1
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El Shamy O, Abra G, Chan C. Patient-Centered Home Hemodialysis: Approaches and Prescription. Clin J Am Soc Nephrol 2024; 19:517-524. [PMID: 37639246 PMCID: PMC11020435 DOI: 10.2215/cjn.0000000000000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/15/2023] [Indexed: 08/29/2023]
Abstract
Writing a home hemodialysis (HD) prescription is a complex, multifactorial process that requires the incorporation of patient values, preferences, and lifestyle. Knowledge of the different options available for home HD modality (conventional, nocturnal, short daily, and alternate nightly) is also important when customizing a prescription. Finally, an understanding of the different home HD machines currently approved for use at home and their different attributes and limitations helps guide providers when formulating their prescriptions. In this review article, we set out to address these different aspects to help guide providers in providing a patient-centered home HD approach.
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Affiliation(s)
- Osama El Shamy
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Graham Abra
- Satellite Healthcare, San Jose, California
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Christopher Chan
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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2
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Anwaar A, Liu S, Montez-Rath M, Neilsen H, Sun S, Abra G, Schiller B, Hussein WF. Predicting transfer to haemodialysis using the peritoneal dialysis surprise question. Perit Dial Int 2024; 44:16-26. [PMID: 38017608 DOI: 10.1177/08968608231214143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND People on peritoneal dialysis (PD) at risk of transfer to haemodialysis (HD) need support to remain on PD or ensure a safe transition to HD. Simple point-of-care risk stratification tools are needed to direct limited dialysis centre resources. In this study, we evaluated the utility of collecting clinicians' identification of patients at high risk of transfer to HD using a single point of care question. METHODS In this prospective observational study, we included 1275 patients undergoing PD in 35 home dialysis programmes. We modified the palliative care 'surprise question' (SQ) by asking the registered nurse and treating nephrologist: 'Would you be surprised if this patient transferred to HD in the next six months?' A 'yes' or 'no' answer indicated low and high risk, respectively. We subsequently followed patient outcomes for 6 months. Cox regression model estimated the hazard ratio (HR) of transfer to HD. RESULTS Patients' mean age was 59 ± 16 years, 41% were female and the median PD vintage was 20 months (interquartile range: 9-40). Responses were received from nurses for 1123 patients, indicating 169 (15%) as high risk and 954 (85%) as low risk. Over the next 6 months, transfer to HD occurred in 18 (11%) versus 29 (3%) of the high and low-risk groups, respectively (HR: 3.92, 95% confidence interval (CI): 2.17-7.05). Nephrologist responses were obtained for 692 patients, with 118 (17%) and 574 (83%) identified as high and low risk, respectively. Transfer to HD was observed in 14 (12%) of the high-risk group and 14 (2%) of the low-risk group (HR: 5.56, 95% CI: 2.65-11.67). Patients in the high-risk group experienced higher rates of death and hospitalisation than low-risk patients, with peritonitis events being similar between the two groups. CONCLUSIONS The PDSQ is a simple point of care tool that can help identify patients at high risk of transfer to HD and other poor clinical outcomes.
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Affiliation(s)
- Ayesha Anwaar
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
- Satellite Healthcare, San Jose, CA, USA
| | - Sai Liu
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Maria Montez-Rath
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Sumi Sun
- Satellite Healthcare, San Jose, CA, USA
| | - Graham Abra
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
- Satellite Healthcare, San Jose, CA, USA
| | - Brigitte Schiller
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
- Satellite Healthcare, San Jose, CA, USA
| | - Wael F Hussein
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
- Satellite Healthcare, San Jose, CA, USA
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3
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Aga Z, McCullough K, Pisoni RL, Zhao J, Fukasawa M, Oh KH, Wilson S, Abra G, Gupta N, Kanjanabuch T, Figueiredo AE, Perl J. Peritoneal Dialysis-Related Drain Pain and Patient and Treatment Characteristics: Findings From the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Am J Kidney Dis 2023; 82:779-782. [PMID: 37393052 DOI: 10.1053/j.ajkd.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/11/2023] [Indexed: 07/03/2023]
Affiliation(s)
- Zeenia Aga
- Division of Nephrology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Ronald L Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | | | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Scott Wilson
- Department of Renal Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Graham Abra
- Division of Nephrology, Department of Medicine, Stanford University, Stanford, California; Satellite Healthcare, San Jose, California
| | - Nupur Gupta
- Division of Nephrology, Department of Medicine, Indiana University, Indianapolis, Indiana
| | - Talerngsak Kanjanabuch
- Center of Excellence in Kidney Metabolic Disorders and Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ana Elizabeth Figueiredo
- School of Health Sciences and Life - Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jeffrey Perl
- Division of Nephrology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
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4
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Hussein WF, Bennett PN, Anwaar A, Atwal J, Legg V, Abra G, Zheng S, Pravoverov L, Schiller B. Implementation of a Staff-Assisted Peritoneal Dialysis Program in the United States: A Feasibility Study. Clin J Am Soc Nephrol 2022; 17:703-705. [PMID: 35383044 PMCID: PMC9269586 DOI: 10.2215/cjn.00940122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Wael F Hussein
- Medical Clinical Affairs, Satellite Healthcare, San Jose, California .,Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Paul N Bennett
- Medical Clinical Affairs, Satellite Healthcare, San Jose, California.,Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Ayesha Anwaar
- Medical Clinical Affairs, Satellite Healthcare, San Jose, California.,Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Jugjeet Atwal
- Medical Clinical Affairs, Satellite Healthcare, San Jose, California
| | - Veronica Legg
- Medical Clinical Affairs, Satellite Healthcare, San Jose, California
| | - Graham Abra
- Medical Clinical Affairs, Satellite Healthcare, San Jose, California.,Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Sijie Zheng
- Department of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Leo Pravoverov
- Department of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Brigitte Schiller
- Medical Clinical Affairs, Satellite Healthcare, San Jose, California.,Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
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5
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Abra G, Poyan Mehr A, Chan CT, Schiller B. The Implementation of a Virtual Home Dialysis Mentoring Program for Nephrologists. Kidney360 2022; 3:734-736. [PMID: 35721601 PMCID: PMC9136906 DOI: 10.34067/kid.0000202022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/25/2022] [Indexed: 06/15/2023]
Abstract
Virtual home dialysis physician mentorship is feasible.In total, 53% of participants perceived the program would change the perspective of participants on prescribing home dialysis.More research is needed to ascertain the effect of virtual mentorship on home dialysis incidence and attrition rates in a wider audience.
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Affiliation(s)
- Graham Abra
- Satellite Healthcare, San Jose, California
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Ali Poyan Mehr
- Department of Nephrology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | | | - Brigitte Schiller
- Satellite Healthcare, San Jose, California
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
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6
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Garcia P, Han J, Montez-Rath M, Sun S, Shang T, Parsonnet J, Chertow G, Anand S, Schiller B, Abra G. SARS-CoV-2 Booster Vaccine Response among Patients Receiving Dialysis. Clin J Am Soc Nephrol 2022; 17:1036-1038. [PMID: 35383042 PMCID: PMC9269633 DOI: 10.2215/cjn.00890122] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Pablo Garcia
- P Garcia, Department of Medicine (Nephrology), Stanford University, Stanford, United States
| | - Jialin Han
- J Han, Department of Medicine (Nephrology), Stanford University, Stanford, United States
| | - Maria Montez-Rath
- M Montez-Rath, Department of Medicine (Nephrology), Stanford University, Stanford, United States
| | - Sumi Sun
- S Sun, Satellite Healthcare, San Jose, United States
| | - Tiffany Shang
- T Shang, Satellite Healthcare, San Jose, United States
| | - Julie Parsonnet
- J Parsonnet, Departments of Medicine (Infectious Diseases and Geographic Medicine), and Epidemiology and Population Health, Stanford University, Stanford, United States
| | - Glenn Chertow
- G Chertow, Departments of Medicine (Nephrology), and Epidemiology and Population Health, Stanford Medicine, Stanford, United States
| | - Shuchi Anand
- S Anand, Department of Medicine (Nephrology), Stanford University, Stanford, United States
| | - Brigitte Schiller
- B Schiller, Department of Medicine (Nephrology), Stanford Medicine, Stanford, United States
| | - Graham Abra
- G Abra, Department of Medicine (Nephrology), Stanford University, Stanford, United States
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7
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Garcia P, Anand S, Han J, Montez-Rath ME, Sun S, Shang T, Parsonnet J, Chertow GM, Schiller B, Abra G. COVID-19 Vaccine Type and Humoral Immune Response in Patients Receiving Dialysis. J Am Soc Nephrol 2022; 33:33-37. [PMID: 34645698 PMCID: PMC8763174 DOI: 10.1681/asn.2021070936] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Pablo Garcia
- Department of Medicine (Nephrology), Stanford University, Stanford, California
| | - Shuchi Anand
- Department of Medicine (Nephrology), Stanford University, Stanford, California
| | - Jialin Han
- Department of Medicine (Nephrology), Stanford University, Stanford, California
| | | | - Sumi Sun
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California
| | - Tiffany Shang
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California
| | - Julie Parsonnet
- Department of Medicine (Infectious Diseases and Geographic Medicine), Stanford University, Stanford, California
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Glenn M. Chertow
- Department of Medicine (Nephrology), Stanford University, Stanford, California
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Brigitte Schiller
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California
| | - Graham Abra
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California
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8
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Carr EJ, Kronbichler A, Graham-Brown M, Abra G, Argyropoulos C, Harper L, Lerma EV, Suri RS, Topf J, Willicombe M, Hiremath S. Review of Early Immune Response to SARS-CoV-2 Vaccination Among Patients With CKD. Kidney Int Rep 2021; 6:2292-2304. [PMID: 34250319 PMCID: PMC8257418 DOI: 10.1016/j.ekir.2021.06.027] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/07/2021] [Accepted: 06/21/2021] [Indexed: 02/07/2023] Open
Abstract
The effects of the coronavirus disease-2019 (COVID-19) pandemic, particularly among those with chronic kidney disease (CKD), who commonly have defects in humoral and cellular immunity, and the efficacy of vaccinations against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are uncertain. To inform public health and clinical practice, we synthesized published studies and preprints evaluating surrogate measures of immunity after SARS-CoV-2 vaccination in patients with CKD, including those receiving dialysis or with a kidney transplant. We found 35 studies (28 published, 7 preprints), with sample sizes ranging from 23 to 1140 participants and follow-up ranging from 1 week to 1 month after vaccination. Seventeen of these studies enrolled a control group. In the 22 studies of patients receiving dialysis, the development of antibodies was observed in 18% to 53% after 1 dose and in 70% to 96% after 2 doses of mRNA vaccine. In the 14 studies of transplant recipients, 3% to 59% mounted detectable humoral or cellular responses after 2 doses of mRNA vaccine. After vaccination, there were a few reported cases of relapse or de novo glomerulonephritis, and acute transplant rejection, suggesting a need for ongoing surveillance. Studies are needed to better evaluate the effectiveness of SARS-CoV-2 vaccination in these populations. Rigorous surveillance is necessary for detection of long-term adverse effects in patients with autoimmune disease and transplant recipients. For transplant recipients and those with suboptimal immune responses, alternate vaccination platforms and strategies should be considered. As additional data arise, the NephJC COVID-19 page will continue to be updated (http://www.nephjc.com/news/covid-vaccine).
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Affiliation(s)
| | | | | | - Graham Abra
- Satellite Healthcare, San Jose, California, USA
- Division of Nephrology, Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Christos Argyropoulos
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Lorraine Harper
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Edgar V. Lerma
- Section of Nephrology, University of Illinois at Chicago/Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Rita S. Suri
- Research Institute, University Health Center, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Joel Topf
- Department of Medicine, Oakland University William Beaumont School of Medicine, Detroit, Michigan, USA
| | | | - Swapnil Hiremath
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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9
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Hussein WF, Bennett PN, Abra G, Watson E, Schiller B. Integrating Patient Activation Into Dialysis Care. Am J Kidney Dis 2021; 79:105-112. [PMID: 34461165 DOI: 10.1053/j.ajkd.2021.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/17/2021] [Indexed: 11/11/2022]
Abstract
Patient activation, the measure of patients' readiness and willingness to manage their own health care, is low among people receiving in-center hemodialysis, which is exacerbated because such centers are commonly set up for patients to passively receive care. In our pursuit of person-centered care and value-based medicine, enabling patients to take a more active role in their care can lead to healthy behaviors, with subsequent reductions in individual burden and costs to the health care system. To improve patient activation, we need to embrace a patient-first approach and combine it with ways to equip patients to thrive with self-management. This requires changes in the training of the health care team as well as changes in care delivery models, promoting interventions such as health coaching and peer mentoring, while leveraging technology to enable self-access to records, self-monitoring, and communication with providers. We also need health care policies that encourage a focus on patient-identified goals, including more attention to patient-reported outcomes. In this article, we review the current status of patient activation in dialysis patients, outline some of the available interventions, and propose steps to change the dynamics of the current system to move toward a more active role for patients in their care.
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Affiliation(s)
- Wael F Hussein
- Satellite Healthcare, San Jose, California; Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California.
| | - Paul N Bennett
- Satellite Healthcare, San Jose, California; Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Graham Abra
- Satellite Healthcare, San Jose, California; Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | | | - Brigitte Schiller
- Satellite Healthcare, San Jose, California; Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
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10
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Garcia P, Anand S, Han J, Montez-Rath M, Sun S, Shang T, Parsonnet J, Chertow GM, Schiller B, Abra G. COVID19 vaccine type and humoral immune response in patients receiving dialysis. medRxiv 2021:2021.08.02.21261516. [PMID: 34373862 PMCID: PMC8351784 DOI: 10.1101/2021.08.02.21261516] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Patients on dialysis vaccinated with the attenuated adenovirus SARS-CoV-2 vaccine might mount an impaired response to vaccination. Methods We evaluated the humoral vaccination response among 2,099 fully vaccinated patients receiving dialysis. We used commercially available assays (Siemens) to assess prevalence of no response or diminished response to COVID-19 vaccination by vaccine type. We defined "no seroconversion" as lack of change from negative to positive in total RBD Ig antibody, no detectable response on semiquantitative RBD IgG antibody (index value <1) as "no RBD IgG response", and a semiquantitative RBD IgG index value <10 as "diminished RBD IgG response". Results Of the 2,099 fully vaccinated patients on dialysis, the proportion receiving the mRNA1273, BNT162b2, and Ad26.COV2.S were 62% (n=1316), 20% (n=416) and 18% (n=367), respectively. A third (33.3%) of patients receiving the attenuated adenovirus Ad26.COV2.S vaccine failed to seroconvert and an additional 36% had no detectable or diminished IgG response even 28-60 days post vaccination. Conclusion One in three fully vaccinated patients receiving dialysis had evidence of an impaired immune response to the attenuated adenovirus Ad26.COV2.S vaccine.
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Affiliation(s)
- Pablo Garcia
- Department of Medicine (Nephrology), Stanford University
| | - Shuchi Anand
- Department of Medicine (Nephrology), Stanford University
| | - Jialin Han
- Department of Medicine (Nephrology), Stanford University
| | | | | | | | - Julie Parsonnet
- Departments of Medicine (Infectious Diseases and Geographic Medicine), and Epidemiology and Population Health, Stanford University
| | - Glenn M Chertow
- Departments of Medicine (Nephrology), and Epidemiology and Population Health, Stanford University
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11
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Abra G, Weinhandl ED. Pulling the goalie: What the United States and the world can learn from Canada about growing home dialysis. Perit Dial Int 2021; 41:437-440. [PMID: 34323152 DOI: 10.1177/08968608211034696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Graham Abra
- Satellite Healthcare, San Jose, CA, USA.,Department of Medicine, Division of Nephrology, 6429Stanford University, Palo Alto, CA, USA
| | - Eric D Weinhandl
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA.,Department of Pharmaceutical Care and Health Systems, 5635University of Minnesota, Minneapolis, MN, USA
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12
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Ashley J, Abra G, Schiller B, Bennett PN, Mehr AP, Bargman JM, Chan CT. The use of virtual physician mentoring to enhance home dialysis knowledge and uptake. Nephrology (Carlton) 2021; 26:569-577. [PMID: 33634548 DOI: 10.1111/nep.13867] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/05/2021] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Abstract
Home dialysis therapies are flexible kidney replacement strategies with documented clinical benefits. While the incidence of end-stage kidney disease continues to increase globally, the use of home dialysis remains low in most developed countries. Multiple barriers to providing home dialysis have been noted in the published literature. Among known challenges, gaps in clinician knowledge are potentially addressable with a focused education strategy. Recent national surveys in the United States and Australia have highlighted the need for enhanced home dialysis knowledge especially among nephrologists who have recently completed training. Traditional in-person continuing professional educational programmes have had modest success in promoting home dialysis and are limited by scale and the present global COVID-19 pandemic. We hypothesize that the use of a 'Hub and Spoke' model of virtual home dialysis mentorship for nephrologists based on project ECHO would support home dialysis growth. We review the home dialysis literature, known educational gaps and plausible educational interventions to address current limitations in physician education.
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Affiliation(s)
- Justin Ashley
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Graham Abra
- Satellite Healthcare, San Jose, California, USA.,Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Brigitte Schiller
- Satellite Healthcare, San Jose, California, USA.,Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Paul N Bennett
- Satellite Healthcare, San Jose, California, USA.,Department of Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Ali Poyan Mehr
- Department of Nephrology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Joanne M Bargman
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Christopher T Chan
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
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13
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Affiliation(s)
- Gates B Colbert
- Baylor University Medical Center at Dallas, 3417 Gaston Ave, Suite 875, Dallas, TX 75246, USA.
| | - Graham Abra
- Stanford University, Palo Alto, CA, USA; Satellite Healthcare, San Jose, CA, USA
| | - Edgar V Lerma
- UIC/ Advocate Christ Medical Center, Oak Lawn, IL USA
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14
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Lei L, Oh G, Sutherland S, Abra G, Higgins J, Sibley R, Troxell M, Kambham N. Myelin bodies in LMX1B-associated nephropathy: potential for misdiagnosis. Pediatr Nephrol 2020; 35:1647-1657. [PMID: 32356190 DOI: 10.1007/s00467-020-04564-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/20/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Myelin figures, or zebra bodies, seen on electron microscopy were historically considered pathognomonic of Fabry disease, a rare lysosomal storage disorder caused by alpha-galactosidase A deficiency and associated with X-linked recessive mode of inheritance. More recently, iatrogenic phospholipidosis has emerged as an important alternate cause of myelin figures in the kidney. METHODS We report two families with autosomal dominant nephropathy presenting with proteinuria and microscopic hematuria, and the kidney biopsies were notable for the presence of myelin figures and zebra bodies. RESULTS Laboratory and genetic work-up for Fabry disease was negative. Genetic testing in both families revealed the same heterozygous missense mutation in LMX1B (C.737G>A, p.Arg246Gln). LMX1B mutations are known to cause nail-patella syndrome, featuring dysplastic nails and patella with or without nephropathy, as well as isolated LMX1B-associated nephropathy in the absence of extrarenal manifestations. CONCLUSIONS LMX1B mutation-associated nephropathy should be considered in hereditary cases of proteinuria and/or hematuria, even in the absence of unique glomerular basement membrane changes indicative of nail-patella syndrome. In addition, LMX1B mutation should be included in the differential diagnosis of myelin figures and zebra bodies on kidney biopsy, so as to avoid a misdiagnosis.
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Affiliation(s)
- Li Lei
- Department of Pathology, Stanford University, H2110, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Gia Oh
- Randall Children's Hospital, Portland, OR, USA
| | - Scott Sutherland
- Department of Pediatrics & Division of Nephrology, Stanford University, Stanford, CA, USA
| | | | - John Higgins
- Department of Pathology, Stanford University, H2110, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Richard Sibley
- Department of Pathology, Stanford University, H2110, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Megan Troxell
- Department of Pathology, Stanford University, H2110, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Neeraja Kambham
- Department of Pathology, Stanford University, H2110, 300 Pasteur Drive, Stanford, CA, 94305, USA.
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15
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Franz DD, Hussein WF, Abra G, Diskin CD, Duggal V, Teuteberg JJ, Chang TI, Schiller B. Outcomes Among Patients With Left Ventricular Assist Devices Receiving Maintenance Outpatient Hemodialysis: A Case Series. Am J Kidney Dis 2020; 77:226-234. [PMID: 32711070 DOI: 10.1053/j.ajkd.2020.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/16/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE The incidence of left ventricular assist device (LVAD) implantation as destination therapy for heart failure is increasing and kidney failure requiring maintenance hemodialysis is a common complication. Because little is known about the safety or efficacy of outpatient hemodialysis among patients with LVADs, this study sought to describe their clinical course. STUDY DESIGN Case series of patients with an LVAD undergoing maintenance outpatient hemodialysis whose clinical data were obtained from an electronic medical record. SETTING & PARTICIPANTS Adults who received an LVAD, survived to hospital discharge, and were subsequently treated with maintenance hemodialysis by a not-for-profit dialysis provider between 2011 and 2019. RESULTS 11 patients were included. 6 had a known history of chronic kidney disease. Patients underwent outpatient hemodialysis for a mean duration of 165.2 (range, 31-542) days, during which they were treated with 544 total dialysis sessions. 6 of these sessions were stopped early due to dialysis-related adverse events (1.1%). More than 80% of follow-up time was spent out of the hospital; however, 55% of patients were rehospitalized within 1 month of starting outpatient hemodialysis. The most common reason for hospitalization was infection (32%), followed by hypervolemia (14%), and cerebrovascular accident or transient ischemic attack (11%). 4 patients recovered kidney function, 1 underwent combined heart and kidney transplantation, 2 continued treatment, 2 died, and 2 were lost to follow-up. LIMITATIONS Retrospective design, small number of cases, and lack of complete follow-up data. CONCLUSIONS Approximately half the patients with complete follow-up either recovered kidney function or underwent combined heart and kidney transplantation. This case series demonstrates that outpatient hemodialysis centers, in partnership with LVAD treatment teams, can successfully provide hemodialysis to patients on LVAD support.
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Affiliation(s)
- Douglas D Franz
- Department of Medicine, Stanford University, Palo Alto, CA; Veteran Affairs Palo Alto Health Care System, Palo Alto, CA.
| | - Wael F Hussein
- Department of Medicine, Stanford University, Palo Alto, CA; Satellite Healthcare, San Jose, CA
| | - Graham Abra
- Department of Medicine, Stanford University, Palo Alto, CA; Satellite Healthcare, San Jose, CA
| | - Charles D Diskin
- Department of Medicine, Stanford University, Palo Alto, CA; Satellite Healthcare, San Jose, CA
| | - Vishal Duggal
- Department of Medicine, Stanford University, Palo Alto, CA; Satellite Healthcare, San Jose, CA
| | | | - Tara I Chang
- Department of Medicine, Stanford University, Palo Alto, CA
| | - Brigitte Schiller
- Department of Medicine, Stanford University, Palo Alto, CA; Satellite Healthcare, San Jose, CA
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Funes I, Velasquez K, Doss-McQuitty S, Hussein WF, Abra G, Anantiyo P, Bennett PN, Schiller B. The Peritoneal Dialysis Transfer Set Replacement Procedure. Nephrol Nurs J 2020; 47:343-346. [PMID: 32830940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Peritoneal dialysis transfer sets (extension lines) are replaced every six to nine months to minimize peritoneal dialysis catheter complications. The aim of this study was to compare a revised non-bag transfer set exchange procedure with the standard bag exchange procedure on nursing time, costs, and safety. Thirty-three people were randomized to two groups - a standard bag exchange procedure group (n = 16) and a non-bag transfer set exchange procedure group (n = 17). The standard bag exchange procedure took a median of 32 minutes (interquartile range [IQR] 25 to 38 minutes) compared to the non-bag transfer set exchange procedure of 6 minutes (IQR 4 to 8 minutes) (p Ò 0.0001). There was one episode of peritonitis in each group within the 72-hour follow-up period. The average cost of the non-bag transfer set exchange procedure was $24.54 lower, a 37% cost reduction. This study has shown the revised non-bag transfer set replacement procedure appears to be safe, consume less participant and staff time, and decreases costs.
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Affiliation(s)
- Irma Funes
- Former Center Manager, Satellite Healthcare, San Jose, CA
| | | | - Sheila Doss-McQuitty
- Director of Clinical Programs and Research, Satellite Healthcare, San Jose, CA
- Past President of ANNA
- member of the Nephrology Nursing Journal Editorial Board
- member of ANNA's Central Missouri Chapter
| | - Wael F Hussein
- Senior Research Director, Satellite Healthcare, San Jose, CA
- Adjunct Clinical Assistant Professor, Division of Nephrology, Department of Medicine, Stanford University School of Medicine Stanford University, Palo Alto, CA
| | - Graham Abra
- Senior Medical Director, Satellite Healthcare, San Jose, CA. and Division of Nephrology, Department of Medicine, Stanford University School of Medicine Stanford University, Palo Alto, CA
| | - Pon Anantiyo
- Vice President of Home Services, Satellite Healthcare, San Jose, CA
| | - Paul N Bennett
- Director of Research, Satellite Healthcare, San Jose, CA; an Honorary Professor of Nursing, Faculty of Health, Deakin University. Melbourne, Australia
- International Member of ANNA
| | - Brigitte Schiller
- Chief Medical Officer, Satellite Healthcare, San Jose, CA; and an Adjunct Lecturer, Division of Nephrology, Department of Medicine, Stanford University School of Medicine Stanford University, Palo Alto, CA
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17
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Affiliation(s)
- Graham Abra
- Satellite Healthcare San Jose CA USA
- Division of Nephrology Department of Medicine Stanford University Palo Alto CA USA
| | - Brigitte Schiller
- Satellite Healthcare San Jose CA USA
- Division of Nephrology Department of Medicine Stanford University Palo Alto CA USA
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18
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Funes I, Velasquez K, Doss-McQuitty S, Hussein WF, Abra G, Anantiyo P, Bennett PN, Schiller B. The Peritoneal Dialysis Transfer Set Replacement Procedure. Nephrol Nurs J 2020. [DOI: 10.37526/1526-744x.2020.47.4.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Plumb TJ, Alvarez L, Ross DL, Lee JJ, Mulhern JG, Bell JL, Abra G, Prichard SS, Chertow GM, Aragon MA. Safety and efficacy of the Tablo hemodialysis system for in-center and home hemodialysis. Hemodial Int 2019; 24:22-28. [PMID: 31697042 PMCID: PMC7027451 DOI: 10.1111/hdi.12795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/17/2019] [Accepted: 09/24/2019] [Indexed: 11/29/2022]
Abstract
Introduction: Home hemodialysis remains underutilized despite observational data indicating more favorable outcomes with home compared with in‐center hemodialysis. The Tablo Hemodialysis system is designed to be easy to learn and use and to facilitate adoption of home hemodialysis. The objective of the current investigational device exemption (IDE) study was to evaluate the safety and efficacy of Tablo managed in‐center by health care professionals and in‐home by patients and/or caregivers. Methods: A prospective, multicenter, open‐label, crossover trial comparing in‐center and in‐home hemodialysis using Tablo. There were 4 treatment periods during which hemodialysis was prescribed 4 times per week: 1‐week Run‐In, 8‐week In‐Center, 4‐week Transition, and 8‐week In‐Home. The primary efficacy endpoint was weekly standard Kt/Vurea ≥ 2.1. The secondary efficacy endpoint was delivery of ultrafiltration (UF) within 10% of prescribed UF. We collected safety and usability data. Findings: Thirty participants enrolled and 28 completed all trial periods. Adherence to the protocol requirement of 4 treatments per week was 96% in‐center and 99% in‐home. The average prescribed and delivered session lengths were 3.4 hours for both the In‐Center and the In‐Home periods. The primary efficacy endpoint for the intention‐to‐treat cohort was achieved in 199/200 (99.5%) of measurements during the In‐Center period and 168/171 (98.3%) In‐Home. The average weekly standard Kt/Vurea was 2.8 in both periods. The secondary efficacy UF endpoint was achieved in the ITT cohort in 94% in both in‐center and in‐home. Two prespecified adverse events (AEs) occurred during the In‐Center period and 6 in the In‐Home period. None of the AEs were deemed by investigators as related to Tablo. The median resolution time of alarms was 8 seconds in‐center and 5 seconds in‐home. Conclusion: Primary and secondary efficacy and safety endpoints were achieved during both In‐Center and In‐Home trial periods. This study confirms that Tablo is safe and effective for home hemodialysis use.
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Affiliation(s)
- Troy J Plumb
- University of Nebraska, Nebraska Medical Center, Omaha, Nebraska, USA
| | - Luis Alvarez
- Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Dennis L Ross
- Kansas Nephrology Research Institute, Wichita, Kansas, USA
| | - Joseph J Lee
- Nephrology Associates Medical Group, Riverside, California, USA
| | - Jeffrey G Mulhern
- Fresenius Kidney Care Pioneer Valley Dialysis, West Springfield, Massachusetts, USA
| | - Jeffrey L Bell
- Southwest Georgia Nephrology Clinic, Albany, Georgia, USA
| | - Graham Abra
- Satellite Healthcare, Mountain View, California, USA
| | | | - Glenn M Chertow
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Michael A Aragon
- Clinical Development, Outset Medical, San Jose, California, USA.,DaVita Grapevine at Home, Grapevine, Texas, USA
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