delivery model and advancement of telehealth and technology in provision of HHD care may increase accessibility of HHD services for older patients. This review examines these factors and explores current unmet needs and barriers to increasing access, inclusion, and opportunities of HHD for the older dialysis population.
Collapse
Affiliation(s)
- Henry H L Wu
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK.,Faculty of Medical and Human Sciences, Manchester Academy of Health Sciences Centre, University of Manchester, Manchester, UK
| | - Andrew C Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK.,Faculty of Medical and Human Sciences, Manchester Academy of Health Sciences Centre, University of Manchester, Manchester, UK.,Department of Renal Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ajay P Dhaygude
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK.,Faculty of Medical and Human Sciences, Manchester Academy of Health Sciences Centre, University of Manchester, Manchester, UK
| | - Anu Jayanti
- Department of Renal Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sandip Mitra
- Faculty of Medical and Human Sciences, Manchester Academy of Health Sciences Centre, University of Manchester, Manchester, UK.,Department of Renal Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
40
|
Delgado C, Baweja M, Burrows NR, Crews DC, Eneanya ND, Gadegbeku CA, Inker LA, Mendu ML, Miller WG, Moxey-Mims MM, Roberts GV, St. Peter WL, Warfield C, Powe NR. Reassessing the Inclusion of Race in Diagnosing Kidney Diseases: An Interim Report from the NKF-ASN Task Force. J Am Soc Nephrol 2021; 32:1305-1317. [PMID: 33837122 PMCID: PMC8259639 DOI: 10.1681/asn.2021010039] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
For almost two decades, equations that use serum creatinine, age, sex, and race to eGFR have included "race" as Black or non-Black. Given considerable evidence of disparities in health and healthcare delivery in African American communities, some regard keeping a race term in GFR equations as a practice that differentially influences access to care and kidney transplantation. Others assert that race captures important non GFR determinants of serum creatinine and its removal from the calculation may perpetuate other disparities. The National Kidney Foundation (NKF) and American Society of Nephrology (ASN) established a task force in 2020 to reassess the inclusion of race in the estimation of GFR in the United States and its implications for diagnosis and subsequent management of patients with, or at risk for, kidney diseases. This interim report details the process, initial assessment of evidence, and values defined regarding the use of race to estimate GFR. We organized activities in phases: (1) clarify the problem and examine evidence, (2) evaluate different approaches to address use of race in GFR estimation, and (3) make recommendations. In phase one, we constructed statements about the evidence and defined values regarding equity and disparities; race and racism; GFR measurement, estimation, and equation performance; laboratory standardization; and patient perspectives. We also identified several approaches to estimate GFR and a set of attributes to evaluate these approaches. Building on evidence and values, the attributes of alternative approaches to estimate GFR will be evaluated in the next phases and recommendations will be made.
Collapse
Affiliation(s)
- Cynthia Delgado
- Nephrology Section, San Francisco Veterans Affairs Medical Center, Division of Nephrology, University of California San Francisco, San Francisco, California
| | - Mukta Baweja
- Nephrology Division, Department of Medicine, Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nilka Ríos Burrows
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deidra C. Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nwamaka D. Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Crystal A. Gadegbeku
- Department of Medicine, Section of Nephrology, Hypertension and Kidney Transplantation, Temple University, Philadelphia, Pennsylvania
| | - Lesley A. Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Mallika L. Mendu
- Division of Renal Medicine and Office of the Chief Medical Officer, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - W. Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Marva M. Moxey-Mims
- Division of Nephrology, Children’s National Hospital, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Glenda V. Roberts
- External Relations and Patient Engagement, Kidney Research Institute, Center for Dialysis Innovation, University of Washington, Seattle, Washington
| | | | | | - Neil R. Powe
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California
| |
Collapse
|
41
|
Boulware LE, Mohottige D. The Seen and the Unseen: Race and Social Inequities Affecting Kidney Care. Clin J Am Soc Nephrol 2021; 16:815-817. [PMID: 33441464 PMCID: PMC8259473 DOI: 10.2215/cjn.12630820] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- L. Ebony Boulware
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Dinushika Mohottige
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| |
Collapse
|
42
|
Mohottige D, Diamantidis CJ, Norris KC, Boulware LE. Racism and Kidney Health: Turning Equity Into a Reality. Am J Kidney Dis 2021; 77:951-962. [PMID: 33639186 DOI: 10.1053/j.ajkd.2021.01.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/15/2021] [Indexed: 12/12/2022]
Abstract
Kidney disease continues to manifest stark racial inequities in the United States, revealing the entrenchment of racism and bias within multiple facets of society, including in our institutions, practices, norms, and beliefs. In this perspective, we synthesize theory and evidence to describe why an understanding of race and racism is integral to kidney care, providing examples of how kidney health disparities manifest interpersonal and structural racism. We then describe racialized medicine and "colorblind" approaches as well as their pitfalls, offering in their place suggestions to embed antiracism and an "equity lens" into our practice. We propose examples of how we can enhance kidney health equity by enhancing our structural competency, using equity-focused race consciousness, and centering investigation and solutions around the needs of the most marginalized. To achieve equitable outcomes for all, our medical institutions must embed antiracism and equity into all aspects of advocacy, policy, patient/community engagement, educational efforts, and clinical care processes. Organizations engaged in kidney care should commit to promoting structural equity and eliminating potential sources of bias across referral practices, guidelines, research agendas, and clinical care. Kidney care providers should reaffirm our commitment to structurally competent patient care and educational endeavors in which empathy and continuous self-education about social drivers of health and inequity, racism, and bias are integral. We envision a future in which kidney health equity is a reality for all. Through bold collective and sustained investment, we can achieve this critical goal.
Collapse
Affiliation(s)
- Dinushika Mohottige
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC; Center for Community and Population Health Improvement, Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC.
| | - Clarissa J Diamantidis
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC; Center for Community and Population Health Improvement, Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC; Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Keith C Norris
- Divisions of Nephrology and General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - L Ebony Boulware
- Center for Community and Population Health Improvement, Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC; Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
| |
Collapse
|
43
|
Ethier I, Cho Y, Hawley C, Pascoe EM, Roberts MA, Semple D, Nadeau-Fredette AC, Sypek MP, Viecelli A, Campbell S, van Eps C, Isbel NM, Johnson DW. Effect of patient- and center-level characteristics on uptake of home dialysis in Australia and New Zealand: a multicenter registry analysis. Nephrol Dial Transplant 2020; 35:1938-1949. [PMID: 32031636 DOI: 10.1093/ndt/gfaa002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/09/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Home-based dialysis therapies, home hemodialysis (HHD) and peritoneal dialysis (PD) are underutilized in many countries and significant variation in the uptake of home dialysis exists across dialysis centers. This study aimed to evaluate the patient- and center-level characteristics associated with uptake of home dialysis. METHODS The Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry was used to include incident dialysis patients in Australia and New Zealand from 1997 to 2017. Uptake of home dialysis was defined as any HHD or PD treatment reported to ANZDATA within 6 months of dialysis initiation. Characteristics associated with home dialysis uptake were evaluated using mixed effects logistic regression models with patient- and center-level covariates, era as a fixed effect and dialysis center as a random effect. RESULTS Overall, 54 773 patients were included. Uptake of home-based dialysis was reported in 24 399 (45%) patients but varied between 0 and 87% across the 76 centers. Patient-level factors associated with lower uptake included male sex, ethnicity (particularly indigenous peoples), older age, presence of comorbidities, late referral to a nephrology service, remote residence and obesity. Center-level predictors of lower uptake included small center size, smaller proportion of patients with permanent access at dialysis initiation and lower weekly facility hemodialysis hours. The variation in odds of home dialysis uptake across centers increased by 3% after adjusting for the era and patient-level characteristics but decreased by 24% after adjusting for center-level characteristics. CONCLUSION Center-specific factors are associated with the variation in uptake of home dialysis across centers in Australia and New Zealand.
Collapse
Affiliation(s)
- Isabelle Ethier
- Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
| | - Carmel Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Matthew A Roberts
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - David Semple
- Department of Renal Medicine, Auckland District Health Board, Auckland, New Zealand.,School of Medicine, University of Auckland, Auckland, New Zealand
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Hôpital Maisonneuve-Rosemont and Research Center, Université de Montréal, Montreal, Canada
| | - Matthew P Sypek
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia
| | - Andrea Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
| | - Scott Campbell
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Carolyn van Eps
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Nicole M Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| |
Collapse
|
44
|
Brown EA, Perl J. Increasing Peritoneal Dialysis Use in Response to the COVID-19 Pandemic: Will It Go Viral? J Am Soc Nephrol 2020; 31:1928-1930. [PMID: 32747353 PMCID: PMC7461664 DOI: 10.1681/asn.2020050729] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Jeffrey Perl
- Division of Nephrology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
45
|
Abstract
Rationale & Objective Community house hemodialysis is a submodality of home hemodialysis that enables patients to perform hemodialysis independent of nursing or medical supervision in a shared house. This study describes the perspectives and experiences of patients using community house hemodialysis in New Zealand to explore ways this dialysis modality may support the wider delivery of independent hemodialysis care. Study Design Qualitative semi-structured in-depth interview study. Setting & Participants 25 patients who had experienced community house hemodialysis. Participants were asked about why they chose community house hemodialysis and their experiences and perspectives of this. Analytical Approach Thematic analysis using an inductive approach. Results 25 patients were interviewed (14 men and 11 women, aged 31-65 years). Most were of Māori or Pacific ethnicity and in part- or full-time employment. More than two-thirds dialyzed for 20 hours a week or more. We identified 4 themes that described patients’ experiences and perspectives of choosing and using community house hemodialysis: reducing burden on family (when home is not an option, minimizing family exposure to dialysis, maintaining privacy and self-identity, reducing the costs of home hemodialysis, and gaining a reprieve from home), offering flexibility and freedom (having a normal life, maintaining employment, and facilitating travel), control of my health (building independence and self-efficacy, a place of wellness, avoiding institutionalization, and creating a culture of extended-hour dialysis), and community support (building social inclusion and supporting peers). Limitations Non-Māori and non-Pacific patient experiences of community house hemodialysis could not be explored. Conclusions Community house hemodialysis is a dialysis modality that overcomes many of the socioeconomic barriers to home hemodialysis, is socially and culturally acceptable to Māori and Pacific people, and supports extended-hour hemodialysis and thereby promotes more equitable access to best practice services. It is therefore a significant addition to independent hemodialysis options available for patients.
Collapse
|
46
|
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.
Collapse
|
47
|
Abstract
The development of dialysis by early pioneers such as Willem Kolff and Belding Scribner set in motion several dramatic changes in the epidemiology, economics and ethical frameworks for the treatment of kidney failure. However, despite a rapid expansion in the provision of dialysis — particularly haemodialysis and most notably in high-income countries (HICs) — the rate of true patient-centred innovation has slowed. Current trends are particularly concerning from a global perspective: current costs are not sustainable, even for HICs, and globally, most people who develop kidney failure forego treatment, resulting in millions of deaths every year. Thus, there is an urgent need to develop new approaches and dialysis modalities that are cost-effective, accessible and offer improved patient outcomes. Nephrology researchers are increasingly engaging with patients to determine their priorities for meaningful outcomes that should be used to measure progress. The overarching message from this engagement is that while patients value longevity, reducing symptom burden and achieving maximal functional and social rehabilitation are prioritized more highly. In response, patients, payors, regulators and health-care systems are increasingly demanding improved value, which can only come about through true patient-centred innovation that supports high-quality, high-value care. Substantial efforts are now underway to support requisite transformative changes. These efforts need to be catalysed, promoted and fostered through international collaboration and harmonization. Dialysis is a life-saving therapy; however, costs of dialysis are high, access is inequitable and outcomes are inadequate. This Review describes the current landscape of dialysis therapy from an epidemiological, economic, ethical and patient-centred framework, and describes initiatives that are aimed at stimulating innovations in the field to one that supports high-quality, high-value care. The global dialysis population is growing rapidly, especially in low-income and middle-income countries; however, worldwide, a substantial number of people lack access to kidney replacement therapy, and millions of people die of kidney failure each year, often without supportive care. The costs of dialysis care are high and will likely continue to rise as a result of increased life expectancy and improved therapies for causes of kidney failure such as diabetes mellitus and cardiovascular disease. Patients on dialysis continue to bear a high burden of disease, shortened life expectancy and report a high symptom burden and a low health-related quality of life. Patient-focused research has identified fatigue, insomnia, cramps, depression, anxiety and frustration as key symptoms contributing to unsatisfactory outcomes for patients on dialysis. Initiatives to transform dialysis outcomes for patients require both top-down efforts (that is, efforts that promote incentives based on systems level policy, regulations, macroeconomic and organizational changes) and bottom-up efforts (that is, patient-led and patient-centred advocacy efforts as well as efforts led by individual teams of innovators). Patients, payors, regulators and health-care systems increasingly demand improved value in dialysis care, which can only come about through true patient-centred innovation that supports high-quality, high-value care.
Collapse
|
48
|
Beaumier M, Béchade C, Dejardin O, Lassalle M, Vigneau C, Longlune N, Launay L, Couchoud C, Ficheux M, Lobbedez T, Châtelet V. Is self-care dialysis associated with social deprivation in a universal health care system? A cohort study with data from the Renal Epidemiology and Information Network Registry. Nephrol Dial Transplant 2020; 35:861-869. [PMID: 31821495 DOI: 10.1093/ndt/gfz245] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/25/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Socioeconomic status is associated with dialysis modality in developed countries. The main objective of this study was to investigate whether social deprivation, estimated by the European Deprivation Index (EDI), was associated with self-care dialysis in France. METHODS The EDI was calculated for patients who started dialysis in 2017. The event of interest was self-care dialysis 3 months after dialysis initiation [self-care peritoneal dialysis (PD) or satellite haemodialysis (HD)]. A logistic model was used for the statistical analysis, and a counterfactual approach was used for the causal mediation analysis. RESULTS Among the 9588 patients included, 2894 (30%) were in the most deprived quintile of the EDI. A total of 1402 patients were treated with self-care dialysis. In the multivariable analysis with the EDI in quintiles, there was no association between social deprivation and self-care dialysis. Compared with the other EDI quintiles, patients from Quintile 5 (most deprived quintile) were less likely to be on self-care dialysis (odds ratio 0.81, 95% confidence interval 0.71-0.93). Age, sex, emergency start, cardiovascular disease, chronic respiratory disease, cancer, severe disability, serum albumin and registration on the waiting list were associated with self-care dialysis. The EDI was not associated with self-care dialysis in either the HD or in the PD subgroups. CONCLUSIONS In France, social deprivation estimated by the EDI is associated with self-care dialysis in end-stage renal disease patients undergoing replacement therapy.
Collapse
Affiliation(s)
- Mathilde Beaumier
- Centre Universitaire des maladies rénales, CHU de Caen, Caen, France
| | - Clémence Béchade
- Centre Universitaire des maladies rénales, CHU de Caen, Caen, France
| | - Olivier Dejardin
- U1086 Inserm, «ANTICIPE », Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | | | - Cécile Vigneau
- Centre Hospitalier Universitaire Pontchaillou, Service de Néphrologie, Rennes, France
| | - Nathalie Longlune
- Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Ludivine Launay
- U1086 Inserm, «ANTICIPE », Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Cécile Couchoud
- REIN Registry, Biomedecine Agency, Saint-Denis-La-Plaine, France
| | - Maxence Ficheux
- Centre Universitaire des maladies rénales, CHU de Caen, Caen, France
| | - Thierry Lobbedez
- Centre Universitaire des maladies rénales, CHU de Caen, Caen, France
| | - Valérie Châtelet
- Centre Universitaire des maladies rénales, CHU de Caen, Caen, France
| |
Collapse
|
49
|
Yap E, Joseph M, Sharma S, El Shamy O, Weinberg AD, Delano BG, Uribarri J, Saggi SJ. Utilization of peritoneal dialysis in the United States: Reasons for underutilization, specifically in New York State and the boroughs of New York City. Semin Dial 2020; 33:140-147. [DOI: 10.1111/sdi.12868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ernie Yap
- Division of Nephrology State University of New York Health Sciences Center at Brooklyn Brooklyn NY USA
| | - Marcia Joseph
- Division of Nephrology State University of New York Health Sciences Center at Brooklyn Brooklyn NY USA
| | - Shuchita Sharma
- Division of Nephrology Department of Medicine Icahn School of Medicine at Mount Sinai New York NY USA
| | - Osama El Shamy
- Division of Nephrology Department of Medicine Icahn School of Medicine at Mount Sinai New York NY USA
| | - Alan D. Weinberg
- Division of Nephrology Department of Medicine Icahn School of Medicine at Mount Sinai New York NY USA
| | - Barbara G. Delano
- Division of Nephrology State University of New York Health Sciences Center at Brooklyn Brooklyn NY USA
| | - Jaime Uribarri
- Division of Nephrology Department of Medicine Icahn School of Medicine at Mount Sinai New York NY USA
| | - Subodh J. Saggi
- Division of Nephrology State University of New York Health Sciences Center at Brooklyn Brooklyn NY USA
| |
Collapse
|
50
|
Weiner DE, Meyer KB. Home Dialysis in the United States: To Increase Utilization, Address Disparities. Kidney Med 2020; 2:95-97. [PMID: 32734953 PMCID: PMC7380419 DOI: 10.1016/j.xkme.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
|