scholarly journals Choice of dialysis modality among patients initiating dialysis: results of the peridialysis study

2020 ◽  
Author(s):  
James Heaf ◽  
Maija Heiro ◽  
Aivars Petersons ◽  
Baiba Vernere ◽  
Johan V Povlsen ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Acute Illness ◽  
Dialysis Modality ◽  
Personal Choice ◽  
Rapid Loss ◽  
Home Dialysis ◽  
Home Haemodialysis ◽  
High Age ◽  
End Stage ◽  
Late Referral

Abstract Background In patients with end-stage kidney disease (ESKD), home dialysis offers socioeconomic and health benefits compared to in-centre dialysis but is generally underutilized. We hypothesized that pre-dialysis course and institutional factors affect choice of dialysis modality after dialysis initiation (DI). Methods The Peridialysis study is a multinational, multicentre prospective observational study assessing the causes and timing of DI and consequences of suboptimal DI. Clinical and biochemical data, details of the pre-dialytic course, reasons for DI and causes of choice of dialysis modality were registered. Results Among 1587 included patients, 516 (32.5%) were judged unsuitable for home dialysis due to contraindications (384; 24.2%) or no assessment (106; 6.7%; mainly due to late referral and/or suboptimal DI) or death (26; 1.6%). High age, comorbidity, late referral, suboptimal DI, acute illness, and rapid loss of renal function associated with unsuitability. Of the remaining 1071 patients, 700 (65.4%) chose peritoneal dialysis (61.7%) or home haemodialysis (3.6%), while 371 (34.6%) chose in-centre HD. Somatic differences between patients choosing home dialysis and in-centre dialysis were minor; factors linked to choice of in-centre dialysis were late referral, suboptimal DI, acute illness and absence of a “home dialysis first” institutional policy. Conclusions Given a personal choice with shared decision making, 65.4% of ESKD patients choose home dialysis. Our data indicate that the incidence of home dialysis potentially could be further increased to reducing the incidence of late referral and unplanned DI, and, in acutely ill patients, by implementing an educational program after improvement of their clinical condition.

scholarly journals Home-to-home dialysis transition: A 24-year single-centre experience

2021 ◽  
pp. 089686082110292
Author(s):  
Mohamed Ahmed Elbokl ◽  
Claire Kennedy ◽  
Joanne M Bargman ◽  
Marg McGrath-Chong ◽  
Christopher T Chan
Keyword(s):  
Transition Period ◽  
Significant Proportion ◽  
Dialysis Modality ◽  
Home Dialysis ◽  
Technique Survival ◽  
Home Haemodialysis ◽  
Single Centre Experience ◽  
Kidney Replacement Therapy ◽  
Technique Failure

Home dialysis (peritoneal dialysis (PD) and home haemodialysis (HHD)) are ideal options for kidney replacement therapy (KRT). Occasionally, because of technique failure, patients are required to transition out of home dialysis, and the most common option tends to be to in-centre HD. There are few published studies on home-to-home transition (PD to HHD or HHD to PD) and dynamics during the transition period. We present a retrospective review of 28 patients who transitioned from a home-to-home dialysis modality at our centre over a 24-year period. We observed a total of 911 home dialysis patients with technique failure (826 PD patients and 85 HHD patients) with only 28 patients (3% of the total with technique failure) having successful home-to-home transition. During the transition period, 11 patients (39%) were hospitalized and 13 patients (46%) required variable periods of in-centre HD. After a median follow-up of 48 months following dialysis modality transition, four patients switched to in-centre HD permanently (home dialysis technique survival of 86% censored for death and kidney transplantation) and four patients died resulting in a patient survival of 86% (censored for switch to in-centre HD and transplantation). In our centre, home-to-home transition is a feasible strategy with comparable patient and technique survival. A significant proportion of patients switching from a home-to-home dialysis modality required variable intervals of hospitalization and in-centre HD during transitions. Future efforts should be directed towards assessment and home dialysis education during the entire process of dialysis transition.

scholarly journals Why and how should we promote home dialysis for patients with end-stage kidney disease during and after the coronavirus 2019 disease pandemic? A French perspective

2021 ◽  
Author(s):  
Guy Rostoker ◽  
Belkacem Issad ◽  
Hafedh Fessi ◽  
Ziad A. Massy
Keyword(s):  
Kidney Disease ◽  
Scientific Data ◽  
Dialysis Patients ◽  
End Stage Kidney Disease ◽  
Health Crisis ◽  
Home Dialysis ◽  
Objective Information ◽  
Home Haemodialysis ◽  
Renal Replacement Therapies ◽  
End Stage

AbstractThe health crisis induced by the pandemic of coronavirus 2019 disease (COVID-19) has had a major impact on dialysis patients in France. The incidence of infection with acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first wave of the COVID-19 epidemic was 3.3% among dialysis patients—13 times higher than in the general population. The corresponding mortality rate was high, reaching 21%. As of 19th April, 2021, the cumulative prevalence of SARS-CoV-2 infection in French dialysis patients was 14%. Convergent scientific data from France, Italy, the United Kingdom and Canada show that home dialysis reduces the risk of SARS-CoV-2 infection by a factor of at least two. Unfortunately, home dialysis in France is not sufficiently developed: the proportion of dialysis patients being treated at home is only 7%. The obstacles to the provision of home care for patients with end-stage kidney disease in France include (i) an unfavourable pricing policy for home haemodialysis and nurse visits for assisted peritoneal dialysis (PD), (ii) insufficient training in home dialysis for nephrologists, (iii) the small number of administrative authorizations for home dialysis programs, and (iv) a lack of structured, objective information on renal replacement therapies for patients with advanced chronic kidney disease (CKD). We propose a number of pragmatic initiatives that could be simultaneously enacted to improve the situation in three areas: (i) the provision of objective information on renal replacement therapies for patients with advanced CKD, (ii) wider authorization of home dialysis networks and (iii) price increases in favour of home dialysis procedures.

P1137FACTORS DETERMINING CHOICE OF DIALYSISI MODALITY AMONG PATIENTS INITIATING DIALYSIS. RESULTS OF THE PERIDIALYSIS STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
James G Heaf ◽  
Maija Heiro ◽  
Aivars Petersons ◽  
Baiba Vernere ◽  
Johan Vestergaard Povlsen ◽  
...  
Keyword(s):  
Free Choice ◽  
University Hospital ◽  
Institutional Factors ◽  
Dialysis Modality ◽  
Home Dialysis ◽  
Factors Associated ◽  
Reactive Protein ◽  
Unplanned Dialysis ◽  
Late Referral ◽  
Socioeconomic Benefits

Abstract Background and Aims Home dialysis with peritoneal dialysis (PD) or home hemodialysis (HD) has medical and socioeconomic benefits but home dialysis is generally underutilized. While many factors determine choice of initial dialysis modality, starting patients on home dialysis requires timely planning, educational activities and an active program to promote home dialysis. Here we investigated factors including patient suitability, pre-dialysis preparations and institutional factors determining choice of dialysis modality among patients initiating dialysis. Method Choice of dialysis modality was investigated in 1588 consecutive patients (age 63.8 ±15.3 years. 35.8% female; diabetic nephropathy 24.4%) participating in the Peridialysis study, a multinational multi-centre prospective study of causes and timing of planned and unplanned dialysis initiation (DI) over a 3-year period in 15 Nordic and Baltic nephrology departments. All dialysis modalities were available and free of charge to patients. All centres offered pre-dialysis education programs to patients with timely referral. Clinical and biochemical data during the pre-dialytic period, centre data, and reasons for DI and choice of dialysis modality were registered. Results: 516 (32.4%) patients were not offered home dialysis because they were judged to be unsuitable (384; 24%): PD was contraindicated in 338 (21.2%) patients - for physical (142; 8.9%), mental (80, 5.0%) or abdominal (116; 7.3%) reasons and HD was contraindicated in 46 (2.9%) patients. In addition, 106 (6.7%) were not offered home dialysis for various reasons; and deaths before modality choice occurred in 26 (1.6%) patients. Factors associated with unsuitability were high age, comorbidity, late referral (risk ratio, RR, 1.9), inflammation (C-reactive protein >50 mg/L (RR 2.6) and rapid loss of renal function (RR 2.0). Patients who were not assessed for home dialysis comprised mainly patients with late referral (RR 5.8) and/or unplanned DI (RR 9.6). Of the remaining 1072 (67.6%) patients, who had a free choice of modality, 700 (65.3%) chose home dialysis, either PD (661; 61.7%) or home HD ( 39 3.6%) while 372 (34.7%) patients chose centre HD. Factors associated with choice of centre dialysis were late referral (RR 1.8), suboptimal DI (RR 2.0), symptomatic uraemia (RR 1.6) and p-urea >30 mM (2.6). Somatic differences between patients choosing home dialysis and centre dialysis were minor. Independent institutional factors reducing information about home dialysis were treatment at a university hospital (RR 4.3) and absence of an active preference for home dialysis, “home dialysis first” policy (RR 3.0). Conclusion The results of the Peridialysis study indicate that the incidence of home dialysis could be increased by a “home dialysis first” department policy and by efforts to reduce the incidence of late referrals and unplanned DI. Acutely ill patients and patients with unplanned DI may be candidates for home dialysis if assessment of home dialysis suitability and dialysis educational program are performed after their clinical condition has improved. Given a free choice, most patients (65%) choose home dialysis.

scholarly journals A Qualitative Assessment of Mismatch between Dialysis Modality Selection and Initiation

2016 ◽  
Vol 36 (4) ◽  
pp. 463-466 ◽  
Author(s):  
Susan Ziolkowski ◽  
Scott Liebman
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Renal Disease ◽  
Replacement Therapy ◽  
End Stage Renal Disease ◽  
Qualitative Assessment ◽  
Dialysis Modality ◽  
Home Dialysis ◽  
Stage Renal Disease ◽  
End Stage

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.

scholarly journals P1448FACTORS ASSOCIATED WITH INCREASED MORTALITY AFTER DIALYSIS INITIATION. RESULTS OF THE PERIDIALYSIS STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
James G Heaf ◽  
Maija Heiro ◽  
Aivars Petersons ◽  
Baiba Vernere ◽  
Johan Vestergaard Povlsen ◽  
...  
Keyword(s):  
Free Choice ◽  
Dialysis Initiation ◽  
University Hospital ◽  
Institutional Factors ◽  
Dialysis Modality ◽  
Home Dialysis ◽  
Factors Associated ◽  
Reactive Protein ◽  
Late Referral ◽  
Socioeconomic Benefits

Abstract Background and Aims Home dialysis with peritoneal dialysis (PD) or home hemodialysis (HD) has medical and socioeconomic benefits but home dialysis is generally underutilized. While many factors determine choice of initial dialysis modality, starting patients on home dialysis requires timely planning, educational activities and an active program to promote home dialysis. Here we investigated factors including patient suitability, pre-dialysis preparations and institutional factors determining choice of dialysis modality among patients initiating dialysis. Method Choice of dialysis modality was investigated in 1588 consecutive patients (age 63.8 ±15.3 years. 35.8% female; diabetic nephropathy 24.4%) participating in the Peridialysis study, a multinational multi-centre prospective study of causes and timing of planned and unplanned dialysis initiation (DI) over a 3-year period in 15 Nordic and Baltic nephrology departments. All dialysis modalities were available and free of charge to patients. All centres offered pre-dialysis education programs to patients with timely referral. Clinical and biochemical data during the pre-dialytic period, centre data, and reasons for DI and choice of dialysis modality were registered. Results: 516 (32.4%) patients were not offered home dialysis because they were judged to be unsuitable (384; 24%): PD was contraindicated in 338 (21.2%) patients - for physical (142; 8.9%), mental (80, 5.0%) or abdominal (116; 7.3%) reasons and HD was contraindicated in 46 (2.9%) patients. In addition, 106 (6.7%) were not offered home dialysis for various reasons; and deaths before modality choice occurred in 26 (1.6%) patients. Factors associated with unsuitability were high age, comorbidity, late referral (risk ratio, RR, 1.9), inflammation (C-reactive protein >50 mg/L (RR 2.6) and rapid loss of renal function (RR 2.0). Patients who were not assessed for home dialysis comprised mainly patients with late referral (RR 5.8) and/or unplanned DI (RR 9.6). Of the remaining 1072 (67.6%) patients, who had a free choice of modality, 700 (65.3%) chose home dialysis, either PD (661; 61.7%) or home HD ( 39 3.6%) while 372 (34.7%) patients chose centre HD. Factors associated with choice of centre dialysis were late referral (RR 1.8), suboptimal DI (RR 2.0), symptomatic uraemia (RR 1.6) and p-urea >30 mM (2.6). Somatic differences between patients choosing home dialysis and centre dialysis were minor. Independent institutional factors reducing information about home dialysis were treatment at a university hospital (RR 4.3) and absence of an active preference for home dialysis, “home dialysis first” policy (RR 3.0). Conclusion The results of the Peridialysis study indicate that the incidence of home dialysis could be increased by a “home dialysis first” department policy and by efforts to reduce the incidence of late referrals and unplanned DI. Acutely ill patients and patients with unplanned DI may be candidates for home dialysis if assessment of home dialysis suitability and dialysis educational program are performed after their clinical condition has improved. Given a free choice, most patients (65%) choose home dialysis.

Analysis of 5 year experience of home dialysis as a treatment modality for patients with end-stage renal failure

1974 ◽  
Vol 57 (5) ◽  
pp. 789-799 ◽  
Author(s):  
Pravit Cadnapaphornchai ◽  
K.Chakko Kuruvila ◽  
Joseph Holmes ◽  
Robert W. Schrier
Keyword(s):  
Renal Failure ◽  
Treatment Modality ◽  
Home Dialysis ◽  
End Stage Renal Failure ◽  
End Stage

scholarly journals Neurologic complications after heart transplantation

2002 ◽  
Vol 60 (2A) ◽  
pp. 192-197 ◽  
Author(s):  
Suzana M.F. Malheiros ◽  
Dirceu R. Almeida ◽  
Ayrton R. Massaro ◽  
Adauto Castelo ◽  
Rosiane V.Z. Diniz ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Prospective Observational Study ◽  
Cord Compression ◽  
Orthotopic Heart Transplantation ◽  
Cns Infection ◽  
Neurologic Complications ◽  
Neurologic Disability ◽  
End Stage ◽  
Neurologic Event

OBJECTIVE: Neurologic complications are known as important cause of morbidity and mortality in orthotopic heart transplantation. Our aim was to identify the frequency and outcome of neurologic complications after heart transplantation in a prospective observational study. METHOD: From September 93 to September 99, as part of our routine heart transplantation protocol all patients with end-stage cardiac failure were evaluated by the same neurologist before and at the time of any neurologic event (symptom or complaint) after transplantation. RESULTS: Out of 120 candidates evaluated, 62 were successfully transplanted (53 male; median age 45.5 years, median follow-up 26.8 months). Fifteen patients (24%) had ischemic, 22 (35%) idiopathic, 24 (39%) Chagas' disease and 1 (2%) had congenital cardiomyopathy. Neurologic complications occurred in 19 patients (31%): tremor, severe headache, transient encephalopathy and seizures related to drug toxicity or metabolic changes in 13; peripheral neuropathy in 4; and spinal cord compression in two (metastatic prostate cancer and epidural abscess). No symptomatic postoperative stroke was observed. CONCLUSIONS: Although frequent, neurologic complications were seldom related to persistent neurologic disability or death. Most of the complications resulted from immunosuppression, however, CNS infection was rare. The absence of symptomatic stroke in our series may be related to the lower frequency of ischemic cardiomyopathy.

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