scholarly journals Birth, Rise, Decline and Revival of Home Hemodialysis – French experience

2018 ◽  
Vol 1 (3) ◽  
pp. 99-103
Author(s):  
Alain Meyrier
Keyword(s):  
Electrolyte Solutions ◽  
Low Flow ◽  
Maintenance Hemodialysis ◽  
Steady Increase ◽  
Rapid Decline ◽  
Home Hemodialysis ◽  
Daily Hemodialysis ◽  
Number Of Patients ◽  
Public Health Authorities ◽  
At Home

The first publication in 1960 on maintenance hemodialysis was followed in 1963 by some reports on dialysis in the home. The introduction of proportioning pumps and concentrated electrolyte solutions led to developing single-patient machines and safety devices that made home hemodialysis possible.  It was demonstrated in 1964 that home hemodialysis can be done overnight, unattended. This led to a steady rise in the number of patients treated at home. The percentage in France was ≈20% by the end of the seventies, out of a total of  ≈ 6 000.  The decline began when Public Health authorities authorized a program of ‘’limited – care’’ units.  A loophole in the regulations led to a massive transfer of patients to these units and a rapid decline of home HD. The revival can be dated to 2012 with the development of disposable dialysate bags that make low flow daily home HD feasible. Efficacy and tolerability are such that the total number of patients treated at home rose from 307 in 2014 to 374 in 2016, owing to those on daily hemodialysis -  an increase from 55 in 2014 to 374 in 2016 and 448 by the end of 2018. Currently, ≈46 000 patients are hemodialyzed in France.   The % of those treated at home is very low but the trend is to a steady increase.

scholarly journals Home dialysis in french speaking countries in 2020 (RDPLF database)

2021 ◽  
Vol 4 (1) ◽  
pp. 55-70
Author(s):  
Christian Verger ◽  
Ghislaine Veniez ◽  
Marie-Christine Padernoz ◽  
Emmanuel Fabre
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Symptoms ◽  
Low Flow ◽  
Central Catheter ◽  
Dialysis Treatment ◽  
Home Dialysis ◽  
Daily Hemodialysis ◽  
French Speaking ◽  
Patient Profiles ◽  
At Home

The RDPLF collects the main peritoneal dialysis data from centers in French-speaking countires and, since 2012, home hemodialysis (HHD) data. This article presents a summary of the main results in the RDPLF in 2020. It highlights important differences in the practices and patient profiles between French-speaking countries. Mortality in patients with clinical symptoms of COVID-19 varied from 15 to 63% depending on the country. A slight drop in the incidence rate for peritoneal dialysis in 2020 was observed when the Covid-19 pandemic should have favored a dialysis treatment at home. In patients with HHD, daily hemodialysis five days a week, at a low flow rate of dialysate, is predominant in the new centers and sometimes begins to appear as a mode of transition which allows to maintain at home patients who cannot anymore be treated by PD. In HHD, the use of a central catheter is frequent in Belgium while this is exceptional in France. Likewise, in France, puncture of an arteriovenous fistula remains classic, while in Belgium the Buttonhole technique is widely preferred. We did not observe COVID-19 mortality in HHD in 2020 but only 47% of HDD patients are included in the RDPLF while 98% of PD patients are included.

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.  

Safety Management of Dialysis Fluid in Japan: Important Duties and Responsibilities of Clinical Engineers

2021 ◽  
pp. 1-6
Author(s):  
Masanori Shibata
Keyword(s):  
Renal Failure ◽  
Safety Management ◽  
Standard Procedure ◽  
Medical Personnel ◽  
Maintenance Hemodialysis ◽  
Dialysis Fluid ◽  
Fluid Delivery ◽  
Technical Ability ◽  
Number Of Patients ◽  
Clinical Engineers

Dialysis therapy is the predominant choice for renal failure in Japan, and almost 30% of the patients with renal failure have been treated for 10 years or more. Dialysis became the standard procedure to treat renal failure nationwide in the 1980s. However, at that time, managing the increased number of patients on maintenance hemodialysis as well as operating and maintaining the newly developed advanced medical technologies at extensive numbers of clinical sites proved problematic. To help address this, the clinical engineer system was established in 1987 and certain aspects of the clinical engineers’ role remain unique to Japan today. For the last 30 years, clinical engineers have worked as frontline medical personnel not only operating dialysis-related devices but also placing their hands directly on patients when providing care, routinely performing puncture, and administering drugs through the blood circuit under physicians’ instructions. As part of their work, they crucially maintain the use of central dialysis fluid delivery systems (CDDSs) – also unique to Japan – which prepare and deliver a large quantity of dialysis fluid through a central circuit to individual dialysis consoles. CDDSs are widely used because they effectively alleviated the early confusion at clinical sites caused by the rapidly increasing hemodialysis population and the serious shortage in medical personnel. Moreover, clinical engineers alone have the technical ability to provide safe dialysis fluids adjusted to strict standards at clinical sites. In this review article, we focus on the crucial roles that clinical engineers have in maintaining the safety of dialysis-related medical devices and the preparation and delivery of dialysis fluid at many dialysis facilities across the country.

scholarly journals Analysis of HIV-related mortality data in a tertiary South African neurology unit, 2006- 2012

2013 ◽  
Vol 14 (3) ◽  
pp. 121-124
Author(s):  
Clara Maria Schutte
Keyword(s):  
South African ◽  
Neurological Complications ◽  
Mortality Data ◽  
Hiv Positive ◽  
Steady Increase ◽  
Number Of Patients ◽  
High Prevalence ◽  
Living With Hiv ◽  
Related Mortality ◽  
Hiv Negative

Background. South Africa (SA) has a high prevalence of HIV infection with almost 11% of the population aged >2 years living with HIV. At the Steve Biko Academic Hospital, Pretoria, the Neurology Department has seen a steady increase in HIV-related neurology patients.Objective. To evaluate the mortality data of this unit as it relates to HIV infection.Methods. The study was a retrospective analysis of records. Patient mortality statistics for 2006, 2008, 2010 and 2012 were analysed regarding cause of death, sex, age and HIV status.Results. During 2006, 85 patients died: 33% were HIV-positive, 13% were HIV-negative and 54% had not tested for HIV. By 2010, these figures were 50%, 22% and 28%, respectively, changing little in 2012 (48%, 28% and 24%, respectively). Causes of death in the HIV-positive group were meningitis in 58% – with tuberculous meningitis the most common aetiology – followed by strokes (14%), space-occupying lesions (8%) and status epilepticus (7%). Among HIV-positive patients aged 20 - 30 years, a larger proportion of young women died than men. In the combined untested and HIV-negative group, strokes accounted for the vast majority of deaths.Conclusion. Neurological complications of HIV remain common in SA and contribute significantly to the overall mortality in our tertiary neurology unit, with TB posing a serious threat. A strong corps of clinical neurologists with training in infective neurology is needed urgently in the coming years to care for this growing number of patients. 

scholarly journals Prevalence and Risk Factors for Chronic Kidney Disease in Family Relatives of a Cameroonian Population of Hemodialysis Patients: A CrossSectional Study

2019 ◽  
Vol 4 (1) ◽  
pp. 12-17
Author(s):  
Mazou Ngou Temgoua ◽  
Gloria Ashuntantang ◽  
Marie José Essi ◽  
Joël Nouktadie Tochie ◽  
Moussa Oumarou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Fasting Blood Glucose ◽  
Hemodialysis Patients ◽  
Biological Data ◽  
Sub Saharan Africa ◽  
Herbal Remedies ◽  
Maintenance Hemodialysis ◽  
Number Of Patients

Background: In sub-Saharan Africa (SSA), the trend in the number of patients admitted for maintenance hemodialysis is on the rise. The identification of risk factors for chronic kidney disease (CKD) ensures adequate primary and secondary preventive measures geared at reducing the burden of CKD in low-resource settings. A family history of CKD is an established risk factor for CKD in high-income countries. However, data on family predisposition to CKD is scarce in the literature on SSA. Objective: The current study aimed to determine the prevalence and risk factors of CKD in family relatives of a Cameroonian population of hemodialysis patients (HDP) followed-up in a major hemodialysis referral center in Cameroon. Methods: The current cross-sectional study was conducted over four months on a consecutive sample of first-degree family relatives of end-stage renal disease patients undergoing maintenance hemodialysis at the hemodialysis unit of the General Hospital of Yaoundé. For each participating family relative, socio-demographic characteristics, clinical data, and biological data including fasting blood glucose, proteinuria, and serum creatinine were collected. Results: A total of 82 first-degree family relatives of HDP were recruited. The prevalence of CKD among the participants was 15.8%. The main identified risk factors for CKD were age (P = 0.0015), female gender (P = 0.0357), hypertension (P = 0.0004), regular intake of herbal remedies (P = 0.0214), and diabetes mellitus (P = 0.0019). Conclusion: Overall, the current findings suggest an urgent need for population education, routine screening of CKD, and the identification of risk factors in first-degree family relatives of HDP in Cameroon.

The Nithsdale Schizophrenia Surveys. VIII: Do Relatives Want Family Intervention – And Does It Help?

1991 ◽  
Vol 158 (1) ◽  
pp. 110-113 ◽  
Author(s):  
R. G. McCreadie ◽  
K. Phillips ◽  
J. A. Harvey ◽  
G. Waldron ◽  
M. Stewart ◽  
...  
Keyword(s):  
British Journal ◽  
Expressed Emotion ◽  
Family Intervention ◽  
Family Meetings ◽  
Number Of Patients ◽  
Before And After ◽  
At Home

Sixty-three relatives of 52 schizophrenics living at home were offered a package of treatments by professionals working in an everyday NHS setting: educational seminars, relatives' groups, and family meetings. Thirty-two relatives refused intervention. Of the 31 relatives who agreed, 14 attended neither the educational seminars nor the relatives' groups. Seventeen relatives had a mean of ten treatment sessions, but there was little change in their level of expressed emotion after intervention. The number of patients who relapsed was the same in the 18 months before and after intervention, although the total number of relapses fell after intervention.British Journal of Psychiatry (1991), 158, 110–113

FP749The effect of short daily home hemodialysis with low-flow, lactate-buffered dialysate on nutritional status and body composition

2019 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Belén Vizcaíno ◽  
Pablo Molina ◽  
Mariola D Molina ◽  
Mercedes González-Moya ◽  
Jonay Pantoja ◽  
...  
Keyword(s):  
Body Composition ◽  
Nutritional Status ◽  
Low Flow ◽  
Home Hemodialysis

scholarly journals Feasibility of Computed Tomography Pulmonary Angiography with Low Flow Rates

2012 ◽  
Vol 2 ◽  
pp. 57 ◽  
Author(s):  
J. Gossner
Keyword(s):  
Computed Tomography ◽  
Contrast Medium ◽  
Pulmonary Arteries ◽  
Venous Access ◽  
Pulmonary Angiography ◽  
Low Flow ◽  
Computed Tomography Pulmonary Angiography ◽  
Flow Rates ◽  
Number Of Patients ◽  
Peripheral Venous Access

Computed tomography pulmonary angiography (CTPA) is the imaging test of choice in suspected pulmonary embolism. High flow rates for the administration of contrast medium are recommended, but these cannot be achieved in a number of patients due to poor peripheral venous access or when using certain central venous catheters. This small feasibility study has examined the CTPA data in a set of 22 patients in whom contrast medium was given at low flow rates (2.0 or 2.5 mL/s). Subjectively, all but one of the patients was judged to be diagnostic. Objectively, enhancement values ≥200 HU were reached in 92% of the examined central vessels (pulmonary trunk, main pulmonary arteries, and lobar arteries). In conclusion, even with a low injection rate CTPA is of diagnostic value in most patients.

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