Home hemodialysis treatment and outcomes: retrospective analysis of the Knowledge to Improve Home Dialysis Network in Europe (KIHDNEy) cohort

Home dialysis, which includes Peritoneal Dialysis and Home Hemodialysis, provides lots of profit to patients suffering of Chronic Kidney Disease, especially in terms of comfort, life quality and autonomy. However, its use is marginal in France, with an inhomogenous distributaion according to geographical regions. We conducted a French national survey of nephrologists to assess the barriers to the development of home dialysis. After analyzing the responses of the 230 participating nephrologists, the main obstacles to the development of the two techniques were identified and classified according to their reporting rate. The major obstacles that emerge from the survey are : the lack of information among the general public, a lack of acknowledgement of nurses specializing in these techniques, the limited number of structures that practice dialysis at home, and information difficulties among patient about dialysis techniques. The specific peritoneal dialysis-related difficulties reported are : difficulties in management of follow-up care and rehabilitation, the fear of insufficient purification and the difficulties related to the dialysis catheter. Concerning home hemodialysis, the barriers concern fear of autopunction and the need for a third party. This study helps to identify the representations of nephrologists on the major obstacles to the development of home dialysis to develop lines of thought for its promotion, both in terms of training, institutional acknowledgement, and the necessary regulatory evolution.

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The Family and Home Hemodialysis: Adolescents' Reactions to a Father on Home Dialysis

The International Journal of Psychiatry in Medicine ◽

10.2190/e6y3-tpvm-mtu0-rcw3 ◽

1981 ◽

Vol 10 (3) ◽

pp. 235-254 ◽

Cited By ~ 6

Author(s):

Rose H. Goldman ◽

George L. Cohn ◽

Robert E. Longnecker

Keyword(s):

Quality Of Life ◽

Active Role ◽

Family Interactions ◽

Home Hemodialysis ◽

Home Dialysis ◽

Role Changes ◽

Developmental Problems ◽

The Family ◽

Psychic Numbing

Quality of life is the most controversial issue surrounding home hemodialysis. We examined how sixteen adolescents and their six families reacted to having a father on home hemodialysis, exploring the interplay between adolescent developmental conflicts and family stresses. Family members underwent role changes to adjust to alterations imposed by hemodialysis. Some adolescents helped relieve family stresses by taking an active role in dialysis. These eight adolescents developed greater self-esteem which enhanced identity growth and facilitated separation. Psychological responses were observed that resembled the “death guilt,” “psychic numbing,” and “invisible contamination” described in Hiroshima survivors. Adolescent developmental problems can be dwarfed by family conflicts around chronic illness and dialysis. Families adjusted to home hemodialysis showing new growth, managing with a barely workable arrangement, or adapting unsuccessfully. Understanding more about how home hemodialysis can influence family interactions can enable the medical staff to facilitate beneficial changes, and thereby improve the quality of life for patient and family.

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Comparison of Psychological Adjustment to Continuous Ambulatory Peritoneal Dialysis and Home Hemodialysis

Peritoneal Dialysis International ◽

10.1177/089686088100200209 ◽

1981 ◽

Vol 2 (2) ◽

pp. 82-84 ◽

Cited By ~ 2

Author(s):

Howard J. Burton ◽

Atara Kaplan De-Nour ◽

John A. Conley ◽

George A. Wells ◽

Lokky Wais

Keyword(s):

Peritoneal Dialysis ◽

Psychological Adjustment ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Sexual Satisfaction ◽

Dialysis Patients ◽

Home Hemodialysis ◽

Home Dialysis ◽

Household Members ◽

Demographic Background

Two groups of home dialysis patients (40 on CAPD and 37 on home hemo dialysis) matched for length of time on dialysis, and for demographic background were studied and compared. The CAPD patients were significantly more satisfied with the support received from household members and from spouses, more satisfied with the relations with spouses, more understood by them and more understanding of their spouses. Sexual satisfaction declined in both groups. However, sexual satisfaction was slightly higher in the CAPD group and these patients experienced slightly less difficulty in adjusting to the decline; none of these differences were statistically significant.

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Clinical Outcome of Home Hemodialysis in Patients with Previous Peritoneal Dialysis Exposure: Evaluation of the Integrated Home Dialysis Model

Peritoneal Dialysis International ◽

10.3747/pdi.2013.00163 ◽

2015 ◽

Vol 35 (3) ◽

pp. 316-323 ◽

Cited By ~ 9

Author(s):

Annie-Claire Nadeau-Fredette ◽

Joanne M. Bargman ◽

Christopher T. Chan

Keyword(s):

Peritoneal Dialysis ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Proportional Hazards Model ◽

Cox Proportional Hazards Model ◽

Rank Test ◽

Home Hemodialysis ◽

Home Dialysis ◽

Technique Survival ◽

Home Based

BackgroundHome dialysis is a cost-effective modality of renal replacement therapy associated with excellent outcomes. Peritoneal dialysis (PD) is the most common home-based modality, but technique failure remains a problem. Transfer from PD to home hemodialysis (HHD) allows the patient to continue with a home-based modality, but the outcomes of patients transitioning to HHD after PD are largely unknown.MethodsIn a retrospective cohort study, including all consecutive HHD patients between January 1996 and December 2011, we evaluated the outcomes of patients with previous PD exposure compared to those without. The primary outcome was the cumulative patient and technique survival. Secondary outcomes included time to first hospitalization and hospitalization rate. Data were compared using the log-rank test and a multivariable Cox proportional hazards model.ResultsAmong our cohort of 207 consecutive HHD patients, 35 (17%) had previous exposure to PD. Median renal replacement therapy (RRT) vintage (12.3 years, interquartile range (IQR) 8.5 – 18.9 vs 0.9 years, IQR 0.2 – 7.5, p < 0.001) and Charlson comorbidity index (CCI) (4, IQR 2 – 6 vs 3, IQR 2 – 4, p = 0.044) were higher among patients with PD exposure than those without. Despite the difference in vintage, cumulative patient and technique survival was similar in the two groups, in both unadjusted (log-rank p = 0.893) and Cox adjusted models (hazard ratio (HR) 1.15, 95% confidence interval (CI) 0.51 – 2.59) for patients with PD exposure compared to those without. The time to first hospitalization was shorter in patients with previous PD exposure compared to PD-naïve patients (log-rank p = 0.021). This association was preserved in the Cox proportional model (HR 1.65, 95% CI 1.08 – 2.54).ConclusionDespite a higher burden of comorbidity, patients with previous PD exposure had similar cumulative patient and technique survival on HHD compared to those without PD exposure. Whenever possible, HHD should be considered in PD patients in need of a new dialysis modality.

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Home dialysis, garbage, and privacy: Nothing is trivial in home hemodialysis

Kidney International ◽

10.1111/j.1523-1755.2005.191_1.x ◽

2005 ◽

Vol 67 (3) ◽

pp. 1190 ◽

Cited By ~ 3

Author(s):

Giorgina Barbara Piccoli ◽

Alberto Jeantet ◽

Massimo Gai ◽

Manuel Burdese ◽

Elisabetta Mezza ◽

...

Keyword(s):

Home Hemodialysis ◽

Home Dialysis

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Mortality After Home Hemodialysis Treatment Failure and Return to In-Center Hemodialysis

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2021.05.021 ◽

2021 ◽

Author(s):

David J. Semple ◽

Matthew Sypek ◽

Shahid Ullah ◽

Christopher Davies ◽

Stephen McDonald

Keyword(s):

Treatment Failure ◽

Home Hemodialysis ◽

Hemodialysis Treatment

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Nocturnal home hemodialysis with low‐flow dialysate: Retrospective analysis of the first European patients

Hemodialysis International ◽

10.1111/hdi.12808 ◽

2019 ◽

Vol 24 (2) ◽

pp. 175-181 ◽

Cited By ~ 1

Author(s):

Venkat Gangaram ◽

Mari Vilpakka ◽

Eric Goffin ◽

Eric D. Weinhandl ◽

Kristine M. Kubisiak ◽

...

Keyword(s):

Retrospective Analysis ◽

Low Flow ◽

Home Hemodialysis

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A Systematic Approach To Promoting Home Hemodialysis during End Stage Kidney Disease

Kidney360 ◽

10.34067/kid.0003132020 ◽

2020 ◽

Vol 1 (9) ◽

pp. 993-1001

Author(s):

Robert Lockridge ◽

Eric Weinhandl ◽

Michael Kraus ◽

Martin Schreiber ◽

Leslie Spry ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Systematic Approach ◽

Transitional Care ◽

Home Hemodialysis ◽

Treatment Frequency ◽

Home Dialysis ◽

Multiple Phenotypes ◽

End Stage ◽

Intensive Hemodialysis ◽

Cardinal Feature

Home dialysis has garnered much attention since the advent of the Advancing American Kidney Health initiative. For many patients and nephrologists, home dialysis and peritoneal dialysis are synonymous. However, home hemodialysis (HHD) should not be forgotten. Since 2004, HHD has grown more rapidly than other dialytic modalities. The cardinal feature of HHD is customizability of treatment intensity, which can be titrated to address the vexing problems of volume and pressure loading during interdialytic gaps and ultrafiltration intensity during each hemodialysis session. Growing HHD utilization requires commitment to introducing patients to the modality throughout the course of ESKD. In this article, we describe a set of strategies for introducing HHD concepts and equipment. First, patients initiating dialysis may attend a transitional care unit, which offers an educational program about all dialytic modalities during 3–5 weeks of in-facility hemodialysis, possibly using HHD equipment. Second, prevalent patients on hemodialysis may participate in “trial-run” programs, which allow patients to experience increased treatment frequency and HHD equipment for several weeks, but without the overt commitment of initiating HHD training. In both models, perceived barriers to HHD—including fear of equipment, anxiety about self-cannulation, catheter dependence, and the absence of a care partner—can be addressed in a supportive setting. Third, patients on peritoneal dialysis who are nearing a transition to hemodialysis may be encouraged to consider a home-to-home transition (i.e., from peritoneal dialysis to HHD). Taken together, these strategies represent a systematic approach to growing HHD utilization in multiple phenotypes of patients on dialysis. With the feature of facilitating intensive hemodialysis, HHD can be a key not only to satiating demand for home dialysis, but also to improving the health of patients on dialysis.

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Left ventricular assist device patient maintained on home hemodialysis: A novel class of patients to the home dialysis population

Hemodialysis International ◽

10.1111/hdi.12631 ◽

2018 ◽

Vol 22 (3) ◽

pp. E36-E38

Author(s):

Ramy M. Hanna ◽

Daniel Cruz ◽

Umut Selamet ◽

Huma Hasnain ◽

Murray Kwon ◽

...

Keyword(s):

Left Ventricular Assist Device ◽

Ventricular Assist Device ◽

Left Ventricular ◽

Home Hemodialysis ◽

Assist Device ◽

Ventricular Assist ◽

Home Dialysis ◽

Left Ventricular Assist

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Sex Selection Bias in Choosing a Dialysis Therapy

Peritoneal Dialysis International ◽

10.1177/089686088400402s28 ◽

1984 ◽

Vol 4 (2_suppl) ◽

pp. 172-175

Author(s):

H.J. Burton ◽

P. Heidenheim ◽

S.A. Kline ◽

R.M. Lindsay ◽

H. Bolley

Keyword(s):

Quality Of Life ◽

Demographic Characteristics ◽

Sex Selection ◽

Dialysis Patients ◽

Home Hemodialysis ◽

Dialysis Therapy ◽

Home Dialysis ◽

Current Selection ◽

Baseline Demographic

This investigation has sought to determine reasons for the disproportionately higher number of females entering CAPD as opposed to home hemodialysis. A sample of 295 home dialysis patients, 97 women and 198 men, were compared in terms of modality of choice, baseline demographic characteristics, treatment outcome, and quality of life. The results indicate that there is no apparent rationale for the current selection basis.

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