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Besarab A, Frinak S, Margassery S, Wish JB. Hemodialysis Vascular Access: A Historical Perspective on Access Promotion, Barriers, and Lessons for the Future. Kidney Med 2024; 6:100871. [PMID: 39220002 PMCID: PMC11364114 DOI: 10.1016/j.xkme.2024.100871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
This review describes the history of vascular access for hemodialysis (HD) over the past 8 decades. Reliable, repeatable vascular access for outpatient HD began in the 1960s with the Quinton-Scribner shunt. This was followed by the autologous Brecia-Cimino radial-cephalic arteriovenous fistula (AVF), which dominated HD vascular access for the next 20 years. Delayed referral and the requirement of 1.5-3 months for AVF maturation led to the development of and increasing dependence on synthetic arteriovenous grafts (AVGs) and tunneled central venous catheters, both of which have higher thrombosis and infection risks than AVFs. The use of AVGs and tunneled central venous catheters increased progressively to the point that, in 1997, the first evidence-based clinical practice guidelines for HD vascular access recommended that they only be used if a functioning AVF could not be established. Efforts to promote AVF use in the United States during the past 2 decades doubled their prevalence; however, recent practice guidelines acknowledge that not all patients receiving HD are ideally suited for an AVF. Nonetheless, improved referral for AVF placement before dialysis initiation and improved conversion of failing AVGs to AVFs may increase AVF use among patients in whom they are appropriate.
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Affiliation(s)
- Anatole Besarab
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Stanley Frinak
- Department of Medicine, Henry Ford Health System, Detroit, MI
| | | | - Jay B. Wish
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
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2
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Platnich JM, Pauly RP. Patient Training and Patient Safety in Home Hemodialysis. Clin J Am Soc Nephrol 2024; 19:1045-1050. [PMID: 38190130 PMCID: PMC11321743 DOI: 10.2215/cjn.0000000000000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
The success of a home hemodialysis program depends largely on a patient safety framework and the risk tolerance of a home dialysis program. Dialysis treatments require operators to perform dozens of steps repeatedly and reliably in a complex procedure. For home hemodialysis, those operators are patients themselves or their care partners, so attention to safety and risk mitigation is front of mind. While newer, smaller, and more user-friendly dialysis machines designed explicitly for home use are slowly entering the marketplace, teaching patients to perform their own treatments in an unsupervised setting hundreds of times remains a foundational programmatic obligation regardless of machine. Just how safe is home hemodialysis? How does patient training affect this safety? There is a surprising lack of literature surrounding these questions. No consensus exists among home hemodialysis programs regarding optimized training schedules or methods, with each program adopting its own approach on the basis of local experience. Furthermore, there are little available data on the safety of home hemodialysis as compared with conventional in-center hemodialysis. This review will outline considerations for training patients on home hemodialysis, discuss the safety of home hemodialysis with an emphasis on the risk of serious and life-threatening adverse effects, and address the methods by which adverse events are monitored and prevented.
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Affiliation(s)
- Jaye M Platnich
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Cheetham MS, Ethier I, Krishnasamy R, Cho Y, Palmer SC, Johnson DW, Craig JC, Stroumza P, Frantzen L, Hegbrant J, Strippoli GF. Home versus in-centre haemodialysis for people with kidney failure. Cochrane Database Syst Rev 2024; 4:CD009535. [PMID: 38588450 PMCID: PMC11001293 DOI: 10.1002/14651858.cd009535.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Home haemodialysis (HHD) may be associated with important clinical, social or economic benefits. However, few randomised controlled trials (RCTs) have evaluated HHD versus in-centre HD (ICHD). The relative benefits and harms of these two HD modalities are uncertain. This is an update of a review first published in 2014. This update includes non-randomised studies of interventions (NRSIs). OBJECTIVES To evaluate the benefits and harms of HHD versus ICHD in adults with kidney failure. SEARCH METHODS We contacted the Information Specialist and searched the Cochrane Kidney and Transplant Register of Studies up to 9 October 2022 using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov. We searched MEDLINE (OVID) and EMBASE (OVID) for NRSIs. SELECTION CRITERIA RCTs and NRSIs evaluating HHD (including community houses and self-care) compared to ICHD in adults with kidney failure were eligible. The outcomes of interest were cardiovascular death, all-cause death, non-fatal myocardial infarction, non-fatal stroke, all-cause hospitalisation, vascular access interventions, central venous catheter insertion/exchange, vascular access infection, parathyroidectomy, wait-listing for a kidney transplant, receipt of a kidney transplant, quality of life (QoL), symptoms related to dialysis therapy, fatigue, recovery time, cost-effectiveness, blood pressure, and left ventricular mass. DATA COLLECTION AND ANALYSIS Two authors independently assessed if the studies were eligible and then extracted data. The risk of bias was assessed, and relevant outcomes were extracted. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) or standardised mean difference (SMD) and 95% CI for continuous outcomes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Meta-analysis was performed on outcomes where there was sufficient data. MAIN RESULTS From the 1305 records identified, a single cross-over RCT and 39 NRSIs proved eligible for inclusion. These studies were of varying design (prospective cohort, retrospective cohort, cross-sectional) and involved a widely variable number of participants (small single-centre studies to international registry analyses). Studies also varied in the treatment prescription and delivery (e.g. treatment duration, frequency, dialysis machine parameters) and participant characteristics (e.g. time on dialysis). Studies often did not describe these parameters in detail. Although the risk of bias, as assessed by the Newcastle-Ottawa Scale, was generally low for most studies, within the constraints of observational study design, studies were at risk of selection bias and residual confounding. Many study outcomes were reported in ways that did not allow direct comparison or meta-analysis. It is uncertain whether HHD, compared to ICHD, may be associated with a decrease in cardiovascular death (RR 0.92, 95% CI 0.80 to 1.07; 2 NRSIs, 30,900 participants; very low certainty evidence) or all-cause death (RR 0.80, 95% CI 0.67 to 0.95; 9 NRSIs, 58,984 patients; very low certainty evidence). It is also uncertain whether HHD may be associated with a decrease in hospitalisation rate (MD -0.50 admissions per patient-year, 95% CI -0.98 to -0.02; 2 NRSIs, 834 participants; very low certainty evidence), compared with ICHD. Compared with ICHD, it is uncertain whether HHD may be associated with receipt of kidney transplantation (RR 1.28, 95% CI 1.01 to 1.63; 6 NRSIs, 10,910 participants; very low certainty evidence) and a shorter recovery time post-dialysis (MD -2.0 hours, 95% CI -2.73 to -1.28; 2 NRSIs, 348 participants; very low certainty evidence). It remains uncertain if HHD may be associated with decreased systolic blood pressure (SBP) (MD -11.71 mm Hg, 95% CI -21.11 to -2.46; 4 NRSIs, 491 participants; very low certainty evidence) and decreased left ventricular mass index (LVMI) (MD -17.74 g/m2, 95% CI -29.60 to -5.89; 2 NRSIs, 130 participants; low certainty evidence). There was insufficient data to evaluate the relative association of HHD and ICHD with fatigue or vascular access outcomes. Patient-reported outcome measures were reported using 18 different measures across 11 studies (QoL: 6 measures; mental health: 3 measures; symptoms: 1 measure; impact and view of health: 6 measures; functional ability: 2 measures). Few studies reported the same measures, which limited the ability to perform meta-analysis or compare outcomes. It is uncertain whether HHD is more cost-effective than ICHD, both in the first (SMD -1.25, 95% CI -2.13 to -0.37; 4 NRSIs, 13,809 participants; very low certainty evidence) and second year of dialysis (SMD -1.47, 95% CI -2.72 to -0.21; 4 NRSIs, 13,809 participants; very low certainty evidence). AUTHORS' CONCLUSIONS Based on low to very low certainty evidence, HHD, compared with ICHD, has uncertain associations or may be associated with decreased cardiovascular and all-cause death, hospitalisation rate, slower post-dialysis recovery time, and decreased SBP and LVMI. HHD has uncertain cost-effectiveness compared with ICHD in the first and second years of treatment. The majority of studies included in this review were observational and subject to potential selection bias and confounding, especially as patients treated with HHD tended to be younger with fewer comorbidities. Variation from study to study in the choice of outcomes and the way in which they were reported limited the ability to perform meta-analyses. Future research should align outcome measures and metrics with other research in the field in order to allow comparison between studies, establish outcome effects with greater certainty, and avoid research waste.
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Affiliation(s)
- Melissa S Cheetham
- Renal Unit, Sunshine Coast University Hospital, Birtinya, Australia
- Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Isabelle Ethier
- Department of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
- Health Innovation and Evaluation Hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Rathika Krishnasamy
- Renal Unit, Sunshine Coast University Hospital, Birtinya, Australia
- Faculty of Medicine, The University of Queensland, Herston, Australia
- Australasian Kidney Trials Network, Translational Research Institute, Woolloongabba, Australia
| | - Yeoungjee Cho
- Faculty of Medicine, The University of Queensland, Herston, Australia
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Jonathan C Craig
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Paul Stroumza
- Medical Office, Diaverum Marseille, Marseille, France
| | - Luc Frantzen
- Medical Office, Diaverum Marseille, Marseille, France
| | - Jorgen Hegbrant
- Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Giovanni Fm Strippoli
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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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.
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Affiliation(s)
- Ying Zhu
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, USA
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5
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Fraga Dias B, Rodrigues A. Managing Transition between dialysis modalities: a call for Integrated care In Dialysis Units. BULLETIN DE LA DIALYSE À DOMICILE 2022. [DOI: 10.25796/bdd.v4i4.69113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Summary
Patients with chronic kidney disease have three main possible groups of dialysis techniques: in-center hemodialysis, peritoneal dialysis, and home hemodialysis. Home dialysis techniques have been associated with clinical outcomes that are equivalent and sometimes superior to those of in-center hemodialysisTransitions between treatment modalities are crucial moments. Transition periods are known as periods of disruption in the patient’s life associated with major complications, greater vulnerability, greater mortality, and direct implications for quality of life. Currently, it is imperative to offer a personalized treatment adapted to the patient and adjusted over time.An integrated treatment unit with all dialysis treatments and a multidisciplinary team can improve results by establishing a life plan, promoting health education, medical and psychosocial stabilization, and the reinforcement of health self-care. These units will result in gains for the patient’s journey and will encourage home treatments and better transitions.Peritoneal dialysis as the initial treatment modality seems appropriate for many reasons and the limitations of the technique are largely overcome by the advantages (namely autonomy, preservation of veins, and preservation of residual renal function).The transition after peritoneal dialysis can (and should) be carried out with the primacy of home treatments. Assisted dialysis must be considered and countries must organize themselves to provide an assisted dialysis program with paid caregivers.The anticipation of the transition is essential to improve outcomes, although there are no predictive models that have high accuracy; this is particularly important in the transition to hemodialysis (at home or in-center) in order to plan autologous access that allows a smooth transition.
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Bussey AT, Tin A, Hoye N, Richardson M. Delivery of Radioiodine Ablation in a Patient with End-Stage Renal Disease. World J Nucl Med 2022; 21:320-324. [PMID: 36398301 PMCID: PMC9665990 DOI: 10.1055/s-0042-1750405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This case presents a pragmatic approach to the management of a radioiodine remnant ablation patient on hemodialysis which required no pretherapeutic dosimetric measurements. Pretreatment radiation dose modeling was performed using literature values for radioiodine hemodialysis extraction efficacies to determine a safe treatment regimen including adjustment of the administered activity and hemodialysis frequency. The pretreatment modeling was subsequently verified using external and blood radiation monitoring during treatment.
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Affiliation(s)
- Andrew T. Bussey
- Department of Nuclear Medicine, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Aung Tin
- The James Cook Cancer Institute, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Neil Hoye
- Department of Renal Medicine, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Mark Richardson
- Department of Nuclear Medicine, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
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7
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St-Jules DE, Fouque D. A Novel Approach for Managing Protein-Energy Wasting in People With Kidney Failure Undergoing Maintenance Hemodialysis: Rationale and Call for Trials. Am J Kidney Dis 2022; 80:277-284. [PMID: 34974032 DOI: 10.1053/j.ajkd.2021.10.012] [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: 08/08/2021] [Accepted: 10/28/2021] [Indexed: 01/27/2023]
Abstract
Protein-energy wasting (PEW) is a unique presentation of protein-energy malnutrition in people with kidney disease that is characterized by body protein catabolism exceeding anabolism. PEW is especially common in patients undergoing maintenance hemodialysis (HD) treatment. Dietary guidelines for managing PEW in HD patients primarily focus on protein adequacy and typically promote the intake of animal-based protein foods. Although intake of protein and essential amino acids is important for protein synthesis, the emphasis on protein adequacy largely fails to address-and may actually exacerbate-many of the root causes of PEW. This perspective examines the dietary determinants of PEW in people undergoing HD treatment, with an emphasis on upstream disease-related factors that reduce dietary protein utilization and impair dietary intakes. From this, we present a theoretical diet model for managing PEW that includes etiology-based dietary strategies to address barriers to intake and treat disease-related factors, as well as supportive dietary strategies to promote adequate energy and protein intakes. Given the complexity of diet-disease interactions in the pathogenesis of PEW, and its ongoing burden in HD patients, interventional trials are urgently needed to evaluate alternative diet therapy approaches for PEW in this population.
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Affiliation(s)
| | - Denis Fouque
- CarMeN Laboratory, INSERM U1060, Université Claude Bernard Lyon 1, Villeurbanne, and Department of Nephrology, Nutrition, and Dialysis, Centre Hopitalier Lyon Sud, Pierre-Benite, France.
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8
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Bellin EY, Hellebrand AM, Kaplan SM, Ledvina JG, Markis WT, Levin NW, Kaufman AM. Post-dialysis recovery time in ESRD patients receiving more frequent hemodialysis in skilled nursing facilities. Hemodial Int 2022; 26:424-434. [PMID: 35388580 PMCID: PMC9543222 DOI: 10.1111/hdi.13012] [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: 12/22/2021] [Revised: 01/26/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
Introduction Post‐dialysis recovery time (DRT) has an important relationship to quality of life and survival, as identified in studies of ESRD patients on conventional dialysis. ESRD patients are often discharged from hospitals to skilled nursing facilities (SNFs) where on‐site treatment using home hemodialysis technology is increasingly offered, but nothing is known about DRT in this patient population. Methods From November 4, 2019 to June 11, 2021, within a dialysis organization providing service across 12 states and 154 SNFs, patients receiving in‐SNF, more frequent dialysis (MFD) (modeled to deliver 14 treatment hours minimum per week and stdKt/V ≥2.0) were asked to describe their post‐dialysis recovery time following their previous treatment, within predefined categoric choices: 0–½, ½–1, 1–2, 2–4, 4–8, 8–12 h, by next morning, or not even by next morning. Patients reporting DRT following at least one full‐week treatment opportunity were included in a mixed model logistic regression of rapid recovery (DRT ≤2 h). Findings Two thousand three hundred and nine patients met the statistical modeling inclusion criteria, providing DRT on 108,876 dialysis sessions, while receiving mean (SD) 4.3 (0.96) weekly dialysis treatments. 2118 (92%) reported DRT ≤2 h. Results appeared biologically plausible, as lower odds of rapid DRT were observed for patients who were older, missed their previous treatment, or experienced intradialytic hypotension. Greater odds of rapid DRT were observed in patients receiving five dialyses in the previous week or having 160–179 mmHg pre‐hemodialysis systolic blood pressure. Rapid recovery was associated with reduced mortality or hospitalization. Discussion SNF dialysis patients receiving 5x per week MFD report rapid recovery time ≤2 h in 92% of dialyses despite advanced age, frailty, and comorbidities. Future studies will assess the practical ramifications of rapid DRT perception/experience on nursing home rehabilitation programs, which could impact patient health beyond the nursing home stay.
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Affiliation(s)
- Eran Y Bellin
- Departments of Epidemiology & Population Health and Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | | | | | - Nathan W Levin
- Internal Medicine, Mount Sinai Icahn School of Medicine, New York, New York, USA
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9
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Jain S, Rathnamala M, Narne VK. Evaluation of Auditory Processing and Working Memory Abilities in Individuals with Chronic Renal Disease Undergoing Hemodialysis. AUDITORY PERCEPTION & COGNITION 2022. [DOI: 10.1080/25742442.2022.2036538] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Saransh Jain
- Associate Professor in Audiology, Jss Institute of Speech and Hearing, University of Mysore, Mysuru, India
| | - Monica Rathnamala
- Clinical Supervisor, Jss Institute of Speech and Hearing, University of Mysore, Mysuru, India
| | - Vijaya Kumar Narne
- Senior Research Scientist, Department of Mechanical Engineering, Indian Institute of Technology, Kanpur, India
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10
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Guía de unidades de hemodiálisis 2020. Nefrologia 2021. [DOI: 10.1016/j.nefro.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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11
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Torreggiani M, Fois A, Njandjo L, Longhitano E, Chatrenet A, Esposito C, Fessi H, Piccoli GB. Toward an individualized determination of dialysis adequacy: a narrative review with special emphasis on incremental hemodialysis. Expert Rev Mol Diagn 2021; 21:1119-1137. [PMID: 34595991 DOI: 10.1080/14737159.2021.1987216] [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: 01/01/2023]
Abstract
INTRODUCTION The search for the 'perfect' renal replacement therapy has been paralleled by the search for the perfect biomarkers for assessing dialysis adequacy. Three main families of markers have been assessed: small molecules (prototype: urea); middle molecules (prototype β2-microglobulin); comprehensive and nutritional markers (prototype of the simplified assessment, albumin levels; composite indexes as malnutrition-inflammation score). After an era of standardization of dialysis treatment, personalized dialysis schedules are increasingly proposed, challenging the dogma of thrice-weekly hemodialysis. AREAS COVERED In this review, we describe the advantages and limitations of the approaches mentioned above, focusing on the open questions regarding personalized schedules and incremental hemodialysis. EXPERT OPINION In the era of personalized dialysis, the assessment of dialysis adequacy should be likewise personalized, due to the limits of 'one size fits all' approaches. We have tried to summarize some of the relevant issues regarding the determination of dialysis adequacy, attempting to adapt them to an elderly, highly comorbidity population, which would probably benefit from tailor-made dialysis prescriptions. While no single biomarker allows precisely tailoring the dialysis dose, we suggest using a combination of clinical and biological markers to prescribe dialysis according to comorbidity, life expectancy, residual kidney function, and small and medium-size molecule depuration.
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Affiliation(s)
| | - Antioco Fois
- Nèphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France
| | - Linda Njandjo
- Nèphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France
| | - Elisa Longhitano
- Department of Clinical and Experimental Medicine, Unit of Nephrology and Dialysis, A.o.u. "G. Martino," University of Messina, Messina, Italy
| | - Antoine Chatrenet
- Nèphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France.,Laboratory "Movement, Interactions, Performance" (EA 4334), Le Mans University, Le Mans, France
| | - Ciro Esposito
- Nephrology and Dialysis, ICS Maugeri S.p.A. Sb, Pavia, Italy.,Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Hafedh Fessi
- Department of Nephrology, Hospital Tenon, Paris, France
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12
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Quantifying Regional and Health Care Variations to Identify Ways to Improve Hemodialysis Service Quality and Survival Outcomes. Am J Med Qual 2021; 36:345-354. [PMID: 34010165 DOI: 10.1097/01.jmq.0000735484.44163.ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors examined variations in hemodialysis care and quantified the effect of these variations on all-cause mortality. Insurance claims data from April 1, 2017 to March 30, 2018 were reviewed. In total, 2895 hospital patients were identified, among whom 398 died from various causes. Controlling effects of the facility and secondary medical care areas, all-cause mortality was associated with older age, heart failure, malignancy, cerebral stroke, severe comorbidity, and the first and ninth centile of physician density. Multilevel analyses indicated a significant variation at facility level (σ22 0.27, 95% confidence interval: 0.09-0.49). Inclusion of all covariates in the final model significantly reduced facility-level variance. Physician density emerged as an important factor affecting survival outcome; thus, a review of workforce and resource allocation policies is needed. Better clinical management and standardized work processes are necessary to attenuate differences in hospital practice patterns.
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13
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Gupta A, Zimmerman D. Complications and challenges of home hemodialysis: A historical review. Semin Dial 2021; 34:269-274. [PMID: 33609415 DOI: 10.1111/sdi.12960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Home hemodialysis (HHD) has evolved as a preferred and safe kidney replacement modality over the past six decades. Despite advances in technological aspects of HHD, potential complications still pose a challenge to health care givers, patients, and their families. In this narrative review, we describe vascular access and cannulation, anticoagulation, nutritional, residual kidney function, psychosocial, technique failure, and machine/procedural-related complications. Addressing these problems is essential for favorable patient outcomes.
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Affiliation(s)
- Ankur Gupta
- Department of Medicine, Whakatane Hospital, Whakatane, New Zealand
| | - Deborah Zimmerman
- Division of Nephrology, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
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14
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Solimano RJ, Lineen J, Naimark DMJ. Preference for Alternate-Day Versus Conventional In-Center Dialysis: A Health Utility Elicitation. Can J Kidney Health Dis 2020; 7:2054358120914426. [PMID: 32426146 PMCID: PMC7218335 DOI: 10.1177/2054358120914426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Mortality rates for patients on hemodialysis (HD) continue to be high, in particular, following the long interdialytic period, yet thrice-weekly conventional HD (CHD) is still an almost universal regimen. Alternate-day dialysis (ADD) may have advantages over the current schedule because it would eliminate the long interdialytic break. A preliminary, as yet unpublished, patient simulation and cost-utility analysis compared CHD versus ADD and demonstrated that the economic attractiveness of ADD was sensitive, in particular, to patients’ preference for ADD versus CHD. To date, this preference has not been elicited. Objective: To elicit utilities for both CHD and ADD using 3 standard elicitation methods among a prevalent cohort of patients on CHD. Design: This study is a single-center survey of patient preferences (utilities). Setting: This study took place within the dialysis units of Sunnybrook Health Centre, a university-affiliated teaching hospital in Toronto, Ontario, Canada, which encompasses 174 patients on in-center HD. Patients: Those older than 18 years of age, on thrice-weekly HD, were included in this study. Measurements: Descriptive statistics were used to summarize patient characteristics and the utility values generated. A multiple linear regression was performed to determine an association between participant characteristics and the utility ratio. Methods: Via standardized face-to-face interviews by a single investigator, 3 utility elicitation methods, visual analogue scale (VAS), time trade-off (TTO), and standard gamble (SG), were administered to generate utilities for each patient for their current health state of CHD (thrice-weekly). After completing this task, we provided each patient with a concise summary regarding the current literature on how ADD may impact their health. Finally, patients were asked to envision their health while on an ADD regimen while repeating the VAS, TTO, and SG. Results: We recruited 65 participants. The mean utilities of CHD versus ADD were similar for all 3 methods. Visual analogue scale, TTO, and SG had utility values of 0.6 ± 0.2, 0.6 ± 0.3, and 0.7 ± 0.3, and 0.6 ± 0.2, 0.7 ± 0.3, and 0.7 ± 0.3 for CHD and ADD, respectively. The ratio for CHD to ADD was 1.1 ± 0.4, 1.1 ± 0.5, and 1.0 ± 0.2 for VAS, TTO, and SG, respectively. Limitations: Small sample size from a single center, where not all participants agreed to participate, wide variability in participant responses and requiring patients to conceptually imagine life on ADD may have affected our results. Conclusions: Compared with CHD, there was no difference in the preference toward ADD which demonstrates promise that adopting an alternate-day schedule may be acceptable to patients. Furthermore, with the generation of a utility for ADD, this will allow for more precise estimates in future simulation studies of the economic attractiveness of ADD. Trial registration: Not required as this article is not a systematic review nor does it report the results of a health care intervention.
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Affiliation(s)
| | | | - David M J Naimark
- Department of Medicine, University of Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
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15
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Imbeault B, Nadeau-Fredette AC. Optimization of Dialysis Modality Transitions for Improved Patient Care. Can J Kidney Health Dis 2019; 6:2054358119882664. [PMID: 31666977 PMCID: PMC6798163 DOI: 10.1177/2054358119882664] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/17/2019] [Indexed: 02/01/2023] Open
Abstract
Purpose of review: Initial and subsequent modality decisions are important, impacting both
clinical outcomes and quality of life. Transition from chronic kidney
disease to dialysis and between dialysis modalities are periods were
patients may be especially vulnerable. Reviewing our current knowledge
surrounding these critical periods and identifying areas for future research
may allow us to develop dialysis strategies beneficial to patients. Sources of information: We searched the electronic database PubMed and queried Google Scholar for
English peer-reviewed articles using appropriate keywords (non-exhaustive
list): dialysis transitions, peritoneal dialysis, home hemodialysis,
integrated care pathway, and health-related quality of life. Primary sources
were accessed whenever possible. Methods: In this narrative review, we aim to expose the controversies surrounding
home-dialysis first strategies and examine the evidence underpinning
home-dialysis first strategies as well as home-to-home and home-to-in-center
transitions. Key findings: Diverse factors must be taken into consideration when choosing initial and
subsequent dialysis modalities. Given the limitations of available data (and
lack of convincing benefit or detriment of one modality over the other),
patient-centered considerations may prime over suspected mortality benefits
of one modality or another. Limitations: Available data stem almost exclusively from retrospective and observational
studies, often using large national and international databases, susceptible
to bias. Furthermore, this is a narrative review which takes into account
the views and opinions of the authors, especially as it pertains to optimal
dialysis pathways. Implications: Emphasis must be placed on individual patient goals and preferences during
modality selection while planning ahead to achieve timely and appropriate
transitions limiting discomfort and anxiety for patients. Further research
is required to ascertain specific interventions which may be beneficial to
patients.
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Affiliation(s)
- Benoit Imbeault
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada.,Division of Nephrology, University Health Network, Toronto, ON, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada.,Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
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16
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Abstract
There is a resurgence in clinical adoption of home hemodialysis globally driven by several demonstrated clinical and economic advantages. Yet, the overall adoption of home hemodialysis remains under-represented in most countries. The practicality of managing ESKD with home hemodialysis is a common concern among practicing nephrologists in the United States. The primary objective of this invited feature is to deliver a practical guide to managing ESKD with home hemodialysis. We have included common clinical scenarios, clinical and infrastructure management problems, and approaches to the day-to-day management of patients undergoing home hemodialysis.
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Affiliation(s)
- Ali Ibrahim
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Christopher T Chan
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
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18
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Huang SHS, MacRae J, Ross D, Imtiaz R, Hollingsworth B, Nesrallah GE, Copland MA, McFarlane PA, Chan CT, Zimmerman D. Buttonhole versus Stepladder Cannulation for Home Hemodialysis: A Multicenter, Randomized, Pilot Trial. Clin J Am Soc Nephrol 2019; 14:403-410. [PMID: 30659057 PMCID: PMC6419275 DOI: 10.2215/cjn.08310718] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/12/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Canadian home hemodialysis guidelines highlight the potential differences in complications associated with arteriovenous fistula (AVF) cannulation technique as a research priority. Our primary objective was to determine the feasibility of randomizing patients with ESKD training for home hemodialysis to buttonhole versus stepladder cannulation of the AVF. Secondary objectives included training time, pain with needling, complications, and cost by cannulation technique. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS All patients training for home hemodialysis at seven Canadian hospitals were assessed for eligibility, and demographic information and access type was collected on everyone. Patients who consented to participate were randomized to buttonhole or stepladder cannulation technique. Time to train for home hemodialysis, pain scores on cannulation, and complications over 12 months was recorded. For eligible but not randomized patients, reasons for not participating in the trial were documented. RESULTS Patient recruitment was November 2013 to November 2015. During this time, 158 patients began training for home hemodialysis, and 108 were ineligible for the trial. Diabetes mellitus as a cause of ESKD (31% versus 12%) and central venous catheter use (74% versus 6%) were more common in ineligible patients. Of the 50 eligible patients, 14 patients from four out of seven sites consented to participate in the study (28%). The most common reason for declining to participate was a strong preference for a particular cannulation technique (33%). Patients randomized to buttonhole versus stepladder cannulation required a shorter time to complete home hemodialysis training. We did not observe a reduction in cannulation pain or complications with the buttonhole method. Data linkages for a formal cost analysis were not conducted. CONCLUSIONS We were unable to demonstrate the feasibility of conducting a randomized, controlled trial of buttonhole versus stepladder cannulation in Canada with a sufficient number of patients on home hemodialysis to be able to draw meaningful conclusions.
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Affiliation(s)
- Shih-Han S. Huang
- Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Jennifer MacRae
- Department of Medicine, Division of Nephrology, Foothills Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Dana Ross
- Ottawa Hospital, Ottawa, Ontario, Canada
| | - Rameez Imtiaz
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Brittany Hollingsworth
- Kidney Research Centre of the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gihad E. Nesrallah
- Faculty of Medicine, Division of Nephrology, Humber River Hospital, Toronto, Ontario, Canada
| | - Michael A. Copland
- Department of Medicine, Division of Nephrology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada; and
| | | | - Christopher T. Chan
- Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Deborah Zimmerman
- Ottawa Hospital, Ottawa, Ontario, Canada
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
- Kidney Research Centre of the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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19
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Palmer K, Walker S, Richardson R, Jassal SV, Battistella M. Pharmacokinetic Study of Cefazolin in Short Daily Hemodialysis. Ann Pharmacother 2018; 53:348-356. [DOI: 10.1177/1060028018809695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: A number of centers across the world offer short daily hemodialysis (SDHD) treatments. To date, cefazolin pharmacokinetics have not been described in patients undergoing SDHD. Objective: The purpose of this study was to investigate the effect of SDHD on the pharmacokinetics of cefazolin. Methods: This was a prospective, open-label, pharmacokinetic study of cefazolin during SDHD in 10 noninfected patients. Participants received a 1-g intravenous (IV) infusion of cefazolin after SDHD on study day 1 and a second dose after SDHD on study day 2. To determine the concentration of cefazolin, 6 blood samples were drawn at 0, 1, 2, 2.3, 4, and 24 hours after initiation of dialysis on day 2, and 2 dialysate samples were drawn at 1 and 2 hours after initiation of dialysis on day 2. Samples were analyzed using high-performance liquid chromatography, and pharmacokinetic parameters were determined. Results: Median interdialysis clearance was 0.16 L/h (interquartile range [IQR]: 0.11-0.21 L/h), and median intradialysis clearance was 1.95 L/h (IQR: 1.66-2.45 L/h). Median interdialysis half-life was 28.2 hours (IQR: 23.5-59.3 hours) as compared with a median intradialysis half-life of 2.3 hours (IQR: 1.7-2.7 hours). The median percentage removal of cefazolin during dialysis was 41% (IQR: 35%-53%). Conclusion and Relevance: Estimated cefazolin dialysis clearance is similar to previous estimates with conventional thrice-weekly regimens. Current dosing recommendations of 1 g IV post-SDHD achieve total serum drug concentrations greater than 40 mg/L in all patients, which is the total drug concentration required for bactericidal activity against Staphylococcus species.
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Affiliation(s)
- Katie Palmer
- University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Scott Walker
- University of Toronto, Toronto, ON, Canada
- Sunnybrook & Women’s College Health Sciences Centre, Toronto, ON, Canada
| | - Robert Richardson
- University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Sarbjit V. Jassal
- University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Marisa Battistella
- University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
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20
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St-Jules DE, Goldfarb DS, Popp CJ, Pompeii ML, Liebman SE. Managing protein-energy wasting in hemodialysis patients: A comparison of animal- and plant-based protein foods. Semin Dial 2018; 32:41-46. [DOI: 10.1111/sdi.12737] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- David E. St-Jules
- Division of Health and Behavior, Department of Population Health; New York University School of Medicine; New York NY USA
| | - David S. Goldfarb
- Division of Nephrology, Department of Medicine; New York University School of Medicine; New York NY USA
| | - Collin J. Popp
- Division of Health and Behavior, Department of Population Health; New York University School of Medicine; New York NY USA
| | - Mary Lou Pompeii
- Division of Health and Behavior, Department of Population Health; New York University School of Medicine; New York NY USA
| | - Scott E. Liebman
- Division of Nephrology, Department of Medicine; University of Rochester School of Medicine; Rochester NY USA
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21
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Abstract
The use of frequent hemodialysis (HD) is growing, with the hope of improving outcomes in end-stage renal disease. We narratively review the three randomized trials, 15 comparative cohort studies, and several case series of frequent HD that empirically demonstrate the potential efficacy and adverse effects of these regimens. Taken together, the randomized studies suggest frequent HD may result in left ventricular mass regression. This effect is most pronounced when left ventricular mass is abnormal, but attenuated by significant residual urine output. Both frequent short and long HD consistently improved blood pressure control and reduced antihypertensive use, despite greater weekly interdialytic weight gains. Serum phosphate was lowered. Frequent short daytime HD improved health-related quality of life, while frequent long overnight HD did not. Regarding adverse effects, frequent HD patients underwent significantly more procedures to salvage arteriovenous vascular accesses. An absolute increase in hypotensive episodes was observed with frequent short HD, while frequent long HD accelerated residual renal function loss and increased perceived caregiver burden. The effect of frequent HD on mortality is controversial, due to conflicting results and limitations of published studies. Finally, pregnancy outcomes may be substantially better with frequent long HD. On the basis of these data, we suggest frequent HD is most likely to benefit patients with left ventricular hypertrophy particularly if there is minimal urine output, those unable to attain dry weight on a thrice weekly schedule, and pregnant women. All patients receiving frequent HD should be advised of and monitored for potential risks.
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Affiliation(s)
- Rita S Suri
- Department of Medicine, University of Montreal, Montreal, Canada
| | - Alan S Kliger
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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22
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Ing TS, Meyers J, Schatell D, Kjellstrand CM. Better Removal of Small Solutes by More Frequent Hemodialysis Sessions than by Conventional, Thrice Weekly Hemodialysis Sessions of Similar Weekly Duration. Int J Artif Organs 2018; 29:639-40. [PMID: 16841294 DOI: 10.1177/039139880602900614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Abstract
Various modalities of high-intensity hemodialysis are gathering increasing popularity. Some of the advantages of these new dialysis regimens are presented. Time and the increasing use of these novel approaches will ultimately determine their role in the overall management of patients with end-stage renal disease.
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Affiliation(s)
- T. S. Ing
- Department of Medicine, Hines VA/Loyola University Medical Center, Hines, Illinois - USA
| | - C. Ronco
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - C. R. Blagg
- Northwest Kidney Centers and University of Washington, Seattle, Washington - USA
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24
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Pérez Alba A, Slon Roblero F, Castellano Gasch S, Bajo Rubio MA. Barriers for the development of home hemodialysis in Spain. Spanish nephrologists survey. Nefrologia 2017; 37:665-668. [PMID: 29122220 DOI: 10.1016/j.nefro.2017.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/19/2017] [Accepted: 02/20/2017] [Indexed: 11/19/2022] Open
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25
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Leduc V, Ficheux M, Bechade C, Dreyfus M, Lobbedez T, Henri P. Pregnancy on short-daily home hemodialysis using low dialysate flow rate: A new hope for the end-stage renal disease patients. Hemodial Int 2017; 22:161-167. [PMID: 28762611 DOI: 10.1111/hdi.12590] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In France in 2014, there were approximately 1500 patients of reproductive age treated by dialysis. Pregnancy in these patients remains rare, however, the incidence has increased since the 2000s, with a parallel increase in the fetal survival rate. We report 2 cases of pregnancy in short-daily home hemodialysis using low dialysate flow rate. METHODS Short-daily hemodialysis was continued at the request of the patients. The treatment consisted in an increase of frequency and duration of hemodialysis sessions, an independent blood pressure and dry weight control supervised by nephrological monitoring twice a month and a regular obstetrics follow-up. FINDINGS Both patients continued hemodialysis at home until delivery and gave birth to 2 moderately premature babies, without other complication and resumed short-daily home hemodialysis fastly after delivery. CONCLUSION Short-daily hemodialysis using low dialysate flow rate during pregnancy seems to allow a good control of uremia and blood pressure without requiring a major increase of weekly dialysis duration. Therefore, it could become an alternative to other hemodialysis programs while allowing the patients to continue their treatment at home. However, other studies are necessary in order to define the position of this procedure during pregnancy.
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Affiliation(s)
- Vincent Leduc
- Department of Nephrology-Dialysis-Transplantation, CHU de Caen, Caen, France.,Universite de Caen Normandie, UFR de Medecine, Caen, France
| | - Maxence Ficheux
- Department of Nephrology-Dialysis-Transplantation, CHU de Caen, Caen, France
| | - Clémence Bechade
- Department of Nephrology-Dialysis-Transplantation, CHU de Caen, Caen, France
| | - Michel Dreyfus
- Universite de Caen Normandie, UFR de Medecine, Caen, France.,Departement of Gynecology-Obstetrics, CHU de Caen, Caen, France
| | - Thierry Lobbedez
- Department of Nephrology-Dialysis-Transplantation, CHU de Caen, Caen, France.,Universite de Caen Normandie, UFR de Medecine, Caen, France
| | - Patrick Henri
- Department of Nephrology-Dialysis-Transplantation, CHU de Caen, Caen, France
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26
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Garg AX, Suri RS, Eggers P, Finkelstein FO, Greene T, Kimmel PL, Kliger AS, Larive B, Lindsay RM, Pierratos A, Unruh M, Chertow GM. Patients receiving frequent hemodialysis have better health-related quality of life compared to patients receiving conventional hemodialysis. Kidney Int 2017; 91:746-754. [PMID: 28094031 DOI: 10.1016/j.kint.2016.10.033] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/19/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
Abstract
Most patients with end-stage kidney disease value their health-related quality of life (HRQoL) and want to know how it will be affected by their dialysis modality. We extended the findings of two prior clinical trial reports to estimate the effects of frequent compared to conventional hemodialysis on additional measures of HRQoL. The Daily Trial randomly assigned 245 patients to receive frequent (six times per week) or conventional (three times per week) in-center hemodialysis. The Nocturnal Trial randomly assigned 87 patients to receive frequent nocturnal (six times per week) or conventional (three times per week) home hemodialysis. All patients were on conventional hemodialysis prior to randomization, with an average feeling thermometer score of 70 to 75 (a visual analog scale from 0 to 100 where 100 is perfect health), an average general health scale score of 40 to 47 (a score from 0 to 100 where 100 is perfect health), and an average dialysis session recovery time of 2 to 3 hours. Outcomes are reported as the between-treatment group differences in one-year change in HRQoL measures and analyzed using linear mixed effects models. After one year in the Daily Trial, patients assigned to frequent in-center hemodialysis reported a higher feeling thermometer score, better general health, and a shorter recovery time after a dialysis session compared to standard thrice-weekly dialysis. After one year in the Nocturnal Trial, patients assigned to frequent home hemodialysis also reported a shorter recovery time after a dialysis session, but no statistical difference in their feeling thermometer or general health scores compared to standard home dialysis schedules. Thus, patients receiving day or nocturnal hemodialysis on average recovered approximately one hour earlier from a frequent compared to conventional hemodialysis session. Patients treated in an in-center dialysis facility reported better HRQoL with frequent compared to conventional hemodialysis.
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Affiliation(s)
- Amit X Garg
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.
| | - Rita S Suri
- Department of Medicine, Section of Nephrology, Centre de Recherche, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Paul Eggers
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Fredric O Finkelstein
- Yale School of Medicine and Yale New Haven Health System, New Haven, Connecticut, USA
| | - Tom Greene
- University of Utah Medical Center, Salt Lake City, Utah, USA
| | - Paul L Kimmel
- Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Alan S Kliger
- Yale School of Medicine and Yale New Haven Health System, New Haven, Connecticut, USA
| | - Brett Larive
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Robert M Lindsay
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | | | - Mark Unruh
- Department of Internal Medicine, Division of Nephrology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Glenn M Chertow
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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Nickel M, Rideout W, Shah N, Reintjes F, Chen JZ, Burrell R, Pauly RP. Estimating patient-borne water and electricity costs in home hemodialysis: a simulation. CMAJ Open 2017; 5:E61-E65. [PMID: 28401120 PMCID: PMC5378499 DOI: 10.9778/cmajo.20160108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Home hemodialysis is associated with lower costs to the health care system compared with conventional facility-based hemodialysis because of lower staffing and overhead costs, and by transferring the treatment cost of utilities (water and power) to the patient. The purpose of this study was to determine the utility costs of home hemodialysis and create a formula such that patients and renal programs can estimate the annual patient-borne costs involved with this type of treatment. METHODS Seven common combinations of treatment duration and dialysate flows were replicated 5 times using various combinations of home hemodialysis and reverse osmosis machines. Real-time utility (electricity and water) consumption was monitored during these simulations. A generic formula was developed to allow patients and programs to calculate a more precise estimate of utility costs based on individual combinations of dialysis intensity, frequency and utility costs unique to any patient. RESULTS Using typical 2014 utility costs for Edmonton, the most expensive prescription was for nocturnal home hemodialysis (8 h at 300 mL/min, 6 d/wk), which resulted in a utility cost of $1269 per year; the least expensive prescription was for conventional home hemodialysis (4 h at 500 mL/min, 3 d/wk), which cost $420 per year. Water consumption makes up most of this expense, with electricity accounting for only 12% of the cost. INTERPRETATION We show that a substantial cost burden is transferred to the patient on home hemodialysis, which would otherwise be borne by the renal program.
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Affiliation(s)
- Matthew Nickel
- Department of Chemical and Materials Engineering (Nickel, Burrell), University of Alberta; Northern Alberta Renal Program (Rideout, Reintjes, Pauly), Alberta Health Services; Division of Nephrology, Department of Medicine (Shah, Pauly), University of Alberta; Department of Medicine (Chen), University of Alberta, Edmonton, Alta
| | - Wes Rideout
- Department of Chemical and Materials Engineering (Nickel, Burrell), University of Alberta; Northern Alberta Renal Program (Rideout, Reintjes, Pauly), Alberta Health Services; Division of Nephrology, Department of Medicine (Shah, Pauly), University of Alberta; Department of Medicine (Chen), University of Alberta, Edmonton, Alta
| | - Nikhil Shah
- Department of Chemical and Materials Engineering (Nickel, Burrell), University of Alberta; Northern Alberta Renal Program (Rideout, Reintjes, Pauly), Alberta Health Services; Division of Nephrology, Department of Medicine (Shah, Pauly), University of Alberta; Department of Medicine (Chen), University of Alberta, Edmonton, Alta
| | - Frances Reintjes
- Department of Chemical and Materials Engineering (Nickel, Burrell), University of Alberta; Northern Alberta Renal Program (Rideout, Reintjes, Pauly), Alberta Health Services; Division of Nephrology, Department of Medicine (Shah, Pauly), University of Alberta; Department of Medicine (Chen), University of Alberta, Edmonton, Alta
| | - Justin Z Chen
- Department of Chemical and Materials Engineering (Nickel, Burrell), University of Alberta; Northern Alberta Renal Program (Rideout, Reintjes, Pauly), Alberta Health Services; Division of Nephrology, Department of Medicine (Shah, Pauly), University of Alberta; Department of Medicine (Chen), University of Alberta, Edmonton, Alta
| | - Robert Burrell
- Department of Chemical and Materials Engineering (Nickel, Burrell), University of Alberta; Northern Alberta Renal Program (Rideout, Reintjes, Pauly), Alberta Health Services; Division of Nephrology, Department of Medicine (Shah, Pauly), University of Alberta; Department of Medicine (Chen), University of Alberta, Edmonton, Alta
| | - Robert P Pauly
- Department of Chemical and Materials Engineering (Nickel, Burrell), University of Alberta; Northern Alberta Renal Program (Rideout, Reintjes, Pauly), Alberta Health Services; Division of Nephrology, Department of Medicine (Shah, Pauly), University of Alberta; Department of Medicine (Chen), University of Alberta, Edmonton, Alta
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28
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Smith JR, Zimmer N, Bell E, Francq BG, McConnachie A, Mactier R. A Randomized, Single-Blind, Crossover Trial of Recovery Time in High-Flux Hemodialysis and Hemodiafiltration. Am J Kidney Dis 2016; 69:762-770. [PMID: 28024931 PMCID: PMC5438239 DOI: 10.1053/j.ajkd.2016.10.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 10/15/2016] [Indexed: 12/12/2022]
Abstract
Background The choice between hemodiafiltration (HDF) or high-flux hemodialysis (HD) to treat end-stage kidney disease remains a matter of debate. The duration of recovery time after treatment has been associated with mortality, affects quality of life, and may therefore be important in informing patient choice. We aimed to establish whether recovery time is influenced by treatment with HDF or HD. Study Design Randomized patient-blinded crossover trial. Settings & Participants 100 patients with end-stage kidney disease were enrolled from 2 satellite dialysis units in Glasgow, United Kingdom. Intervention 8 weeks of HD followed by 8 weeks of online postdilution HDF or vice versa. Outcomes Posttreatment recovery time, symptomatic hypotension events, dialysis circuit clotting events, and biochemical parameters. Measurements Patient-reported recovery time in minutes, incidence of adverse events during treatments, hematology and biochemistry results, quality-of-life questionnaire. Results There was no overall difference in recovery time between treatments (medians for HDF vs HD of 47.5 [IQR, 0-240] vs 30 [IQR, 0-210] minutes, respectively; P = 0.9). During HDF treatment, there were significant increases in rates of symptomatic hypotension (8.0% in HDF vs 5.3% in HD; relative risk [RR], 1.52; 95% CI, 1.2-1.9; P < 0.001) and intradialytic tendency to clotting (1.8% in HDF vs 0.7% in HD; RR, 2.7; 95% CI, 1.5-5.0; P = 0.002). Serum albumin level was significantly lower during HDF (3.2 vs 3.3 g/dL; P < 0.001). Health-related quality-of-life scores were equivalent. Limitations Single center; mean achieved HDF convection volume, 20.6 L. Conclusions Patients blinded to whether they were receiving HD or HDF in a randomized controlled crossover study reported similar posttreatment recovery times and health-related quality-of-life scores.
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Affiliation(s)
- James R Smith
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom; Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland, United Kingdom.
| | - Norica Zimmer
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom
| | - Elizabeth Bell
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom
| | - Bernard G Francq
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Robert Mactier
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom
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Pladys A, Bayat S, Kolko A, Béchade C, Couchoud C, Vigneau C. French patients on daily hemodialysis: clinical characteristics and treatment trajectories. BMC Nephrol 2016; 17:107. [PMID: 27473376 PMCID: PMC4966797 DOI: 10.1186/s12882-016-0306-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/14/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Increasing the weekly frequency of hemodialysis sessions has positive effects, on the control of several biological data of patients. However, knowledge about Daily HemoDialysis (DHD) practices is limited in France. The aim of the present study was to describe the characteristics and treatment trajectories of all French patients undergoing DHD. METHODS All patients older than 18 years who started DHD between 2003 and 2012 in France were included and followed until December 31, 2013. The patients' demographic and clinical characteristics and treatment modalities were extracted from the French Renal Epidemiological and Information Network (REIN) registry. RESULTS During the inclusion period, 753 patients started DHD in France. Based on their median age (64 years), patients were classified in two groups: "old" group (≥64 years) and "young" group (<64 years). Patients in the old group had more comorbidities than in the young group: 48 % had diabetes (vs 29 % in the young group), 17 % an active malignancy (vs 10 %) and 80 % ≥1 cardiovascular disease (vs 41 %). Concerning patients' treatment trajectories, 496 (66 %) patients started with another dialysis before switching to DHD and 257 (34 %) directly with DHD. At the end of the follow-up, 69 % of patients in the old group were dead (27.4 % in the young group) and kidney transplantation was more frequent in the young group (30.4 % vs 0.5 %). CONCLUSION In France, DHD is proposed not only to young in rather good clinical conditions and waiting for kidney transplantation, but also to old and frail patients with higher mortality.
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Affiliation(s)
- Adélaïde Pladys
- EHESP Rennes, Sorbonne Paris Cité, Rennes, France
- Université Rennes 1, UMR CNRS 6290, Rennes, France
| | - Sahar Bayat
- EHESP Rennes, Sorbonne Paris Cité, Rennes, France
- EHESP Rennes, Sorbonne Paris Cité, EA MOS, Rennes, France
| | | | - Clémence Béchade
- CHU Caen, Service de néphrologie, Caen, France
- Université de Caen Normandie, 1086 INSERM, Caen, France
| | - Cécile Couchoud
- Registre REIN, Agence de la biomédecine, Saint Denis La Plaine, France
| | - Cécile Vigneau
- Université Rennes 1, UMR CNRS 6290, Rennes, France
- CHU Pontchaillou, Service de néphrologie, Rennes, France
| | - on behalf of the REIN registry
- EHESP Rennes, Sorbonne Paris Cité, Rennes, France
- Université Rennes 1, UMR CNRS 6290, Rennes, France
- EHESP Rennes, Sorbonne Paris Cité, EA MOS, Rennes, France
- Association AURA, Paris, France
- CHU Caen, Service de néphrologie, Caen, France
- Université de Caen Normandie, 1086 INSERM, Caen, France
- Registre REIN, Agence de la biomédecine, Saint Denis La Plaine, France
- CHU Pontchaillou, Service de néphrologie, Rennes, France
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30
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Di Lullo L, Rivera R, Barbera V, Bellasi A, Cozzolino M, Russo D, De Pascalis A, Banerjee D, Floccari F, Ronco C. Sudden cardiac death and chronic kidney disease: From pathophysiology to treatment strategies. Int J Cardiol 2016; 217:16-27. [PMID: 27174593 DOI: 10.1016/j.ijcard.2016.04.170] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 04/27/2016] [Accepted: 04/30/2016] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD) patients demonstrate higher rates of cardiovascular mortality and morbidity; and increased incidence of sudden cardiac death (SCD) with declining kidney failure. Coronary artery disease (CAD) associated risk factors are the major determinants of SCD in the general population. However, current evidence suggests that in CKD patients, traditional cardiovascular risk factors may play a lesser role. Complex relationships between CKD-specific risk factors, structural heart disease, and ventricular arrhythmias (VA) contribute to the high risk of SCD. In dialysis patients, the occurrence of VA and SCD could be exacerbated by electrolyte shifts, divalent ion abnormalities, sympathetic overactivity, inflammation and iron toxicity. As outcomes in CKD patients after cardiac arrest are poor, primary and secondary prevention of SCD and cardiac arrest could reduce cardiovascular mortality in patients with CKD.
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Affiliation(s)
- L Di Lullo
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Rome, Italy.
| | - R Rivera
- Division of Nephrology, S. Gerardo Hospital, Monza, Italy
| | - V Barbera
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Rome, Italy
| | - A Bellasi
- Department of Nephrology and Dialysis, S. Anna Hospital, Como, Italy
| | - M Cozzolino
- Department of Health Sciences, Renal Division, San Paolo Hospital, University of Milan, Italy
| | - D Russo
- Division of Nephrology, University of Naples "Federico II", Naples, Italy
| | - A De Pascalis
- Department of Nephrology and Dialysis, Vito Fazzi Hospital, Lecce, Italy
| | - D Banerjee
- Consultant Nephrologist and Reader, Clinical Sub Dean, Renal and Transplantation Unit, St George's University, London, UK
| | - F Floccari
- Department of Nephrology and Dialysis, S. Paolo Hospital, Civitavecchia, Italy
| | - C Ronco
- International Renal Research Institute, S. Bortolo Hospital, Vicenza, Italy
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31
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Slinin Y, Greer N, Ishani A, MacDonald R, Olson C, Rutks I, Wilt TJ. Timing of dialysis initiation, duration and frequency of hemodialysis sessions, and membrane flux: a systematic review for a KDOQI clinical practice guideline. Am J Kidney Dis 2016; 66:823-36. [PMID: 26498415 DOI: 10.1053/j.ajkd.2014.11.031] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/03/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND In 2006, NKF-KDOQI (National Kidney Foundation-Kidney Disease Outcomes Quality Initiative) published clinical practice guidelines for hemodialysis adequacy. Recent studies evaluating hemodialysis adequacy as determined by initiation timing, frequency, duration, and membrane type and prompted an update to the guideline. STUDY DESIGN Systematic review and evidence synthesis. SETTING & POPULATION Patients with advanced chronic kidney disease receiving hemodialysis. SELECTION CRITERIA FOR STUDIES We screened publications from 2000 to March 2014, systematic reviews, and references and consulted the NKF-KDOQI Hemodialysis Adequacy Work Group members. We included randomized or controlled clinical trials in patients undergoing long-term hemodialysis if they reported outcomes of interest. INTERVENTIONS Early versus late dialysis therapy initiation; more frequent (>3 times a week) or longer duration (>4.5 hours) compared to conventional hemodialysis; low- versus high-flux dialyzer membranes. OUTCOMES All-cause and cardiovascular mortality, myocardial infarction, stroke, hospitalizations, quality of life, depression or cognitive function scores, blood pressure, number of antihypertensive medications, left ventricular mass, interdialytic weight gain, and harms or complications related to vascular access or the process of dialysis. RESULTS We included 32 articles reporting on 19 trials. Moderate-quality evidence indicated that earlier dialysis therapy initiation (at estimated creatinine clearance [eClcr] of 10-14mL/min) did not reduce mortality compared to later initiation (eClcr of 5-7mL/min). More than thrice-weekly hemodialysis and extended-length hemodialysis during a short follow-up did not improve clinical outcomes compared to conventional hemodialysis and resulted in a greater number of vascular access procedures (very low-quality evidence). Hemodialysis using high-flux membranes did not reduce all-cause mortality, but reduced cardiovascular mortality compared to hemodialysis using low-flux membranes (moderate-quality evidence). LIMITATIONS Few studies were adequately powered to evaluate mortality. Heterogeneity of study designs and interventions precluded pooling data for most outcomes. CONCLUSIONS Limited data indicate that earlier dialysis therapy initiation and more frequent and longer hemodialysis did not improve clinical outcomes compared to conventional hemodialysis.
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Affiliation(s)
- Yelena Slinin
- Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN; Department of Medicine, University of Minnesota, Minneapolis, MN.
| | - Nancy Greer
- Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN
| | - Areef Ishani
- Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN; Department of Medicine, University of Minnesota, Minneapolis, MN
| | | | - Carin Olson
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Indulis Rutks
- Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN
| | - Timothy J Wilt
- Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN; Department of Medicine, University of Minnesota, Minneapolis, MN
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32
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Daugirdas JT, Depner TA, Inrig J, Mehrotra R, Rocco MV, Suri RS, Weiner DE, Greer N, Ishani A, MacDonald R, Olson C, Rutks I, Slinin Y, Wilt TJ, Rocco M, Kramer H, Choi MJ, Samaniego-Picota M, Scheel PJ, Willis K, Joseph J, Brereton L. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update. Am J Kidney Dis 2015; 66:884-930. [DOI: 10.1053/j.ajkd.2015.07.015] [Citation(s) in RCA: 603] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 07/31/2015] [Indexed: 12/13/2022]
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Chertow GM, Levin NW, Beck GJ, Daugirdas JT, Eggers PW, Kliger AS, Larive B, Rocco MV, Greene T. Long-Term Effects of Frequent In-Center Hemodialysis. J Am Soc Nephrol 2015; 27:1830-6. [PMID: 26467779 DOI: 10.1681/asn.2015040426] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 09/15/2015] [Indexed: 11/03/2022] Open
Abstract
The Frequent Hemodialysis Network Daily Trial randomized 245 patients to receive six (frequent) or three (conventional) in-center hemodialysis sessions per week for 12 months. As reported previously, frequent in-center hemodialysis yielded favorable effects on the coprimary composite outcomes of death or change in left ventricular mass and death or change in self-reported physical health. Here, we determined the long-term effects of the 12-month frequent in-center hemodialysis intervention. We determined the vital status of patients over a median of 3.6 years (10%-90% range, 1.5-5.3 years) after randomization. Using an intention to treat analysis, we compared the mortality hazard in randomized groups. In a subset of patients from both groups, we reassessed left ventricular mass and self-reported physical health a year or more after completion of the intervention; 20 of 125 patients (16%) randomized to frequent hemodialysis died during the combined trial and post-trial observation periods in contrast to 34 of 120 patients (28%) randomized to conventional hemodialysis. The relative mortality hazard for frequent versus conventional hemodialysis was 0.54 (95% confidence interval, 0.31 to 0.93); with censoring of time after kidney transplantation, the relative hazard was 0.56 (95% confidence interval, 0.32 to 0.99). Bayesian analysis suggested a relatively high probability of clinically significant benefit and a very low probability of harm with frequent hemodialysis. In conclusion, a 12-month frequent in-center hemodialysis intervention significantly reduced long-term mortality, suggesting that frequent hemodialysis may benefit selected patients with ESRD.
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Affiliation(s)
- Glenn M Chertow
- Department of Medicine, Stanford University, Palo Alto, California;
| | | | | | | | - Paul W Eggers
- National Institutes of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | | | | | | | - Tom Greene
- Cleveland Clinic Foundation, Cleveland, Ohio; University of Utah, Salt Lake City, Utah
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Chazot C, Farrington K, Nistor I, Van Biesen W, Joosten H, Teta D, Siriopol D, Covic A. Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients. Int Urol Nephrol 2015; 47:1809-16. [PMID: 26377489 DOI: 10.1007/s11255-015-1107-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 12/11/2022]
Abstract
In the last decade, an increasing number of patients over 75 years of age are starting renal replacement therapy. Frailty is highly prevalent in elderly patients with end-stage renal disease (ESRD) in the context of the increased prevalence of some ESRD-associated conditions: protein-energy wasting, inflammation, anaemia, acidosis or hormonal disturbances. There are currently no hard data to support guidance on the optimal duration of dialysis for frail/elderly ESRD patients. The current debate is not about starting dialysis or managing conservatory frail ESRD patients, but whether a more intensive regimen once dialysis is initiated (for whatever reasons and circumstances) would improve patients' outcome. The most important issue is that all studies performed with extended/alternative dialysis regimens do not specifically address this particular type of patients and therefore all the inferences are derived from the general ESRD population. Care planning should be responsive to end-of-life needs whatever the treatment modality. Care in this setting should focus on symptom control and quality of life rather than life extension. We conclude that, similar to the general dialysed population, extensive application of more intensive dialysis schedules is not based on solid evidence. However, after a thorough clinical evaluation, a limited period of a trial of intensive dialysis could be prescribed in more problematic patients.
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Affiliation(s)
| | - Ken Farrington
- Renal Unit, Lister Hospital, Stevenage, Hertfordshire, UK
- Postgraduate Medical School, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Ionut Nistor
- ERBP, Ghent University Hospital, Ghent, Belgium
- Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Wim Van Biesen
- ERBP, Ghent University Hospital, Ghent, Belgium
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Hanneke Joosten
- Department of Internal Medicine, UMCG, Groningen, The Netherlands
| | - Daniel Teta
- Service of Nephrology, Department of Medicine, University Hospital Lausanne, Lausanne, Switzerland
| | - Dimitrie Siriopol
- Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Adrian Covic
- Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.
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Abstract
The control of serum phosphorus by dialysis is made difficult by the fact that intradialytic blood levels tend to be low, and because phosphorus is removed almost exclusively from the plasma during its passage through the dialyzer. The most practical way to increase phosphorus removal is to extend dialysis time, although attention to dialysis efficiency (surface area, advanced membrane, and higher blood and dialysate flow rates) also plays a role. Benefits of hemodiafiltration in helping control serum phosphorus have been claimed, but not found in all studies. Because serum phosphorus levels tend to plateau during the later parts of a dialysis session, extending weekly dialysis time is of greater benefit for phosphorus removal than for urea removal. Increasing dialysis frequency also probably has a small benefit. It appears that 18-30 hours of dialysis per week are required to obviate the need for phosphorus binders. Several promising models of phosphorus kinetics are under development. These may help predict the change in treatment on serum phosphorus levels, but their ability to do so has not yet been critically assessed.
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Affiliation(s)
- John T Daugirdas
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
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36
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Chiu DYY, Sinha S, Kalra PA, Green D. Sudden cardiac death in haemodialysis patients: preventative options. Nephrology (Carlton) 2015; 19:740-9. [PMID: 25231407 DOI: 10.1111/nep.12337] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2014] [Indexed: 01/26/2023]
Abstract
Sudden cardiac death (SCD) is the most common cause of death in haemodialysis patients, accounting for 25% of all-cause mortality. There are many potential pathological precipitants as most patients with end-stage renal disease have structurally or functionally abnormal hearts. For example, at initiation of dialysis, 74% of patients have left ventricular hypertrophy. The pathophysiological and metabolic milieu of patients with end-stage renal disease, allied to the regular stresses of dialysis, may provide the trigger to a fatal cardiac event. Prevention of SCD can be seen as a legitimate target to improve survival in this patient group. In the general population, this is most effective by reducing the burden of ischaemic heart disease. However, the aetiology of SCD in haemodialysis patients appears to be different, with myocardial fibrosis, vascular calcification and autonomic dysfunction implicated as possible causes. Thus, the range of therapies is different to the general population. There are potential preventative measures emerging as our understanding of the underlying mechanisms progresses. This article aims to review the evidence for therapies to prevent SCD effective in the general population when applied to dialysis patients, as well as promising new treatments specific to this population group.
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Affiliation(s)
- Diana Yuan Yng Chiu
- Vascular Research Group, Manchester Academic Health Sciences Centre, Institute of Population Health, The University of Manchester, Manchester, UK; Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
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37
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Lockridge R, Cornelis T, Van Eps C. Prescriptions for home hemodialysis. Hemodial Int 2015; 19 Suppl 1:S112-27. [DOI: 10.1111/hdi.12279] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Tom Cornelis
- Department of Internal Medicine; Division of Nephrology; Maastricht University Medical Center; Maastricht The Netherlands
| | - Carolyn Van Eps
- Princess Alexandra Hospital; Brisbane New South Wales Australia
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38
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Kotanko P, Garg AX, Depner T, Pierratos A, Chan CT, Levin NW, Greene T, Larive B, Beck GJ, Gassman J, Kliger AS, Stokes JB. Effects of frequent hemodialysis on blood pressure: Results from the randomized frequent hemodialysis network trials. Hemodial Int 2015; 19:386-401. [PMID: 25560227 DOI: 10.1111/hdi.12255] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hypertension is a common complication of chronic kidney disease and persists among most patients with end-stage renal disease despite the provision of conventional thrice weekly hemodialysis (HD). We analyzed the effects of frequent HD on blood pressure in the randomized controlled Frequent Hemodialysis Network trials. The daily trial randomized 245 patients to 12 months of 6× ("frequent") vs. 3× ("conventional") weekly in-center hemodialysis; the nocturnal trial randomized 87 patients to 12 months of 6× weekly nocturnal HD vs. 3× weekly predominantly home-based hemodialysis. In the daily trial, compared with 3× weekly HD, 2 months of frequent HD lowered predialysis systolic blood pressure by -7.7 mmHg [95% confidence interval (CI): -11.9 to -3.5] and diastolic blood pressure by -3.9 mmHg [95% CI: -6.5 to -1.3]. In the nocturnal trial, compared with 3× weekly HD, 2 months of frequent HD lowered systolic blood pressure by -7.3 mmHg [95% CI: -14.2 to -0.3] and diastolic blood pressure by -4.2 mmHg [95% CI: -8.3 to -0.1]. In both trials, blood pressure treatment effects were sustained until month 12. Frequent HD resulted in significantly fewer antihypertensive medications (daily: -0.36 medications [95% CI: -0.65 to -0.08]; nocturnal: -0.44 mediations [95% CI: -0.89 to -0.03]). In the daily trial, the relative risk per dialysis session for intradialytic hypotension was lower with 6×/week HD but given the higher number of sessions per week, there was a higher relative risk for intradialytic hypotensive requiring saline administration. In summary, frequent HD reduces blood pressure and the number of prescribed antihypertensive medications.
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Affiliation(s)
- Peter Kotanko
- Renal Research Institute, New York City, New York, USA
| | - Amit X Garg
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Western University, London, Ontario, Canada
| | - Tom Depner
- Davis Medical Center, University of California Davis, Sacramento, California, USA
| | - Andreas Pierratos
- Humber River Regional Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christopher T Chan
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Tom Greene
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA.,Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Brett Larive
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Gerald J Beck
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jennifer Gassman
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Alan S Kliger
- Department of Medicine, Hospital of Saint Raphael, Yale University School of Medicine, New Haven, Connecticut, USA
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39
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Weinhandl ED, Nieman KM, Gilbertson DT, Collins AJ. Hospitalization in Daily Home Hemodialysis and Matched Thrice-Weekly In-Center Hemodialysis Patients. Am J Kidney Dis 2015; 65:98-108. [DOI: 10.1053/j.ajkd.2014.06.015] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 06/09/2014] [Indexed: 11/11/2022]
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40
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Labriola L, Morelle J, Jadoul M. Con: Frequent haemodialysis for all chronic haemodialysis patients. Nephrol Dial Transplant 2014; 30:23-7. [PMID: 25538159 DOI: 10.1093/ndt/gfu382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Frequent haemodialysis (HD) regimens have been proposed with the aim to improve survival and other important patient outcomes. They indeed avoid the long interdialytic interval and have been associated with some proven benefits, i.e. an improvement in blood pressure and phosphataemia control, a reduction in left ventricular mass and lower ultrafiltration rates. However, the actual impact of frequent HD regimens on survival is, at best, inconclusive and, at worse, harmful, and remains uncertain regarding nutritional status and anaemia control. Moreover, the higher rates of vascular access complications and more rapid development of anuria with frequent HD regimens are worrying. Frequent HD also considerably increases the burden for patients and their caregivers, logistics and costs, especially with in-centre frequent schedules. In our opinion, before increasing HD frequency, a number of underused strategies summarized in our review and able to improve patient tolerance and/or HD dose should be tested first, taking into account patient's characteristics and life expectancy. Frequent HD schedules should be reserved for selected cases, only after all other available options have failed.
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Affiliation(s)
- Laura Labriola
- Department of Nephrology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Johann Morelle
- Department of Nephrology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Michel Jadoul
- Department of Nephrology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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41
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Palmer SC, Palmer AR, Craig JC, Johnson DW, Stroumza P, Frantzen L, Leal M, Hoischen S, Hegbrant J, Strippoli GFM. Home versus in-centre haemodialysis for end-stage kidney disease. Cochrane Database Syst Rev 2014; 2014:CD009535. [PMID: 25412074 PMCID: PMC7390476 DOI: 10.1002/14651858.cd009535.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Home haemodialysis is associated with improved survival and quality of life in uncontrolled studies. However, relative benefits and harms of home versus in-centre haemodialysis in randomised controlled trials (RCTs) are uncertain. OBJECTIVES To evaluate the benefits and harms of home haemodialysis versus in-centre haemodialysis in adults with end-stage kidney disease (ESKD). SEARCH METHODS The Cochrane Renal Group's Specialised Register was searched up to 31 October 2014. SELECTION CRITERIA RCTs of home versus in-centre haemodialysis in adults with ESKD were included. DATA COLLECTION AND ANALYSIS Data were extracted by two investigators independently. Study risk of bias and other patient-centred outcomes were extracted. Insufficient data were available to conduct meta-analyses. MAIN RESULTS We identified a single cross-over RCT (enrolling 9 participants) that compared home haemodialysis (long hours: 6 to 8 hours, 3 times/week) with in-centre haemodialysis (short hours: 3.5 to 4.5 hours, 3 times/weeks) for 8 weeks in prevalent home haemodialysis patients. Outcome data were limited and not available for the end of the first phase of treatment in this cross-over study which was at risk of bias due to differences in dialysate composition between the two treatment comparisons.Overall, home haemodialysis reduced 24 hour ambulatory blood pressure and improved uraemic symptoms, but increased treatment-related burden of disease and interference in social activities. Insufficient data were available for mortality, hospitalisation or dialysis vascular access complications or treatment durability. AUTHORS' CONCLUSIONS Insufficient randomised data were available to determine the effects of home haemodialysis on survival, hospitalisation, and quality of life compared with in-centre haemodialysis. Given the consistently observed benefits of home haemodialysis on quality of life and survival in uncontrolled studies, and the low prevalence of home haemodialysis globally, randomised studies evaluating home haemodialysis would help inform clinical practice and policy.
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Affiliation(s)
- Suetonia C Palmer
- University of Otago ChristchurchDepartment of Medicine2 Riccarton AvePO Box 4345ChristchurchNew Zealand8140
| | - Andrew R Palmer
- Consorzio Mario Negri SudDepartment of Clinical Pharmacology and EpidemiologyVia Nationale 8/aMaria ImbaroItaly66030
| | - Jonathan C Craig
- The University of SydneySydney School of Public HealthEdward Ford Building A27SydneyNSWAustralia2006
- The Children's Hospital at WestmeadCochrane Renal Group, Centre for Kidney ResearchWestmeadNSWAustralia2145
| | - David W Johnson
- Princess Alexandra HospitalDepartment of NephrologyIpswich RdWoolloongabbaQueenslandAustralia4102
| | - Paul Stroumza
- Diaverum MarseilleMedical OfficeRue Gaston BergerMarseilleFrance13010
| | - Luc Frantzen
- Diaverum MarseilleMedical OfficeRue Gaston BergerMarseilleFrance13010
| | - Miguel Leal
- Diaverum PortugalMedical OfficeSintra Business Park, Zona Industrial da AbrunheiraEdificio 4 ‐ Escritorio 2CSintraPortugal2710‐089
| | | | - Jorgen Hegbrant
- Diaverum Renal Services GroupMedical OfficePO Box 4167LundSwedenSE‐227 22
| | - Giovanni FM Strippoli
- The University of SydneySydney School of Public HealthEdward Ford Building A27SydneyNSWAustralia2006
- Mario Negri Sud ConsortiumDepartment of Clinical Pharmacology and EpidemiologySanta Maria ImbaroItaly
- DiaverumMedical‐Scientific OfficeLundSweden
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42
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Watanabe Y, Ohno Y, Inoue T, Takane H, Okada H, Suzuki H. Home hemodialysis and conventional in-center hemodialysis in Japan: A comparison of health-related quality of life. Hemodial Int 2014; 18 Suppl 1:S32-8. [DOI: 10.1111/hdi.12221] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yusuke Watanabe
- Department of Nephrology; Saitama Medical University; Saitama Japan
| | - Yoichi Ohno
- Department of Nephrology; Saitama Medical University; Saitama Japan
| | - Tsutomu Inoue
- Department of Nephrology; Saitama Medical University; Saitama Japan
| | - Hiroshi Takane
- Department of Nephrology; Saitama Medical University; Saitama Japan
| | - Hirokazu Okada
- Department of Nephrology; Saitama Medical University; Saitama Japan
| | - Hiromichi Suzuki
- Department of Nephrology; Saitama Medical University; Saitama Japan
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Pauly RP, Komenda P, Chan CT, Copland M, Gangji A, Hirsch D, Lindsay R, MacKinnon M, MacRae JM, McFarlane P, Nesrallah G, Pierratos A, Plaisance M, Reintjes F, Rioux JP, Shik J, Steele A, Stryker R, Wu G, Zimmerman DL. Programmatic variation in home hemodialysis in Canada: results from a nationwide survey of practice patterns. Can J Kidney Health Dis 2014; 1:11. [PMID: 25780606 PMCID: PMC4349311 DOI: 10.1186/2054-3581-1-11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/07/2014] [Indexed: 11/18/2022] Open
Abstract
Background Over 40% of patients with end stage renal disease in the United States were treated with home hemodialysis (HHD) in the early 1970’s. However, this number declined rapidly over the ensuing decades so that the overwhelming majority of patients were treated in-centre 3 times per week on a 3-4 hour schedule. Poor outcomes for patients treated in this fashion led to a renewed interest in home hemodialysis, with more intensive dialysis schedules including short daily (SDHD) and nocturnal (NHD). The relative infancy of these treatment schedules means that there is a paucity of data on ‘how to do it’. Objective We undertook a systematic survey of home hemodialysis programs in Canada to describe current practice patterns. Design Development and deployment of a qualitative survey instrument. Setting Community and academic HHD programs in Canada. Participants Physicians, nurses and technologists. Measurements Programmatic approaches to patient selection, delivery of dialysis, human resources available, and follow up. Methods We developed the survey instrument in three phases. A focus group of Canadian nephrologists with expertise in NHD or SDHD discussed the scope the study and wrote questions on 11 domains. Three nephrologists familiar with all aspects of HHD delivery reviewed this for content validity, followed by further feedback from the whole group. Multidisciplinary teams at three sites pretested the survey and further suggestions were incorporated. In July 2010 we distributed the survey electronically to all renal programs known to offer HHD according to the Canadian Organ Replacement Registry. We compiled the survey results using qualitative and quantitative methods, as appropriate. Results Of the academic and community programs that were invited to participate, 80% and 63%, respectively, completed the survey. We observed wide variation in programmatic approaches to patient recruitment, human resources, equipment, water, vascular access, patient training, dialysis prescription, home requirements, patient follow up, medications, and the approach to non-adherent patients. Limitations Cross-sectional survey, unable to link variation to outcomes. Competition for patients between HHD and home peritoneal dialysis means that case mix for HHD may also vary between centres. Conclusions There is wide variation between programs in all domains of HHD delivery in Canada. We plan further study of the extent to which differences in approach are related to outcomes. Electronic supplementary material The online version of this article (doi:10.1186/2054-3581-1-11) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Robert P Pauly
- Department of Medicine, Division of Nephrology, Northern Alberta Renal Program and the University of Alberta Hospital, University of Alberta, Edmonton, AB Canada
| | - Paul Komenda
- Department of Medicine, Section of Nephrology, University of Manitoba, Winnipeg, MB Canada
| | | | - Michael Copland
- Division of Nephrology, University of British Columbia, Vancouver General Hospital, Vancouver, BC Canada
| | - Azim Gangji
- Department of Medicine, Division of Nephrology, McMaster University, Hamilton, ON Canada
| | - David Hirsch
- Department of Medicine, Division of Nephrology, Dalhousie University, Halifax, NS Canada
| | - Robert Lindsay
- Director Home Hemodialysis, London Health Sciences Centre, Western University, London, ON Canada
| | - Martin MacKinnon
- Division of Nephrology, Horizon Heath, St John Regional Hospital, St John, NB Canada
| | - Jennifer M MacRae
- Department of Medicine and Department of Cardiac Sciences, Division of Nephrology, Southern Alberta Renal Program, University of Calgary, Calgary, AB Canada
| | - Philip McFarlane
- Department of Medicine, Division of Nephrology, St Michaels Hospital, Toronto, ON Canada
| | - Gihad Nesrallah
- The Li Ka Shing Knowledge Institute, Keenan Research Centre, St Michael's Hospital, and Nephrology Program, Humber River Hospital, Toronto, ON Canada
| | | | - Martin Plaisance
- Departement de Medecine, Service de Nephrologie, Centre Hospitalier Universitaire de Sherbrooke, Universite de Sherbrooke, Sherbrooke, QC Canada
| | - Frances Reintjes
- Department of Medicine, Division of Nephrology, Northern Alberta Renal Program and the University of Alberta Hospital, University of Alberta, Edmonton, AB Canada
| | - Jean-Philippe Rioux
- Department of Medicine, Division of Nephrology, Hopital du Sacre-Coeur de Montreal, University of Montreal, Montreal, QC Canada
| | - John Shik
- Department of Medicine, Division of Nephrology, Health Science Centre, Memorial University of Newfoundland, St Johns, Newfoundland Canada
| | - Andrew Steele
- Division of Nephrology, Lakeridge Health, Oshawa, ON Canada
| | - Rod Stryker
- Department of Medicine, Division of Nephrology, University of Saskachewan, Saskatoon, Saskatchewan Canada
| | - George Wu
- Division of Nephrology, Trillium Health Partners, Mississauga, ON Canada
| | - Deborah L Zimmerman
- Department of Medicine, Division of Nephrology, Ottawa Hospital and the University of Ottawa, Ottawa, ON Canada
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Suri RS, Larive B, Hall Y, Kimmel PL, Kliger AS, Levin N, Kurella Tamura M, Chertow GM. Effects of frequent hemodialysis on perceived caregiver burden in the Frequent Hemodialysis Network trials. Clin J Am Soc Nephrol 2014; 9:936-42. [PMID: 24721892 PMCID: PMC4011443 DOI: 10.2215/cjn.07170713] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 01/28/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients receiving hemodialysis often perceive their caregivers are overburdened. We hypothesize that increasing hemodialysis frequency would result in higher patient perceptions of burden on their unpaid caregivers. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In two separate trials, 245 patients were randomized to receive in-center daily hemodialysis (6 days/week) or conventional hemodialysis (3 days/week) while 87 patients were randomized to receive home nocturnal hemodialysis (6 nights/week) or home conventional hemodialysis for 12 months. Changes in overall mean scores over time in the 10-question Cousineau perceived burden scale were compared. RESULTS In total, 173 of 245 (70%) and 80 of 87 (92%) randomized patients in the Daily and Nocturnal Trials, respectively, reported having an unpaid caregiver at baseline or during follow-up. Relative to in-center conventional dialysis, the 12-month change in mean perceived burden score with in-center daily hemodialysis was -2.1 (95% confidence interval, -9.4 to +5.3; P=0.58). Relative to home conventional dialysis, the 12-month change in mean perceived burden score with home nocturnal dialysis was +6.1 (95% confidence interval, -0.8 to +13.1; P=0.08). After multiple imputation for missing data in the Nocturnal Trial, the relative difference between home nocturnal and home conventional hemodialysis was +9.4 (95% confidence interval, +0.55 to +18.3; P=0.04). In the Nocturnal Trial, changes in perceived burden were inversely correlated with adherence to dialysis treatments (Pearson r=-0.35; P=0.02). CONCLUSION Relative to conventional hemodialysis, in-center daily hemodialysis did not result in higher perceptions of caregiver burden. There was a trend to higher perceived caregiver burden among patients randomized to home nocturnal hemodialysis. These findings may have implications for the adoption of and adherence to frequent nocturnal hemodialysis.
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Affiliation(s)
- Rita S Suri
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Leypoldt JK, Agar BU, Culleton BF. Simplified phosphorus kinetic modeling: predicting changes in predialysis serum phosphorus concentration after altering the hemodialysis prescription. Nephrol Dial Transplant 2014; 29:1423-9. [DOI: 10.1093/ndt/gfu032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Wong B, Zimmerman D, Reintjes F, Courtney M, Klarenbach S, Dowling G, Pauly RP. Procedure-Related Serious Adverse Events Among Home Hemodialysis Patients: A Quality Assurance Perspective. Am J Kidney Dis 2014; 63:251-8. [DOI: 10.1053/j.ajkd.2013.07.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 07/03/2013] [Indexed: 11/11/2022]
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47
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Woo KT, Choong HL, Foo MW, Tan HK, Wong KS, Chan CM. Survival with daily hemodialysis. Kidney Int 2014; 85:478-9. [DOI: 10.1038/ki.2013.483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Waniewski J, Debowska M, Lindholm B. Are dialysis adequacy indices independent of solute generation rate? ASAIO J 2013; 60:90-4. [PMID: 24322716 DOI: 10.1097/mat.0000000000000017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
KT/V is by definition independent of solute generation rate. Alternative dialysis adequacy indices (DAIs) such as equivalent renal clearance (EKR), standard KT/V (stdKT/V), and solute removal index (SRI) are estimated as the ratio of solute mass removed to an average solute mass in the body or solute concentration in blood; both nominator and denominator in these formulas depend on the solute generation rate. Our objective was to investigate whether and under which conditions the alternative DAIs are independent of solute generation rate. By using general compartment modeling, we show that for the metabolically stable patient (in whom the solute generated during the dialysis cycle, typically, 1 week, is equal to the solute removed from the body), DAIs estimated for the dialysis cycle are in general independent of the average solute generation rate (although they may depend on the pattern of oscillations in the generation rate). However, the alternative adequacy parameters (such as EKR, stdKT/V, and SRI) may depend on solute generation rate for metabolically unstable patients.
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Affiliation(s)
- Jacek Waniewski
- From the *Department for Mathematical Modelling of Physiological Processes, Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland; and †Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Zaritsky J, Rastogi A, Fischmann G, Yan J, Kleinman K, Chow G, Gales B, Salusky IB, Wesseling-Perry K. Short daily hemodialysis is associated with lower plasma FGF23 levels when compared with conventional hemodialysis. Nephrol Dial Transplant 2013; 29:437-41. [PMID: 24009282 DOI: 10.1093/ndt/gft382] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The utilization of short-term daily hemodialysis has increased over the last few years, but little is known on its effects on the control of serum phosphate and fibroblast growth factor 23 (FGF23) levels. METHODS We therefore performed a cross-sectional study to compare FGF23 levels as well as other biochemical variables between 24 patients undergoing short daily hemodialysis using the NxStage System® and 54 patients treated with conventional in-center hemodialysis. FGF23 levels were measured using the second-generation Immutopics® C-terminal assay. RESULTS Short daily hemodialysis patients were younger than patients on conventional hemodialysis but there were no differences between groups in the duration of end-stage renal disease nor in the number of patients with residual renal function. A greater number of short daily hemodialysis patients received vitamin D sterol therapy than did conventional in-center hemodialysis patients while there were no differences in the use of different phosphate binders and calcimimetic therapy between groups. Overall serum calcium, phosphorus and intact parathyroid hormone levels were similar between groups. While serum phosphorus levels correlated with FGF23 concentrations in each group separately [r=0.522 (P<0.01) and r=0.42 (P<0.01) in short daily and conventional in-center hemodialysis, respectively], FGF23 levels were lower [823 RU/mL (263, 2169)] in the patients receiving short daily hemodialysis than in patients treated with conventional hemodialysis [2521 RU/mL (909, 5556)] (P<0.01 between groups). CONCLUSIONS These findings demonstrate that FGF23 levels are significantly lower in short daily hemodialysis patients and suggest that FGF23 levels may be a more sensitive biomarker of cumulative phosphate burden than single or multiple serum phosphorus determinations in patients treated with hemodialysis.
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Affiliation(s)
- Joshua Zaritsky
- Department of Pediatrics at Nemours/A.I. duPont Hospital for Children, Wilmington, DE, USA
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Schachter ME, Chan CT. Current state of intensive hemodialysis: a comparative review of benefits and barriers. Nephrol Dial Transplant 2013; 27:4307-13. [PMID: 23235954 DOI: 10.1093/ndt/gfs506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The current interest in intensive hemodialysis (HD) was born out of the impasse in an effort to improve survival and quality of life (QOL) in patients with end-stage renal disease. In this review, we have summarized the emerging data of intensive HD on (i) survival, (ii) cardiovascular outcomes, (iii) phosphate balance and (iv) QOL. Although there is a consistent and compelling signal favoring intensive HD, it is important to balance the enthusiasm with the significant amount of perceived and actual barriers for our patients to overcome to receive or perform intensive HD. For an individual patient, the answer to the question 'What is the best form of intensive hemodialysis?' should be a consideration between the benefits sought and the obstacles in attaining intensive HD. In the future, changes in dialysis technology, healthcare delivery and education strategy are needed to allow the majority of patients to receive optimal renal replacement therapy.
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Affiliation(s)
- Michael E Schachter
- Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, Canada
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