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Damery S, Lambie M, Williams I, Coyle D, Fotheringham J, Solis-Trapala I, Allen K, Potts J, Dikomitis L, Davies SJ. Centre variation in home dialysis uptake: A survey of kidney centre practice in relation to home dialysis organisation and delivery in England. Perit Dial Int 2024:8968608241232200. [PMID: 38445495 DOI: 10.1177/08968608241232200] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Disparities in home dialysis uptake across England suggest inequity and unexplained variation in access. We surveyed staff at all English kidney centres to identify patterns in service organisation/delivery and explore correlations with home therapy uptake, as part of a larger study ('Inter-CEPt'), which aims to identify potentially modifiable factors to address observed variations. METHODS Between June and September 2022, staff working at English kidney centres were surveyed and individual responses combined into one centre-level response per question using predetermined data aggregation rules. Descriptive analysis described centre practices and their correlation with home dialysis uptake (proportion of new home dialysis starters) using 2019 UK Renal Registry 12-month home dialysis incidence data. RESULTS In total, 180 responses were received (50/51 centres, 98.0%). Despite varied organisation of home dialysis services, most components of service delivery and practice had minimal or weak correlations with home dialysis uptake apart from offering assisted peritoneal dialysis and 'promoting flexible decision-making about dialysis modality'. Moderate to strong correlations were identified between home dialysis uptake and centres reporting supportive clinical leadership (correlation 0.32, 95% Confidence Interval (CI): 0.05-0.55), an organisational culture that values trying new initiatives (0.57, 95% CI: 0.34-0.73); support for reflective practice (0.38, 95% CI: 0.11-0.60), facilitating research engagement (0.39, 95% CI: 0.13-0.61) and promoting continuous quality improvement (0.29, 95% CI: 0.01-0.53). CONCLUSIONS Uptake of home dialysis is likely to be driven by organisational culture, leadership and staff attitudes, which provide a supportive clinical environment within which specific components of service organisation and delivery can be effective.
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Affiliation(s)
- Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mark Lambie
- Renal Research Group, School of Medicine, Keele University, Keele, UK
| | - Iestyn Williams
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - David Coyle
- NIHR Devices for Dignity, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - James Fotheringham
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Kerry Allen
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Jessica Potts
- Renal Research Group, School of Medicine, Keele University, Keele, UK
| | - Lisa Dikomitis
- Kent and Medway Medical School, University of Kent, Canterbury, UK
| | - Simon J Davies
- Renal Research Group, School of Medicine, Keele University, Keele, UK
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2
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Shammas A, Joshi S, Shah AD. Nutrition in Peritoneal Dialysis. Adv Kidney Dis Health 2023; 30:537-545. [PMID: 38453271 DOI: 10.1053/j.akdh.2023.12.008] [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] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 03/09/2024]
Abstract
The use of peritoneal dialysis (PD) has been associated with improved quality of life, cost-effectiveness, and better outcomes for patients with kidney failure. However, many patients utilizing PD for replacement therapy face numerous nutritional hurdles. As the use of PD continues to increase worldwide, malnutrition has become an increasingly recognized concern for patients undergoing PD. The nephrology community needs to recognize and treat malnutrition to promote optimal nutritional states for our patients. In this review, we discuss several factors that contribute to malnutrition and protein-energy wasting and explore the benefits and limitations of nutritional parameters used to assess protein-calorie malnutrition. We also emphasize updated guidelines on daily caloric, protein, and micronutrient recommendations, as well as their effects on electrolyte homeostasis.
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Affiliation(s)
- Andrew Shammas
- Warren Alpert Medical School of Brown University, Providence, RI; Department of Medicine, Kent Hospital, Warwick, RI
| | - Shivam Joshi
- Department of Veterans Affairs, Orlando, FL; Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Ankur D Shah
- Warren Alpert Medical School of Brown University, Providence, RI; Division of Kidney Disease and Hypertension, Department of Medicine, Rhode Island Hospital, Providence, RI.
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3
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Scofano R, Monteiro A, Motta L. Evaluation of the experience with the use of telemedicine in a home dialysis program-a qualitative and quantitative study. BMC Nephrol 2022; 23:190. [PMID: 35590287 PMCID: PMC9117587 DOI: 10.1186/s12882-022-02824-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/05/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Assisted home hemodialysis is a therapeutic modality for patients diagnosed with end-stage renal disease who require dialysis replacement therapy and have concomitant health limitations that prevent them from attending a satellite dialysis unit or performing their own treatment. OBJECTIVE The main objective of this study was to evaluate whether telemedicine provided through telemonitoring can improve the ongoing relationship between the doctor, the nurse and the patient. METHOD This prospective longitudinal, qualitative and quantitative study analyzes the impact of telemedicine through an evaluation of the experiences of patients and nurses. During the study, we performed remote weekly monitoring for 6 months. RESULTS A total of 17 patients and 12 nurses were included. We observed that the patients and nurses had positive experiences with telemonitoring and highlighted feelings of being cared for and improved confidence, although they indicated that telemonitoring does not replace face-to-face visits. CONCLUSION Telemonitoring is a useful tool to increase satisfaction with and confidence in home hemodialysis.
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Affiliation(s)
- Raquel Scofano
- Telessaúde UERJ, Universidade do Estado do Rio de Janeiro, UERJ, Avenida Vinte Oito de setembro 77, 3° andar, Rio de Janeiro-RJ, Vila Isabel CEP, 20551-030, Brazil.
| | - Alexandra Monteiro
- Telessaúde UERJ, Universidade do Estado do Rio de Janeiro, UERJ, Avenida Vinte Oito de setembro 77, 3° andar, Rio de Janeiro-RJ, Vila Isabel CEP, 20551-030, Brazil
| | - Luciana Motta
- Telessaúde UERJ, Universidade do Estado do Rio de Janeiro, UERJ, Avenida Vinte Oito de setembro 77, 3° andar, Rio de Janeiro-RJ, Vila Isabel CEP, 20551-030, Brazil
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4
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Singh G. Filling the gaps: the home dialysis discussion. J Nephrol 2022. [PMID: 35000135 DOI: 10.1007/s40620-021-01211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
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5
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Bhat JG, Weiss S. ETC Model: How One Small Dialysis Organization Is Navigating Uncharted Policy Waters. Adv Chronic Kidney Dis 2022; 29:45-51. [PMID: 35690403 DOI: 10.1053/j.ackd.2022.01.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/13/2021] [Accepted: 01/03/2022] [Indexed: 11/11/2022]
Abstract
The ETC model proposes to increase access to home dialysis and transplant for patients with ESRD. Implementation of this model is happening while many dialysis organizations are still suffering the far-reaching effects of the coronavirus disease 2019 (COVID-19) pandemic. In addition, the model has the potential to negatively affect small and independent dialysis organizations disproportionately. It incentivizes home dialysis over transplant and promotes development of new home dialysis programs, rewards achievement over improvement, and places an excessive burden on small and independent dialysis organizations. Advantages of the program include the focus on self-care as an acceptable alternative to home dialysis for some patients and the potential for some organizations to make improvements in care with increased reimbursements. The authors hope that the Centers for Medicare and Medicaid Services will address many of these concerns in updated rulemaking and guidance.
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Affiliation(s)
- J Ganesh Bhat
- Atlantic Dialysis Management Services, LLC, College Point, NY; Departments of Medicine & Physiology, Xavier University School of Medicine, Oranjestad, Aruba.
| | - Steven Weiss
- Atlantic Dialysis Management Services, LLC, College Point, NY
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6
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Bonenkamp AA, Reijnders TDY, der Sluijs AVEV, Hagen EC, Abrahams AC, van Ittersum FJ, van Jaarsveld BC. Key elements in selection of pre-dialysis patients for home dialysis. Perit Dial Int 2021; 41:494-501. [PMID: 34219552 DOI: 10.1177/08968608211023263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Most pre-dialysis patients are medically eligible for home dialysis, and home dialysis has several advantages over incentre dialysis. However, accurately selecting patients for home dialysis appears to be difficult, since uptake of home dialysis remains low. The aim of this study was to investigate which medical or psychosocial elements contribute most to the selection of patients eligible for home dialysis. METHODS All patients from a Dutch teaching hospital, who received treatment modality education and subsequently started dialysis treatment, were included. The pre-dialysis programme consisted of questionnaires for the patient, nephrologist and social worker, followed by an assessment of eligibility for home dialysis by a multidisciplinary team. Clinimetric assessment and logistic regression were used to identify domains and questions associated with home dialysis treatment. RESULTS A total of 135 patients were included, of whom 40 were treated with home dialysis and 95 with incentre haemodialysis. The key elements associated with long-term home dialysis treatment were part of the domains 'suitability of the housing', 'self-care', 'social support' and 'patient capacity', with adjusted odds ratios ranging from 0.13 for negative to 18.3 for positive associations. CONCLUSION The assessment of contraindications by a nephrologist followed by the assessment of possibilities by a social worker or dialysis nurse who investigates four key elements, ideally during a home visit, and subsequent detailed education offered by specialized nurses is an optimal way to select patients for home dialysis.
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Affiliation(s)
- Anna A Bonenkamp
- Department of Nephrology, 522567Amsterdam UMC, University of Amsterdam, Research Institute Amsterdam Cardiovascular Sciences, The Netherlands
| | - Tom D Y Reijnders
- Department of Internal Medicine, 1170Meander Medical Centre, Amersfoort, The Netherlands
| | | | - E Christiaan Hagen
- Department of Internal Medicine, 1170Meander Medical Centre, Amersfoort, The Netherlands.,Medworq B.V., Medworq, Zeist, The Netherlands
| | - Alferso C Abrahams
- Department of Nephrology and Hypertension, 8124University Medical Centre Utrecht, The Netherlands
| | - Frans J van Ittersum
- Department of Nephrology, 522567Amsterdam UMC, University of Amsterdam, Research Institute Amsterdam Cardiovascular Sciences, The Netherlands
| | - Brigit C van Jaarsveld
- Department of Nephrology, 522567Amsterdam UMC, University of Amsterdam, Research Institute Amsterdam Cardiovascular Sciences, The Netherlands
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7
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Mendu ML, Divino-Filho JC, Vanholder R, Mitra S, Davies SJ, Jha V, Damron KC, Gallego D, Seger M. Expanding Utilization of Home Dialysis: An Action Agenda From the First International Home Dialysis Roundtable. Kidney Med 2021; 3:635-643. [PMID: 34401729 PMCID: PMC8350829 DOI: 10.1016/j.xkme.2021.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Indexed: 01/12/2023] Open
Abstract
In a groundbreaking meeting, leading global kidney disease organizations came together in the fall of 2020 as an International Home Dialysis Roundtable (IHDR) to address strategies to increase access to and uptake of home dialysis, both peritoneal dialysis and home hemodialysis. This challenge has become urgent in the wake of the coronavirus disease 2019 (COVID-19) pandemic, during which patients with advanced kidney disease, who are more susceptible to viral infections and severe complications, must be able to safely physically distance at home. To boost access to home dialysis on a global scale, IHDR members committed to collaborate, through the COVID-19 public health emergency and beyond, to promote uptake of home dialysis on a broad scale. Their commitments included increasing the reach and influence of key stakeholders with policy makers, building a cooperative of advocates and champions for home dialysis, working together to increase patient engagement and empowerment, and sharing intelligence about policy, education, and other programs so that such efforts can be operationalized globally. In the spirit of international cooperation, IHDR members agreed to document, amplify, and replicate established efforts shown to improve access to home dialysis and support new policies that facilitate access through procedures, innovation, and reimbursement.
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Affiliation(s)
- Mallika L. Mendu
- Division of Renal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of the Chief Medical Officer, Brigham and Women’s Hospital, Boston, MA
| | - José Carolino Divino-Filho
- Division of Renal Medicine, CLINTEC, Karolinska Institute, Campus Flemingsberg, Stockholm, Sweden
- Latin America Chapter (LAC-DD)-International Society for Peritoneal Dialysis
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent
- European Kidney Health Alliance (EKHA), Brussels, Belgium
| | - Sandip Mitra
- Department of Renal Medicine, Manchester University NHS Foundation Trust, Manchester
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester
- National Institute of Health Research MedTech and In-vitro Diagnostics Co-operative, Devices for Dignity, Sheffield
| | - Simon J. Davies
- Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, United Kingdom
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | | | | | | | - International Home Dialysis Roundtable Steering Committee
- Division of Renal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of the Chief Medical Officer, Brigham and Women’s Hospital, Boston, MA
- Division of Renal Medicine, CLINTEC, Karolinska Institute, Campus Flemingsberg, Stockholm, Sweden
- Latin America Chapter (LAC-DD)-International Society for Peritoneal Dialysis
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent
- European Kidney Health Alliance (EKHA), Brussels, Belgium
- Department of Renal Medicine, Manchester University NHS Foundation Trust, Manchester
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester
- National Institute of Health Research MedTech and In-vitro Diagnostics Co-operative, Devices for Dignity, Sheffield
- Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, United Kingdom
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- National Kidney Foundation, New York, NY
- European Kidney Patients Federation, Vienna, Austria
- Venn Strategies, Washington, DC
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8
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Li PKT, Chan GCK, Chen J, Chen HC, Cheng YL, Fan SLS, He JC, Hu W, Lim WH, Pei Y, Teo BW, Zhang P, Yu X, Liu ZH. Tackling Dialysis Burden around the World: A Global Challenge. Kidney Dis (Basel) 2021; 7:167-175. [PMID: 34179112 PMCID: PMC8215964 DOI: 10.1159/000515541] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/26/2021] [Indexed: 11/19/2022]
Abstract
CKD is a global problem that causes significant burden to the healthcare system and the economy in addition to its impact on morbidity and mortality of patients. Around the world, in both developing and developed economies, the nephrologists and governments face the challenges of the need to provide a quality and cost-effective kidney replacement therapy for CKD patients when their kidneys fail. In December 2019, the 3rd International Congress of Chinese Nephrologists was held in Nanjing, China, and in the meeting, a symposium and roundtable discussion on how to deal with this CKD burden was held with opinion leaders from countries and regions around the world, including Australia, Canada, China, Hong Kong, Singapore, Taiwan, the UK, and the USA. The participants concluded that an integrated approach with early detection of CKD, prompt treatment to slow down progression, promotion of home-based dialysis therapy like peritoneal dialysis and home HD, together with promotion of kidney transplantation, are possible effective ways to combat this ongoing worldwide challenge.
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Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Gordon Chun-Kau Chan
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Jianghua Chen
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hung-Chun Chen
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yuk-Lun Cheng
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong, China
| | - Stanley L.-S. Fan
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, United Kingdom
| | - John Cijiang He
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Weixin Hu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Wai-Hon Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Washington, Australia
| | - York Pei
- Department of Medicine, University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Boon Wee Teo
- Division of Nephrology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ping Zhang
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xueqing Yu
- Department of Nephrology, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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9
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Maldonado M, Ossorio M, Del Peso G, Santos-Alonso C, Álvarez L, Sánchez-Villanueva R, Rivas B, Vega C, Selgas R, Bajo MA. COVID-19 incidence and outcomes in a home dialysis unit in Madrid (Spain) at the height of the pandemic. Nefrologia 2021; 41:329-336. [PMID: 36166248 PMCID: PMC8373627 DOI: 10.1016/j.nefroe.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/15/2020] [Accepted: 09/27/2020] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION The 2019 coronavirus (COVID-19) is a viral infection caused by a new coronavirus that is affecting the entire world. There have been studies of patients on in-center hemodialysis (HD), but home dialysis population data are scarce. Our objective is to study the incidence and course of COVID-19 in a home dialysis unit (HDU) at the height of the pandemic. METHODS an observational, retrospective study enrolling all patients diagnosed with COVID-19 from the HDU of Hospital Universitario La Paz [La Paz University Hospital] (Madrid, Spain) between March 10 and May 15, 2020. We collected clinical data from the HDU (57 patients on peritoneal dialysis [PD] and 22 patients on home hemodialysis [HHD]) and compared the clinical characteristics and course of patients with and without COVID-19 infection. RESULTS twelve patients were diagnosed with COVID-19 (9 PD; 3 HHD). There were no statistically significant differences in terms of clinical characteristics between patients with COVID-19 and the rest of the unit. The mean age was 62 ± 18.5 years; most were men (75%). All patients but one required hospitalization. Ten patients (83%) were discharged following a mean of 16.4 ± 9.7 days of hospitalization. Two patients were diagnosed while hospitalised for other conditions, and these were the only patients who died. Those who died were older than those who survived. CONCLUSION The incidence of COVID-19 in our HDU in Madrid at the height of the pandemic was high, especially in patients on PD. No potential benefit for preventing the infection in patients on home dialysis was observed. Advanced age and nosocomial transmission were the main factors linked to a worse prognosis.
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Affiliation(s)
- María Maldonado
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, Spain.
| | - Marta Ossorio
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, Spain; Instituto de investigación La Paz (IdiPAZ), Madrid, Spain
| | - Gloria Del Peso
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, Spain; Instituto de investigación La Paz (IdiPAZ), Madrid, Spain; Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Laura Álvarez
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, Spain; Instituto de investigación La Paz (IdiPAZ), Madrid, Spain
| | - Rafael Sánchez-Villanueva
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, Spain; Instituto de investigación La Paz (IdiPAZ), Madrid, Spain
| | - Begoña Rivas
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, Spain; Instituto de investigación La Paz (IdiPAZ), Madrid, Spain; Departamento de Nefrología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Cristina Vega
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, Spain; Instituto de investigación La Paz (IdiPAZ), Madrid, Spain; Departamento de Nefrología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rafael Selgas
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, Spain; Instituto de investigación La Paz (IdiPAZ), Madrid, Spain; Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Nefrología, Universidad Autónoma de Madrid, Madrid, Spain
| | - María A Bajo
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, Spain; Instituto de investigación La Paz (IdiPAZ), Madrid, Spain; Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Nefrología, Universidad Autónoma de Madrid, Madrid, Spain
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10
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Lavoie-Cardinal M, Nadeau-Fredette AC. Physical Infrastructure and Integrated Governance Structure for Home Hemodialysis. Adv Chronic Kidney Dis 2021; 28:149-156. [PMID: 34717861 DOI: 10.1053/j.ackd.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 02/11/2021] [Accepted: 02/25/2021] [Indexed: 01/17/2023]
Abstract
In view of the growing enthusiasm for home dialysis use, new dialysis centers may build or expend their home hemodialysis program in the next few years. This review will discuss the main challenges faced by small and large home hemodialysis programs in terms of physical spaces, human resource, training considerations, and overall governance. We will elaborate on the inclusion of home hemodialysis in the kidney replacement therapy care continuum, with a specific interest for collaboration and transition between peritoneal dialysis and home hemodialysis programs.
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11
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El Shamy O, Muller T, Tokita J, Cummings Y, Sharma S, Uribarri J. Home Dialysis: A Majority Chooses It, a Minority Gets It. Blood Purif 2021; 50:818-822. [PMID: 33503613 DOI: 10.1159/000512539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/27/2020] [Accepted: 10/23/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION When choosing a modality for outpatient renal replacement therapy, patients and medical providers have 3 options to choose from in-center hemodialysis (HD), home HD (HHD), and peritoneal dialysis (PD). In 2017, just over 10% of incident ESKD patients were on a home dialysis modality. We set out to determine outcomes of dialysis modality education in both pre-dialysis and dialysis patients. Moreover, we examined barriers that preclude patients from choosing home dialysis. METHODS This was a single-center, retrospective study looking at patients who were referred to the CKD educator for dialysis modality education between January 1, 2019, and March 31, 2020. Patient demographics, preferred language of communication, stage of renal disease, and reasons for patients' refusal to undertake a home dialysis modality were recorded. Patients' average household income and driving distance to our home dialysis unit were calculated using their home zip code. RESULTS 167 patients were referred for CKD education. Mean age was 60 years, and 59% male, 42% African American, 22% White, 7% Asian, and 28% were Hispanic or Latino. Only 23% of the total cohort chose in-center HD, while 74% chose a home dialysis modality (59% PD and 15% HHD), and the remaining patients remained undecided. 56% of in-center HD patients chose a home dialysis modality. The most commonly cited barriers to home dialysis were lack of a care partner, lack of home space, and patient preference. LIMITATIONS Over 90% of our patients reside in NY City where home space is limited. We require in our home HD program that patients have a trained care partner present during their treatments. We cannot assume that all CKD stage-4 patients or higher were either referred for CKD education or followed through on the referral. CONCLUSIONS A large discrepancy between informed patients' choices and the reality of the current dialysis landscape. Absence of a care partner, lack of home space, and patients not deemed appropriate surgical candidates were the main driving forces in their not opting for a home modality.
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Affiliation(s)
- Osama El Shamy
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA,
| | - Tamara Muller
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joji Tokita
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yvette Cummings
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shuchita Sharma
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jaime Uribarri
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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12
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Maldonado M, Ossorio M, Del Peso G, Santos C, Álvarez L, Sánchez-Villanueva R, Rivas B, Vega C, Selgas R, Bajo MA. [COVID-19 incidence and outcomes in a home dialysis unit in Madrid (Spain) at the height of the pandemic]. Nefrologia 2020; 41:329-336. [PMID: 33248799 PMCID: PMC7643625 DOI: 10.1016/j.nefro.2020.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/22/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023] Open
Abstract
Introducción La enfermedad por coronavirus 2019 (COVID-19) es una infección viral causada por un nuevo coronavirus que está afectando a todo el mundo. Hay estudios previos de pacientes en hemodiálisis en centro, pero hay pocos datos sobre población en diálisis domiciliaria. Nuestro objetivo es estudiar la incidencia y evolución de la COVID-19 en una unidad de diálisis domiciliaria (UDD) durante el pico de la pandemia. Métodos Estudio observacional y retrospectivo que incluye todos los pacientes diagnosticados de COVID-19 de la UDD del Hospital Universitario La Paz (Madrid, España) entre el 10 de marzo y el 15 de mayo de 2020. Se recogieron los datos clínicos de la UDD (57 pacientes en diálisis peritoneal y 22 pacientes en hemodiálisis domiciliaria) y comparamos las características clínicas y la evolución de los pacientes con o sin infección por COVID-19. Resultados Doce pacientes fueron diagnosticados de COVID-19 (9 diálisis peritoneal, 3 hemodiálisis domiciliaria). No hubo diferencias estadísticamente significativas entre las características clínicas de los pacientes con COVID-19 y el resto de la unidad. La edad media fue 62 ± 18,5 años; la mayoría eran varones (75%). Todos los pacientes menos uno necesitaron hospitalización. Diez pacientes (83%) fueron dados de alta tras una media de 16,4 ± 9,7 días de hospitalización. Dos pacientes fueron diagnosticados durante su hospitalización por otro motivo y fueron los únicos que fallecieron. Los fallecidos eran de mayor edad que los supervivientes. Conclusión La incidencia de COVID-19 en nuestra UDD en Madrid durante el pico de la pandemia fue alto, especialmente en los pacientes en diálisis peritoneal, sin observarse un potencial beneficio para prevenir la infección en los pacientes en diálisis domiciliaria. La edad avanzada y la transmisión nosocomial fueron los principales factores relacionados con peor pronóstico.
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Affiliation(s)
- María Maldonado
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España.
| | - Marta Ossorio
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación La Paz (IdiPAZ), Madrid, España
| | - Gloria Del Peso
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación La Paz (IdiPAZ), Madrid, España; Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, España
| | - Carlos Santos
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España
| | - Laura Álvarez
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación La Paz (IdiPAZ), Madrid, España
| | - Rafael Sánchez-Villanueva
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación La Paz (IdiPAZ), Madrid, España
| | - Begoña Rivas
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación La Paz (IdiPAZ), Madrid, España; Departamento de Nefrología, Universidad Autónoma de Madrid, Madrid, España
| | - Cristina Vega
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación La Paz (IdiPAZ), Madrid, España; Departamento de Nefrología, Universidad Autónoma de Madrid, Madrid, España
| | - Rafael Selgas
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación La Paz (IdiPAZ), Madrid, España; Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, España; Departamento de Nefrología, Universidad Autónoma de Madrid, Madrid, España
| | - María A Bajo
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación La Paz (IdiPAZ), Madrid, España; Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, España; Departamento de Nefrología, Universidad Autónoma de Madrid, Madrid, España
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13
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Abstract
The coronavirus disease 2019 pandemic has had a significant impact on patients with end-stage kidney disease and their care, especially given the potential for severe coronavirus disease 2019 in those with a depressed immune status. Patients receiving in-center hemodialysis have been particularly affected by this pandemic because of their need to travel multiple times a week to receive treatment. Although patients on home dialysis are able to avoid such exposure, they face their own unique challenges. In this review, we will discuss the challenges posed by the coronavirus disease 2019 pandemic for patients on home dialysis, the impact of coronavirus disease 2019 on various aspects of their care, and the resultant rapid adaptations in policy/health-care delivery mechanisms with implications for the future care of patients on home dialysis.
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Affiliation(s)
- Preethi Yerram
- Division of Nephrology, Department of Medicine, University of Missouri, Columbia, MO.
| | - Madhukar Misra
- Division of Nephrology, Department of Medicine, University of Missouri, Columbia, MO
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14
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Bonenkamp AA, van Eck van der Sluijs A, Hoekstra T, Verhaar MC, van Ittersum FJ, Abrahams AC, van Jaarsveld BC. Health-Related Quality of Life in Home Dialysis Patients Compared to In-Center Hemodialysis Patients: A Systematic Review and Meta-analysis. Kidney Med 2020; 2:139-154. [PMID: 32734235 PMCID: PMC7380444 DOI: 10.1016/j.xkme.2019.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Indexed: 02/06/2023] Open
Abstract
RATIONALE & OBJECTIVE Dialysis patients judge health-related quality of life (HRQoL) as an essential outcome. Remarkably, little is known about HRQoL differences between home dialysis and in-center hemodialysis (HD) patients worldwide. STUDY DESIGN Systematic review and meta-analysis. SETTING & STUDY POPULATIONS Search strategies were performed on the Cochrane Library, Pubmed, and EMBASE databases between 2007 and 2019. Home dialysis was defined as both peritoneal dialysis and home HD. SELECTION CRITERIA FOR STUDIES Randomized controlled trials and observational studies that compared HRQoL in home dialysis patients versus in-center HD patients. DATA EXTRACTION The data extracted by 2 authors included HRQoL scores of different questionnaires, dialysis modality, and subcontinent. ANALYTICAL APPROACH Data were pooled using a random-effects model and results were expressed as standardized mean difference (SMD) with 95% CIs. Heterogeneity was explored using subgroup analyses. RESULTS Forty-six articles reporting on 41 study populations were identified. Most studies were cross-sectional in design (90%), conducted on peritoneal dialysis patients (95%), and used the 12-item or 36-item Short-Form Health Survey questionnaires (83%). More than half the studies showed moderate or high risk of bias. Pooled analysis of 4,158 home dialysis patients and 7,854 in-center HD patients showed marginally better physical HRQoL scores in home dialysis patients compared with in-center HD patients (SMD, 0.14; 95% CI, 0.04 to 0.24), although heterogeneity was high (I 2>80%). In a subgroup analysis, Western European home dialysis patients had higher physical HRQoL scores (SMD, 0.39; 95% CI, 0.17 to 0.61), while home dialysis patients from Latin America had lower physical scores (SMD, -0.20; 95% CI, -0.28 to -0.12). Mental HRQoL showed no difference in all analyses. LIMITATIONS No randomized controlled trials were found and high heterogeneity among studies existed. CONCLUSIONS Although pooled data showed marginally better physical HRQoL for home dialysis patients, the quality of design of the included studies was poor. Large prospective studies with adequate adjustments for confounders are necessary to establish whether home dialysis results in better HRQoL. TRIAL REGISTRATION PROSPERO 95985.
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Affiliation(s)
- Anna A. Bonenkamp
- Department of Nephrology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | | | - Tiny Hoekstra
- Department of Nephrology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Marianne C. Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frans J. van Ittersum
- Department of Nephrology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Alferso C. Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Brigit C. van Jaarsveld
- Department of Nephrology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
- Diapriva Dialysis Center, Amsterdam, the Netherlands
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15
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Choi SJ, Obi Y, Ko GJ, You AS, Eriguchi R, Wang M, Rhee CM, Kalantar-Zadeh K. Comparing Patient Survival of Home Hemodialysis and Peritoneal Dialysis Patients. Am J Nephrol 2020; 51:192-200. [PMID: 31991403 DOI: 10.1159/000504691] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/03/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is not clear whether peritoneal dialysis (PD) and home hemodialysis (HHD) have similar outcomes, and little is known about how mortality associated with HHD versus PD differs according to the duration of dialysis. METHODS We examined a national cohort of incident end-stage renal disease patients that was comprised of 1,993 and 16,514 patients transitioning to HHD and PD, respectively, from 2007 to 2011. The HHD patients were matched with PD patients using propensity score (PS). Demographics, comorbidities, duration of dialysis, and body mass index were adjusted for in logistic regression models using PS matching. We matched 1,915 HHD patients with 1,915 PD patients based on the PS. The patients were categorized by their vintage (duration of dialysis) at the time of the transition to HHD or PD (<3, 3 to <12, and ≥12 months). RESULTS In the matched cohort, 237 and 359 deaths occurred in the HHD and PD patients, respectively (cumulative incidence 9.6 vs. 12.9/100 patient-years, p < 0.001). PD patients who transitioned within 12 months of starting dialysis had similar mortality risks, while PD patients who transitioned >12 months after starting dialysis had an 83% higher risk for mortality (hazard ratio 1.83; 95% CI 1.33-2.52). CONCLUSIONS Whereas there was no meaningful survival difference in the first 12 months between HHD and PD, patients who transitioned to PD after 12 months of dialysis had worse survival than their HHD counterparts. Additional studies are warranted to investigate clinical implications of these differences.
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Affiliation(s)
- Soo Jeong Choi
- Division of Nephrology and Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Yoshitsugu Obi
- Division of Nephrology and Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Gang Jee Ko
- Division of Nephrology and Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Amy S You
- Division of Nephrology and Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Rieko Eriguchi
- Division of Nephrology and Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Mengjing Wang
- Division of Nephrology and Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
- Division of Nephrology, Department of Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Connie M Rhee
- Division of Nephrology and Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA,
- Fielding School of Public Health at University of California-Los Angeles, Los Angeles, California, USA,
- Section of Nephrology, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California, USA,
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16
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Nadeau-Fredette AC, Chan CT, Bargman JM, Copland MA, Finkle SN, Oliver MJ, Pauly RP, Perl J, Shah NA, Zimmerman DL, Tennankore KK. Predictors of Care Gaps in Home Dialysis: The Home Dialysis Virtual Ward Study. Am J Nephrol 2019; 50:392-400. [PMID: 31600760 DOI: 10.1159/000503439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/11/2019] [Accepted: 09/01/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Home dialysis patients may be at an increased risk of adverse events after transitional states. The home dialysis virtual ward (HDVW) trial was conducted in Canadian dialysis centers and aimed to evaluate potential care gaps and patient satisfaction during the HDVW. METHODS The HDVW was a multicenter single-arm trial including peritoneal dialysis and home hemodialysis patients after 4 different events (hospital discharge, medical procedure, antibiotics, completion of training). Telephone-led interviews using a standardized assessment tool were performed over a 2-week period to assess a patient's care and adjust treatment as required. Upon completion, patients were surveyed to evaluate their perceived impact on domains of care using a rating scale; 1 not satisfied to 10 completely satisfied. RESULTS The HDVW trial included 193 patients with a median number of potential care gaps/interventions of 1 (0-2) per patient. Patients admitted to the HDVW after hospital discharge were at a higher risk of potential gaps in care (OR 2.16, 95% CI 1.29-3.62), while longer dialysis vintage was -associated with a lower number of gaps/interventions (OR 0.97 per year, 95% CI 0.95-0.98). A total of 105/193 (54%) patients completed satisfaction surveys. Patients were highly satisfied with the HDVW (median rating scale score 8, IQR 2) and felt it had a positive impact (rating scale score ≥7) on their overall health, understanding of treatment and access to a nephrologist. CONCLUSION The HDVW was effective at identifying several potential care gaps, and patients were satisfied across several domains of care. This intervention may be valuable in supporting home dialysis patients during care transitions.
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Affiliation(s)
| | - Christopher T Chan
- University Health Network/Toronto General Hospital, Toronto, Ontario, Canada
| | - Joanne M Bargman
- University Health Network/Toronto General Hospital, Toronto, Ontario, Canada
| | | | - S Neil Finkle
- Dalhousie University/Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | | | | | - Jeffrey Perl
- St. Michael's Hospital, Toronto, Ontario, Canada
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17
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van Eck van der Sluijs A, Bonenkamp AA, Dekker FW, Abrahams AC, van Jaarsveld BC. Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes (DOMESTICO): rationale and design. BMC Nephrol 2019; 20:361. [PMID: 31533665 PMCID: PMC6751675 DOI: 10.1186/s12882-019-1526-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 07/16/2019] [Accepted: 08/16/2019] [Indexed: 12/18/2022] Open
Abstract
Background More than 6200 End Stage Renal Disease patients in the Netherlands are dependent on dialysis, either performed at home or in a dialysis centre. Visiting a dialysis centre three times a week is considered a large burden by many patients. However, recent data regarding the effects of dialysis at home on quality of life, clinical outcomes, and costs compared with in-centre haemodialysis are lacking. Methods The Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes (DOMESTICO) is a nationwide, prospective, observational cohort study that will include adult patients starting with a form of dialysis. Health-related quality of life, as the primary outcome, clinical outcomes and costs, as secondary outcomes, will be measured every 3–6 months in patients on home dialysis, and compared with a control group consisting of in-centre haemodialysis patients. During a 3-year period 800 home dialysis patients (600 peritoneal dialysis and 200 home haemodialysis patients) and a comparison group of 800 in-centre haemodialysis patients will be included from 53 Dutch dialysis centres (covering 96% of Dutch centres) and 1 Belgian dialysis centre (covering 4% of Flemish centres). Discussion DOMESTICO will prospectively investigate the effect of home dialysis therapies on health-related quality of life, clinical outcomes and costs, in comparison with in-centre haemodialysis. The findings of this study are expected to ameliorate the shared decision-making process and give more guidance to healthcare professionals, in particular to assess which type of patients may benefit most from home dialysis. Trial registration The DOMESTICO study is registered with the National Trial Register on (number: NL6519, date of registration: 22 August 2017) and the Central Committee on Research Involving Human Subjects (CCMO) (number: NL63277.029.17). Electronic supplementary material The online version of this article (10.1186/s12882-019-1526-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A van Eck van der Sluijs
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A A Bonenkamp
- Department of Nephrology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - F W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - A C Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B C van Jaarsveld
- Department of Nephrology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Diapriva Dialysis Center, Amsterdam, The Netherlands.
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18
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Guerrero Riscos MA, Toro Prieto FJ, Batalha Caetano P, Salgueira Lazo M, González Cabrera F, Marrero Robayna S, Santana Estupiñán R, Álvarez Martín C. Advanced chronic renal failure (ACRF) study. Baseline characteristics, evaluation of the application of the structured information for the election of renal replacement therapy and one-year evolution of the incident patients in the ACRF medical office. Nefrologia 2019; 39:629-637. [PMID: 31027895 DOI: 10.1016/j.nefro.2019.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 06/26/2018] [Revised: 01/26/2019] [Accepted: 02/20/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Analyze evolution Renal Chronic Failure stage 4-5 (ACRF) patients and influence information they receive (educational process, EP) in modality Renal Replacement Therapy (RRT) or conservative treatment (CT) in multidisciplinar ACRF Office. MATERIAL AND METHODS Prospective, multicenter study (3 centers). Inclusion: from June-01-2014 to October-01-2015; observation: 12 months or until start RRT or death if they occur before 12 months; ends October-01-2016. RESULTS 336 patients were included (60% males), median and intercuartile rank 71.5 (17), 55% ≥ 70 years; Follow up initiation eGFR CKD-EPI: 21 (9) ml / min / 1.73m2; Charlson Index (ChI) with / without age 8 (3) / 4 (2); Diabetic patients: 52,4%. The EP was carried out in 168, eGFR 15 (10) ml / min / 1.73m2. The initial treatment election: 26% peritoneal dialysis (PD), 45% hemodyalisis (HD), 26% CT, kidney trasplant 3%; 60 patients started RRT: 3.3% kidney traspant; 30% PD, 66% HD; 104 admissions in 73 patients, the most frequent cause: cardiovascular disease (42%). Fallecimiento: 23 patients (6.8%). Age was higher (78.4 (6) vs. 67.8 (13.4), P<.001), higher ChI 9.8 (2.1) vs. 7.4 (2.5), P<.001). All deceased who received EP had chosen CT; 61% of deceased had at least one hospital admission vs. 39% alive (P<0.001). Cox regression: age and Charlson index were the predictive mortality variables. CONCLUSIONS The population of ACRF patients is elder, comorbid, with high rate hospitalizations rate. The PD election is higher than usual. The EP has been very useful tool and has favored the PD choice.
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Affiliation(s)
| | | | | | | | - Fayna González Cabrera
- Servicio de Nefrología, Hospital Universitario Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | - Silvia Marrero Robayna
- Servicio de Nefrología, Hospital Universitario Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | - Raquel Santana Estupiñán
- Servicio de Nefrología, Hospital Universitario Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
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19
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Abstract
The leaders of 20th century kidney failure treatment took chances; 21st century leaders of integrated kidney care must do the same. Some risks are clinical, some are organizational, and some are financial. Decent and constructive leadership entails humility. A working practitioner is a better leader. Effective leaders empower their employees and collaborators to lead and encourage them to work together. Integrated kidney care leadership supports exchange of ideas within and among organizations, uninhibited by competitive considerations. ESRD Seamless Care Organizations lead us toward the kidney care of the future; they will be strengthened by expansion to include patients who have advanced kidney disease not yet requiring renal replacement therapy and patients treated by transplant. Adjustment of reimbursement policy to realign incentives will be essential to the long-term success of care coordination. Population health management, with downside risk for participating organizations, is the future of integrated kidney care. Critical goals for integrated kidney care are to delay or avoid dialysis; increase use of home dialysis, transplantation, nondialytic care, and hospice; and to improve end of life care. It's about the patients, stupid.
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Thumfart J, Müller D, Wagner S, Jayanti A, Borzych-Duzalka D, Schaefer F, Warady B, Schmitt CP. Barriers for implementation of intensified hemodialysis: survey results from the International Pediatric Dialysis Network. Pediatr Nephrol 2018; 33:705-712. [PMID: 29103152 DOI: 10.1007/s00467-017-3831-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 07/13/2017] [Revised: 09/20/2017] [Accepted: 10/13/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND In patients on conventional hemodialysis (HD), morbidity is high and quality of life is poor. Intensified HD programs have been developed to help overcome these shortcomings, , but very few pediatric dialysis centers have reported the implementation of such a HD program. METHODS An online survey was sent to all 221 pediatric dialysis centers which participate in the International Pediatric Dialysis Network (IPDN). The aim of the survey was to assess the attitude of pediatric nephrologists towards intensified HD, the penetrance of intensified HD into their clinical practice and barriers to implementation. RESULTS Of the 221 pediatric dialysis centers sent the survey, respondents from 61% (134) replied. Among these respondents, 69% acknowledged being aware of the evidence in support of the use of intensified HD, independent of whether intensified HD was offered at their own center, and 50% associated the use of daily nocturnal HD with the best overall patient outcome. In contrast, only 2% of respondents were in favor of conventional HD. Overall, 38% of the respondents stated that at their center intensified HD is prescribed to a subgroup of patients, most commonly in the form of short daily HD sessions. The most important barriers to expansion of intensified HD programs were lack of adequate funding (66%) and shortage of staff (63%), whereas lack of expertise and of motivation were reported infrequently as obstacles (21 and 14%, respectively). CONCLUSION Intensified HD is considered by many pediatric nephrologists to be the dialysis modality most likely associated with the best patient outcome. The limited use of this treatment approach highlights the importance of defining and successfully addressing the barriers to implementation.
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Affiliation(s)
- Julia Thumfart
- Department of Pediatric Nephrology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Dominik Müller
- Department of Pediatric Nephrology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | | | - Anuradha Jayanti
- Manchester Institute of Nephrology & Transplantation, Manchester Royal Infirmary, Manchester, UK
| | - Dagmara Borzych-Duzalka
- Department Pediatrics, Nephrology & Hypertension, Medical University of Gdansk, Gdansk, Poland
| | - Franz Schaefer
- Department of Pediatric Nephrology, University Hospital for Pediatric and Adolescent Medicine, Heidelberg, Germany
| | - Bradley Warady
- Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Claus Peter Schmitt
- Department of Pediatric Nephrology, University Hospital for Pediatric and Adolescent Medicine, Heidelberg, Germany
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Krishna VN, Managadi K, Smith M, Wallace E. Telehealth in the Delivery of Home Dialysis Care: Catching up With Technology. Adv Chronic Kidney Dis 2017; 24:12-16. [PMID: 28224937 DOI: 10.1053/j.ackd.2016.11.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/15/2016] [Accepted: 11/15/2016] [Indexed: 11/11/2022]
Abstract
Geographic and socioeconomic barriers may pose a significant difficulty in delivering home dialysis care to remote underserved populations leading to low utilization rates and poor outcomes. Telehealth may serve as a solution to overcome geographic barriers in delivering home dialysis care. Although technologic advances in telehealth have progressed rapidly making it accessible and inexpensive, it has been underused by nephrologists. Components of a regular face-to-face visit that can be successfully accomplished remotely using telehealth techniques include physician-patient communication, physical examination, laboratory and treatment data monitoring, nursing and nutrition education. Regulatory and reimbursement-related policies continue to present barriers that need to be overcome in operationalizing telehealth and widespread adoption of telehealth solutions. Although more quality evidence is needed to study the impact of telehealth on home dialysis outcomes and uptake, telehealth holds the promise of increasing access to care, improving quality of life, and improving quality of care for current and would be home dialysis patients.
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Abstract
At our institution, we have noted that end-stage renal disease patients choosing a home dialysis modality after education often initiate renal replacement therapy with in-center hemodialysis (HD) instead. We interviewed 24 such patients (23 choosing peritoneal dialysis [PD], one choosing home HD) to determine reasons for this mismatch. The most common reasons cited for not starting home dialysis were: lack of confidence/concerns about complications, lack of space or home-related issues, a feeling of insufficient education, and perceived medical or social contraindications. We propose several potential strategies to help patients start with their preferred modality.
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Affiliation(s)
| | - Scott Liebman
- University of Rochester Medical Center, Rochester, NY
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23
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Harvey A, Walsh M, Jain AK, Bosch E, Moreau C, Garland J, Brimble KS. The WISHED Trial: implementation of an interactive health communication application for patients with chronic kidney disease. Can J Kidney Health Dis 2016; 3:29. [PMID: 27307996 PMCID: PMC4908673 DOI: 10.1186/s40697-016-0120-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 12/29/2015] [Accepted: 04/19/2016] [Indexed: 11/25/2022] Open
Abstract
Background Despite many advantages over facility-based therapies, less than 25 % of prevalent dialysis patients in Ontario are on a home therapy. Interactive health communication applications, web-based packages for patients, have been shown to have a beneficial effect on knowledge, social support, self-efficacy, and behavioral and clinical outcomes but have not been evaluated in patients with chronic kidney disease (CKD). Web-based tools designed for patients with CKD exist but to our knowledge have not been assessed in their ability to influence dialysis modality decision-making. Objective To determine if a web-based tool increases utilization of a home-based therapy in patients with CKD starting dialysis. Design This is a multi-centered randomized controlled study. Setting Participants will be recruited from sites in Canada. Participants Two hundred and sixty-four consenting patients with an estimated glomerular filtration rate (eGFR) less than 20 ml/min/1.73 m2 who have received modality education will be enrolled in the study. Measurements The primary outcome will be the proportion of participants who are on dialysis using a home-based therapy within 3 months of dialysis initiation. Secondary outcomes will include the proportion of patients intending to perform a home-based modality and measures of dialysis knowledge, decision conflict, and social support. Methods The between-group differences in frequencies will be expressed as either absolute risk differences and/or by calculating the odds ratio and its associated 95 % confidence interval. Conclusions This study will assess whether access to a website dedicated to supporting and promoting home-based dialysis therapies will increase the proportion of patients with CKD who initiate a home-based dialysis therapy. Trial registration ClinicalTrials.gov #NCT01403454, registration date: July 21, 2011. Electronic supplementary material The online version of this article (doi:10.1186/s40697-016-0120-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Michael Walsh
- Division of Nephrology, McMaster University, Hamilton, ON Canada
| | - Arsh K Jain
- Division of Nephrology, University of Western Ontario, London, ON Canada
| | - Eric Bosch
- Division of Nephrology, McMaster University, Hamilton, ON Canada
| | - Cathy Moreau
- Division of Nephrology, McMaster University, Hamilton, ON Canada
| | - Jocelyn Garland
- Division of Nephrology, Queen's University, Kingston, ON Canada
| | - K Scott Brimble
- McMaster University, 50 Charlton Ave. E, Hamilton, ON L8N 4A6 Canada
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Harel Z, Silver SA, McQuillan RF, Weizman AV, Thomas A, Chertow GM, Nesrallah G, Chan CT, Bell CM. How to Diagnose Solutions to a Quality of Care Problem. Clin J Am Soc Nephrol 2016; 11:901-907. [PMID: 27016495 PMCID: PMC4858489 DOI: 10.2215/cjn.11481015] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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: 11/23/2022]
Abstract
To change a particular quality of care outcome within a system, quality improvement initiatives must first understand the causes contributing to the outcome. After the causes of a particular outcome are known, changes can be made to address these causes and change the outcome. Using the example of home dialysis (home hemodialysis and peritoneal dialysis), this article within this Moving Points feature on quality improvement will provide health care professionals with the tools necessary to analyze the steps contributing to certain outcomes in health care quality and develop ideas that will ultimately lead to their resolution. The tools used to identify the main contributors to a quality of care outcome will be described, including cause and effect diagrams, Pareto analysis, and process mapping. We will also review common change concepts and brainstorming activities to identify effective change ideas. These methods will be applied to our home dialysis quality improvement project, providing a practical example that other kidney health care professionals can replicate at their local centers.
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Affiliation(s)
- Ziv Harel
- Division of Nephrology, St. Michael’s Hospital
- Keenan Research Center, Li Ka Shing Knowledge Institute of St. Michael’s Hospital
| | | | - Rory F. McQuillan
- Division of Nephrology, University Health Network, Toronto General Hospital
| | | | | | - Glenn M. Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
| | - Gihad Nesrallah
- Keenan Research Center, Li Ka Shing Knowledge Institute of St. Michael’s Hospital
- Department of Nephrology, Humber River Regional Hospital, Toronto, Ontario, Canada
| | | | - Chaim M. Bell
- Department of Medicine, Mount Sinai Hospital, and
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Gorrin MR, Teruel-Briones JL, Vion VB, Rexach L, Quereda C. Palliative peritoneal dialysis: Implementation of a home care programme for terminal patients treated with peritoneal dialysis (PD). Nefrologia 2015; 35:146-9. [PMID: 26300507 DOI: 10.1016/j.nefro.2015.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 07/08/2014] [Accepted: 10/21/2014] [Indexed: 10/23/2022] Open
Abstract
Terminal-stage patients on peritoneal dialysis (PD) are often transferred to haemodialysis as they are unable to perform the dialysis technique themselves since their functional capacities are reduced. We present our experience with five patients on PD with a shortterm life-threatening condition, whose treatment was shared by primary care units and who were treated with a PD modality adapted to their circumstances, which we call Palliative Peritoneal Dialysis.
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Affiliation(s)
| | | | | | - Lourdes Rexach
- Cuidados Paliativos. Hospital Ramón y Cajal. IRYCIS. Madrid (España)
| | - Carlos Quereda
- Nefrología. Hospital Ramón y Cajal. IRYCIS. Madrid (España)
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Schick-Makaroff K, Molzahn A. Brief communication: patient satisfaction with the use of tablet computers: a pilot study in two outpatient home dialysis clinics. Can J Kidney Health Dis 2014; 1:22. [PMID: 25960887 PMCID: PMC4424498 DOI: 10.1186/s40697-014-0022-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/08/2014] [Indexed: 11/23/2022] Open
Abstract
Background Electronic capture of patients’ reports of their health is significant in clinical nephrology research because health-related quality of life (HRQOL) for patients with end-stage renal disease is compromised and assessment by patients of their HRQOL in practice is relatively uncommon. Objective The purpose of this study was to evaluate patient satisfaction with and time involved in administering HRQOL and symptom assessment measures using tablet computers in two outpatient home dialysis clinics. Design A cross-sectional observational study design was employed. Setting The study was conducted in two home dialysis clinics. Patients Fifty-six patients participated in the study; 35 males (63%) and 21 females (37%) with a mean age of 66 ± 12 (36-90 years old) were included. Forty-nine participants were on peritoneal dialysis (87%), 6 on home hemodialysis (11%), and 1 on nocturnal home hemodialysis (2%). Measurements Measures included the Kidney Disease Quality of Life-36 (KDQOL-36), the Edmonton Symptom Assessment Scale (ESAS) and Participant’s Level of Satisfaction in Using a Tablet Computer. Methods Using a tablet computer, participants completed the three measures. Descriptive statistics and bivariate correlations were calculated. Results Participants’ satisfaction with use of the tablet computer was high; 66% were “very satisfied”, 7% “satisfied”, 2% “slightly satisfied”, and 18% “neutral”. On the 7-point Likert-type scale, the mean satisfaction score was 5.11 (SD = 1.6). Mean time to complete the measures was: Level of Satisfaction 1.15 minutes (SD = 0.41), ESAS 2.55 minutes (SD = 1.04), and KDQOL 9.56 minutes (SD = 2.03); the mean time to complete all three instruments was 13.19 minutes (SD = 2.42). There were no significant correlations between level of satisfaction and age, gender, HRQOL, time taken to complete surveys, computer experience, or comfort with technology. Comfort with technology and computer experience were highly correlated, r = .7, p (one-tailed) < 0.01. Limitations Limitations include lack of generalizability because of a small self-selected sample of relatively healthy patients and a lack of psychometric testing on the measure of satisfaction. Conclusions Participants were satisfied with the platform and the time involved for completion of instruments was modest. Routine use of HRQOL measures for clinical purposes may be facilitated through use of tablet computers.
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Affiliation(s)
- Kara Schick-Makaroff
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, AB, T6G 1C9 Canada
| | - Anita Molzahn
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, AB, T6G 1C9 Canada
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Abstract
Home dialysis modalities are underutilized in the USA with only 8% of the dialysis patients undergoing renal replacement therapy at home versus 92% being treated with center hemodialysis. This is in contrast to the nephrology professionals’ opinion about the best dialysis therapy and their potential choice in the hypothetical situation of choosing a dialysis modality for themselves. Pre-dialysis education changes the distribution of dialysis modality significantly, as 50% of informed patients choose home dialysis. Close collaboration among nephrology professionals, patients and providers is required to make home therapy a reality for any interested patient.
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Affiliation(s)
- Brigitte Schiller
- Satellite Healthcare, Department of Research, San Jose, CA, USA ; Department of Medicine, Division of Nephrology, Stanford University, School of Medicine, Stanford, CA, USA
| | - Hayley Munroe
- Satellite Healthcare, Department of Research, San Jose, CA, USA
| | - Andrea Neitzer
- Satellite Healthcare, Department of Research, San Jose, CA, USA
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