FC 117TIME TRENDS IN PROBABILITY OF STARTING HOME DIALYSIS OVER A 20 YEAR PERIOD: A DUTCH REGISTRY STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Anna Bonenkamp ◽  
Tiny Hoekstra ◽  
Marc Hemmelder ◽  
Anita Van Eck van der Sluijs ◽  
Alferso C Abrahams ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
The Netherlands ◽  
Risk Model ◽  
The Elderly ◽  
Dialysis Patients ◽  
Dialysis Treatment ◽  
Home Dialysis ◽  
System Utilization ◽  
Number Of Patients ◽  
Kidney Transplantations

Abstract Background and Aims A growing number of patients suffers from End Stage Kidney Disease(ESKD), causing a logistical and economic burden to the healthcare system. Utilization of home dialysis is low in many countries worldwide, although home dialysis has several advantages including higher quality of life and possibly lower costs. The aim of this study is to explore time trends in the use of home dialysis in the Netherlands. Method Anonymized registry data from the Dutch Renal Registry (RENINE) were used for this study. All dialysis episodes of adult patients who started dialysis treatment between 1997 through 2016 in the Netherlands were included, including those who previously underwent kidney transplantation. Dialysis episodes shorter than 90 days were excluded. The probability of starting home dialysis between 1997 through 2016 was evaluated in time periods of 5 years, using logistic regression analysis. Home dialysis was defined as start with peritoneal dialysis or home haemodialysis, or transfer to either within 2 years after dialysis start. A logistic multilevel model was used to adjust for clustering at patient level. The cumulative incidence function of start of home dialysis in incident patients was estimated with a competing risk model with recovery of kidney function, kidney transplantations, and all-cause mortality as competing events. All analyses were stratified for age categories at dialysis start: 20-44 years, 45-64 years, 65-74 years and ≥75 years. Results A total of 33,340 dialysis episodes in 31,569 patients were evaluated. Between 1997 and 2016, mean age at start of dialysis treatment increased from 62.5±14.0 to 65.5±14.5 years in in-centre haemodialysis patients, whereas it increased from 51.9±15.1 to 62.5±14.6 years in home dialysis patients. In patients < 65 years, the probability of starting home dialysis was significantly lower during each 5-year period compared to the previous period, and kidney transplantation occurred more often. In patients ≥ 65 years, incidence of home dialysis remained constant, whereas mortality decreased. Conclusion In patients < 65 years, the overall probability of starting home dialysis declined consistently over the past 20 years. The age of home dialysis patients increased more rapidly than that of in-centre dialysis patients, implying that pre-dialysis education and organization of home dialysis must be adapted to the needs of the elderly patient. These developments have a significant impact on the organisation of home dialysis for patients with ESKD.

scholarly journals COVID-19—Importance for Patients on the Waiting List and after Kidney Transplantation—A Single Center Evaluation in 2020–2021

Pathogens ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 429
Author(s):  
Simone C. Boedecker ◽  
Pascal Klimpke ◽  
Daniel Kraus ◽  
Stefan Runkel ◽  
Peter R. Galle ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Waiting List ◽  
Smoking History ◽  
Immunocompromised Patients ◽  
Dialysis Patients ◽  
Vaccination Programs ◽  
Mild Disease ◽  
Probability Of Survival ◽  
Number Of Patients ◽  
Immunosuppressed Patients

(1) Background: Dialysis patients and recipients of a kidney allograft are at high risk for infection with SARS-CoV-2. It has been shown that the development of potent neutralizing humoral immunity against SARS CoV-2 leads to an increased probability of survival. However, the question of whether immunocompromised patients develop antibodies has not yet been sufficiently investigated; (2) Methods: SARS-CoV-2 antibodies were examined in hemodialysis patients on the waiting list for kidney transplantation as well as patients after kidney transplantation. Patients were interviewed about symptoms and comorbidities, BMI, and smoking history; (3) Results: SARS-CoV-2 antibodies were found in 16 out of 259 patients (6%). The trend of infections here reflects the general course of infection in Germany with a peak in November/December of 2020. Remarkably, patients on the waiting list experienced only mild disease. In contrast, transplanted patients had to be hospitalized but recovered rapidly from COVID-19. Most interesting is that all immunosuppressed patients developed antibodies against SARS-CoV-2 after infection; (4) Conclusions: Even with extensive hygiene concepts, an above-average number of patients were infected with SARS-CoV-2 during the second wave of infections in Germany. Because SARS-CoV-2 infection triggered the formation of antibodies even in these immunocompromised patients, we expect vaccination to be effective in this group of patients. Thus, dialysis patients and patients after kidney transplantation should be given high priority in vaccination programs.

scholarly journals Key elements in selection of pre-dialysis patients for home dialysis

2021 ◽  
pp. 089686082110232
Author(s):  
Anna A Bonenkamp ◽  
Tom D Y Reijnders ◽  
Anita van Eck van der Sluijs ◽  
E Christiaan Hagen ◽  
Alferso C Abrahams ◽  
...  
Keyword(s):  
Social Support ◽  
Social Worker ◽  
Home Visit ◽  
Dialysis Patients ◽  
Dialysis Treatment ◽  
Home Dialysis ◽  
Patient Capacity ◽  
Selection Of Patients ◽  
Selection Of

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.

scholarly journals MO836INCIDENCE AND OUTCOME OF SARS-COV-2 INFECTION IN THE POPULATION UNDERGOING DIALYSIS TREATMENT IN LAZIO REGION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Claudia Marino ◽  
Laura Angelici ◽  
Enrico Calandrini ◽  
Silvia Cascini ◽  
Santo Morabito ◽  
...  
Keyword(s):  
Intensive Care ◽  
Mortality Rate ◽  
Incidence Rate ◽  
Dialysis Patients ◽  
Lazio Region ◽  
Dialysis Treatment ◽  
Number Of Patients ◽  
Adjusted Incidence Rate ◽  
Incident Rate ◽  
Population Source

Abstract Background and Aims Patients with chronic kidney disease (CKD) represent a frail population with severe co-morbidities and different degrees of immune dysfunction. These patients might be at higher risk of SARS-CoV-2 infection and might experience severe consequences of COVID-19. In March 2020, the Lazio Regional Dialysis and Transplantation Registry (LRDTR) implemented a questionnaire to obtain information on dialysis patients who have developed SARS-CoV-2 infection. The aims of this study is to evaluate the incidence and the short-term lethality of SARS-CoV-2 infection in the population undergoing dialysis treatment in Lazio Region. Method A cohort of patients treated in the dialysis units of Lazio Region was enrolled. Prevalent dialysis patients at 1/1/2020 and incident patients during the period 01/01/2020-08/01/2020 were included. The LRDTR collects information on dialysis patients from the start of chronic dialysis treatments with biannual update and immediately informing about the end of dialytic treatment (death, renal transplant, etc). Infection was traced in the LRDTR from March 2020 to 08/13/2020. The information on vital status was obtained from LRDTR and the mortality Lazio registry up to 10/30/2020. Poisson models, crude and adjusted for sex and age, were used to estimate incident rate of infection and mortality rate on dialysis patients and on dialysis patients who have developed SARS-CoV-2 infection, and respective confidence intervals of 95% (CI95%). Results During the study period, the estimate of the number of patients undergoing dialysis treatment was 5196 in Lazio Region, 65% were males with mean age of 70 years. Thirty-seven patients were infected with SARS-CoV-2: 70% males, mean age 73 years. These patients were treated in 24 different dialysis units. The cumulative incidence rate of SARS-CoV-2 infection was 0.71% (95% CI 0.52-0.98) and the adjusted incidence rate was 3.3 *100,000 Person Days (PD) (95% CI 2.4-4.7). The distribution of positive swabs by month was: 21 in March 7 in April, 6 in May, 1 in June, 2 in July. Twenty-seven patients had symptoms while 10 patients, who have had contact with infected individuals, had positive swabs in absence of symptoms. Infected and hospitalised dialysis patients were 78%. Of the 29 hospitalized patients: 6 were in sub-intensive care, 16 in intensive care, of these 7 needed intubations, 9 underwent non-invasive ventilation. The adjusted cumulative mortality rate in dialysis patients was 6.8% (95% CI 6.0-7.6), the same measure for SARS-CoV-2 infected patients was 37.4% (95% CI 19.8-70.4) with an average follow-up of 205 PD. The adjusted mortality rate was 3.3 * 10,000PD (95% CI: 2.9-3.7) among dialysis patients and 21.2*10,000PD (95% CI: 11.1-40.7) among infected dialysis patients. Conclusion This study highlights a greater susceptibility of dialysis patients to SARS-CoV-2 infection, with a rate three times higher than that observed in the general population (source: Civil Protection Department). Mortality risk for dialysis patients with SARS-CoV-2 infection is about 6 times higher than in the dialysis patients it suggesting a major impact of infection on this fragile population.

Prevalence-Based Targets Underestimate Home Dialysis Program Activity and Requirements for Growth

2018 ◽  
Vol 38 (3) ◽  
pp. 200-205
Author(s):  
Micheli U. Bevilacqua ◽  
Lee Er ◽  
Michael A. Copland ◽  
R. Suneet Singh ◽  
Abeed Jamal ◽  
...  
Keyword(s):  
Dialysis Patients ◽  
Activity Data ◽  
Prevalence Data ◽  
Attrition Rates ◽  
Home Dialysis ◽  
Program Activity ◽  
Number Of Patients ◽  
Patient Turnover ◽  
Total Program ◽  
Complex Trajectories

Background Many renal programs have targets to increase home dialysis prevalence. Data from a large Canadian home dialysis pro gram were analyzed to determine if home dialysis prevalence accurately reflects program activity and whether prevalence-based assessments adequately reflect the work required for program growth. Methods Data from home dialysis programs in British Columbia, Canada, were analyzed from 2005 to 2015. Prevalence data were com pared to dialysis activity data including intakes and exits to describe program turnover. Using current attrition rates, recruitment rates needed to increase home dialysis prevalence proportions were identified. Results We analyzed 7,746 patient-years of peritoneal dialysis (PD) and 1,362 patient-years of home hemodialysis (HHD). The proportion of patients on home dialysis increased by 3.34% over the ten years examined, while the number of prevalent home dialysis patients increased 2.65% per year and the number of patients receiving home dialysis at any time in the year increased 4.04% per year. For every 1 patient net home dialysis growth, 13.6 new patients were recruited. Patient turnover included higher rates of transplantation in home dialysis than facility-based HD. Overall, the proportion dialyzing at home increased from 29.3 to 32.6%. Conclusions There is high patient turnover in home dialysis such that program prevalence is an incomplete marker of total program activity. This turnover includes high rates of transplantation, which is a desirable interaction that affects home dialysis prevalence. The shortcomings of this commonly used metric are important for renal programs to consider, and better understanding of the activities that support home dialysis and the complex trajectories that home dialysis patients follow is needed

scholarly journals HOME DIALYSIS DURING COVID-19 OUTBREAK– IT IS WORTH TO CONSIDER

2020 ◽  
Vol 73 (10) ◽  
pp. 2316-2318
Author(s):  
Paweł Żebrowski ◽  
Jacek Zawierucha ◽  
Wojciech Marcinkowski ◽  
Tomasz Prystacki ◽  
Inga Chomicka ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Medical Personnel ◽  
Medical Facility ◽  
Immune Disorders ◽  
Dialysis Patients ◽  
Home Hemodialysis ◽  
Home Dialysis ◽  
Number Of Patients

The epidemic with the new SARS-CoV-2 virus poses a serious threat to patients treated with renal replacement therapy. Besides clinical risk factors (such as numerous comorbidities, immune disorders), dialysis patients are additionally exposed to the virus through regular stays for several hours in a dialysis center and ambulance journeys. In such an epidemiological situation, it seems that peritoneal dialysis and home hemodialysis are good alternatives for treatment. Currently available telemedicine and medical technologies allow for effective renal replacement therapy also outside dialysis centers. Thanks to this, it is possible to limit the stay of patients in a medical facility to clinically justified situations. For this reason, increasing the number of patients treated with peritoneal dialysis, which is carried out at home and without contact with medical personnel, seems to be a good solution. Enabling patients to undergo home hemodialysis treatment, nowadays unavailable in Poland and establishing it as a guaranteed benefit in the health care system will enable renal replacement therapy to be adapted to the clinical condition and the need for isolation.

Comorbidities, Hospitalization, and Living Status of Dialysis Patients Over 80 Years

2016 ◽  
Vol 42 (4) ◽  
pp. 282-286
Author(s):  
Til Leimbach ◽  
Joachim Kron ◽  
Wolfgang Pommer ◽  
Birgit Urbach ◽  
Susanne Kron
Keyword(s):  
Quality Of Life ◽  
Chronic Dialysis ◽  
Dialysis Patients ◽  
Dialysis Treatment ◽  
Younger Patients ◽  
Number Of Patients ◽  
Age Range ◽  
Hospital Days ◽  
Satisfactory Quality

Background: An increasing number of patients start dialysis when they are over 80 years or reaches their eighties on dialysis. The burden of dialysis can affect their quality of life. Methods: Clinical and social data of all patients aged 80 years or older who underwent chronic dialysis treatment in a single center were analyzed. Results: Fifty-nine patients aged between 80 and 92 years were in chronic dialysis treatment on December 31, 2015. Median time on dialysis was 57 months (3-330 months). Hospitalization rate and days in hospital were lower in this group than in younger patients (1.05 vs. 1.34 hospitalizations; 8.3 vs. 9.0 hospital days per patient and year) despite the presence of many comorbidities. The median patency of the currently used arteriovenous shunt was 70 months (6-194 months). Social status was comparable with the population of the rest of the same average age range. Conclusion: Dialysis patients aged ≥80 years have a satisfactory quality of life with no more complications than younger patients.

scholarly journals Home dialysis and Covid-19 in french speaking countries (RDPLF data-base)

2021 ◽  
Vol 4 (3) ◽  
pp. 227-237
Author(s):  
Christian Verger ◽  
Emmanuel Fabre ◽  
Pierre-Yves Durand ◽  
Jacques Chanliau ◽  
Isabelle Vernier ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Data Base ◽  
Dialysis Patients ◽  
Home Hemodialysis ◽  
Home Dialysis ◽  
Number Of Patients ◽  
French Speaking ◽  
Surgical Teams ◽  
At Home

Aims of the study: to assess the frequency of symptomatic Covid-19 in home dialysis patients and its influence on the number of patients treated at home in dialysis units of centers included in the French-speaking peritoneal and home hemodialysis Registry (RDPLF). Focus is placed on patients treated by peritoneal dialysis (PD) in mainland France. Results: in home hemodialysis (HHD)the incidence is 6% in Belgium and 4.8% in mainland France. On peritoneal dialysis it is 10.6% in Belgium, 6.7% in mainland France, 10.8% in Morocco and 11.5% in Tunisia. Lethality is less than 5% in HHD and between 8.4% and 42.7% in PD depending on age and associated comorbidities. In France, the percentage of patients who have had symptomatic Covid-19 is lower on home dialysis, all methods combined. Nevertheless, among the home methods, the higher frequencies and severities are observed in mainland France in home assisted PD: these are the oldest and most co-morbid patients. Transfers from PD to in center hemodialysis have increased during Covid-19 pandemic while the number of transplants has decreased. Conclusion: if the drop in the number of transplants can be explained by a reduced availability of operating theaters and surgical teams during a pandemic period, it is paradoxical that the prescription of home dialysis, which should be supposed to limit the risk of contagion, has decreased. More investigation should be performed to understand this paradox.  

Neuropsychiatric Symptoms and Antipsychotic Therapy in the Elderly Patients with Dementia

Psychiatry ◽  
2020 ◽  
Vol 18 (4) ◽  
pp. 6-15
Author(s):  
I. V. Kolykhalov
Keyword(s):  
Neuropsychiatric Symptoms ◽  
The Elderly ◽  
Psychotic Symptoms ◽  
Mixed Dementia ◽  
Short Term ◽  
Antipsychotic Therapy ◽  
Dementia Patients ◽  
Frequency Of Use ◽  
Number Of Patients ◽  
High Incidence

The objective of the study was to investigate syndromal-nosological specificities of neuropsychiatric symptoms (NPS) and the frequency of use of antipsychotics in patients with various types of dementias, institutionalized to geriatric units of mental hospitals.Patients and methods: a total of 106 in-patients of three psychogeriatric units were examined. The median age of patients is 75 years [69; 80].The diagnostic distribution of patients at the time of the examination was as follows: in 33 subjects (31.1%) Alzheimer’s disease (AD) was diagnosed, in 25 (23.6%) - mixed dementia (MD), in 32 (30.2%) - vascular dementia (VD) and in 16 (15.1%) patients had dementia of complex origin (DCO).Results: a high incidence (54.7%) of NPS was found in patients with dementia of various origins. The greatest number of patients with behavioral and psychotic symptoms was found in AD and MD. The proportion of dementia patients with such disorders in each of these types of dementia is about 70%, while in CGD and VD, the proportion of patients with NPS is noticeably smaller (30% and 40%, respectively). For the treatment of NPS, antipsychotics were most often prescribed, but their use caused adverse events (AEs) in 1/3 of cases. Patients with VD are most susceptible to the development of AE, and AD patients are the least susceptible.Conclusion: the study showed that NPS are one of the important components of dementia, regardless of the nosology and stage of the disease. The treatment of NPS in dementia is particularly challenging because, although the symptoms cause significant distress, there are currently no effective alternative therapies. The risk of AE can be minimized by carefully considering the indications for prescribing antipsychotics and their short-term use, regular monitoring of the patient’s condition, and educating caregivers.

scholarly journals Current status of vascular access in Japan—from Dialysis Access Symposium 2017

2019 ◽  
Vol 20 (1_suppl) ◽  
pp. 38-44
Author(s):  
Mizuya Fukasawa
Keyword(s):  
Vascular Access ◽  
Current Status ◽  
Good Survival ◽  
Chronic Glomerulonephritis ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Survival Prognosis ◽  
Access Methods ◽  
Number Of Patients ◽  
Wide Range

At the second Dialysis Access Symposium held in Nagoya, Japan, a proposal was made to investigate the differences in vascular access methods used in different countries. In this article, we describe the management of vascular access in Japan. The Japanese population is rapidly aging, and the proportion of elderly patients on dialysis is also increasing. There were 325,000 dialysis patients in Japan at the end of 2015, of whom 65.1% were aged 65 years or above. The number of patients with diabetic nephropathy or nephrosclerosis as the underlying condition is also increasing, whereas the number with chronic glomerulonephritis is steadily decreasing. The Japanese health insurance system enables patients to undergo medical treatment at almost no out-of-pocket cost. Percutaneous transluminal angioplasty suffers from a severe device lag compared with other countries, but although there are limitations on permitted devices, the use of those that have been authorized is covered by medical insurance. One important point that is unique to Japan is that vascular access is performed and managed by doctors involved in dialysis across a wide range of disciplines, including nephrologists, surgeons, and urologists. This may be one factor contributing to the good survival prognosis of Japanese dialysis patients.

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