scholarly journals Home dialysis : what are the barriers . A French nephrologist survey

2019 ◽  
Vol 2 (2) ◽  
pp. 47-53
Author(s):  
Magalie Geneviève ◽  
Stanislas Bataille ◽  
Julie Beaume ◽  
Aldjia Hocine ◽  
Louis De Laforcade ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Life Quality ◽  
Reporting Rate ◽  
Third Party ◽  
Regulatory Evolution ◽  
Home Hemodialysis ◽  
Home Dialysis ◽  
Lack Of Information ◽  
Geographical Regions

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.

scholarly journals A comparison of technique survival in Canadian peritoneal dialysis and home hemodialysis patients

2019 ◽  
Vol 34 (11) ◽  
pp. 1941-1949 ◽  
Author(s):  
Emilie Trinh ◽  
James A Hanley ◽  
Annie-Claire Nadeau-Fredette ◽  
Jeffrey Perl ◽  
Christopher T Chan
Keyword(s):  
Peritoneal Dialysis ◽  
Risk Model ◽  
Patient Characteristics ◽  
First Year ◽  
Home Hemodialysis ◽  
Home Dialysis ◽  
Technique Survival ◽  
And Gender ◽  
Technique Failure

AbstractBackgroundHigh discontinuation rates remain a challenge for home hemodialysis (HHD) and peritoneal dialysis (PD). We compared technique failure risks among Canadian patients receiving HHD and PD.MethodsUsing the Canadian Organ Replacement Register, we studied adult patients who initiated HHD or PD within 1 year of beginning dialysis between 2000 and 2012, with follow-up until 31 December 2013. Technique failure was defined as a transfer to any alternative modality for a period of ≥60 days. Technique survival between HHD and PD was compared using a Fine and Gray competing risk model. We also examined the time dependence of technique survival, the association of patient characteristics with technique failure and causes of technique failure.ResultsBetween 2000 and 2012, 15 314 patients were treated with a home dialysis modality within 1 year of dialysis initiation: 14 461 on PD and 853 on HHD. Crude technique failure rates were highest during the first year of therapy for both home modalities. During the entire period of follow-up, technique failure was lower with HHD compared with PD (adjusted hazard ratio = 0.79; 95% confidence interval 0.69–0.90). However, the relative technique failure risk was not proportional over time and the beneficial association with HHD was only apparent after the first year of dialysis. Comparisons also varied among subgroups and the superior technique survival associated with HHD relative to PD was less pronounced in more recent years and among older patients. Predictors of technique failure also differed between modalities. While obesity, smoking and small facility size were associated with higher technique failure in both PD and HHD, the association with age and gender differed. Furthermore, the majority of discontinuation occurred for medical reasons in PD (38%), while the majority of HHD patients experienced technique failure due to social reasons or inadequate resources (50%).ConclusionsIn this Canadian study of home dialysis patients, HHD was associated with better technique survival compared with PD. However, patterns of technique failure differed significantly among these modalities. Strategies to improve patient retention across all home dialysis modalities are needed.

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

1981 ◽  
Vol 2 (2) ◽  
pp. 82-84 ◽  
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.

scholarly journals Synthetic 2018 data report of the French Language Peritoneal Dialysis and Home Hemodialysis Registry (RDPLF)

2019 ◽  
Vol 2 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Christian Verger ◽  
Emmanuel Fabre ◽  
Ghislaine Veniez ◽  
Marie Christine Padernoz
Keyword(s):  
Peritoneal Dialysis ◽  
French Language ◽  
Home Hemodialysis ◽  
Dialysate Flow ◽  
Dialysate Flow Rate ◽  
Core Module ◽  
French Speaking ◽  
Patient Profiles ◽  
Transitional Mode

The RDPLF was created in 1986 and collects the main data of peritoneal dialysis of French patients and of various French-speaking countries. The database is structured in several modules: a compulsory core module including a follow-up of comorbidities, assistance, infections, survival, transplantation, and optional modules following more specific aspects: nursing, catheter, anemia, nutrition, heart failure. In addition, since 2012 patients treated at home in hemodialysis are also followed. This article presents a summary of the main characteristics of patients in the RDPLF in 2018. It highlights important differences in practices and patient profiles between francophone countries. Daily low dialysate flow rate hemodialysis is predominant in the new centers and sometimes begins to appear as a transitional mode that allows home maintenance for patients who cannot continue on peritoneal dialysis.

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

2015 ◽  
Vol 35 (3) ◽  
pp. 316-323 ◽  
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.

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

Kidney360 ◽  
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.

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

1981 ◽  
Vol 2 (2) ◽  
pp. 76-78 ◽  
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.

scholarly journals Transition between peritoneal dialysis and home hemodialysis in Belgium and France in the RDPLF

2020 ◽  
Vol 3 (3) ◽  
pp. 169-176
Author(s):  
Christian Verger ◽  
Emmanuel Fabre
Keyword(s):  
Peritoneal Dialysis ◽  
Home Care ◽  
Median Duration ◽  
Hemodialysis Patients ◽  
Home Hemodialysis ◽  
Home Dialysis ◽  
Daily Hemodialysis ◽  
Daily Dialysis ◽  
Previously Treated ◽  
Interim Period

A renewed interest in home hemodialysis has emerged in recent years, favored by the availability of new dialysis machines and encouraging publication about  daily hemodialysis. Since 2013, the RDPLF has become a home dialysis registry that records the data of patients treated with peritoneal dialysis and those treated with home hemodialysis, all techniques combined. Nine Belgian centers and fifty seven French centers communicate information about their patients treated by hemodialysis at home. In the RDPLF centers, 56% of Belgian home hemodialysis patients are treated with daily hemodialysis, in France 83% of home patients are on daily dialysis. This French difference however is not representative of the whole country but can be explained through recruitment of new centers already involved in peritoneal dialysis and convinced by the interest of continuaous daily treatment. In both countries, 13% of home hemodialysis patients have been previously treated with peritoneal dialysis with an interim period of in-center hemodialysis or transplantation. The median duration of in center hemodialysis is 10 months with extremes ranging from 2 months to 25 years. PD patients treated secondarily in home hemodialysis are mainly young, non-diabetic and independent patients. Early information in patients who have a risk of peritoneal dialysis failure, and the provision of materials allowing both techniques would reduce or abolish a transient transfer to in center hemodialysis  and would ensure home care in patients who prefer.

scholarly journals Development and Content Validity of a Patient-Reported Experience Measure for Home Dialysis

2021 ◽  
pp. CJN.15570920
Author(s):  
Matthew B. Rivara ◽  
Todd Edwards ◽  
Donald Patrick ◽  
Lisa Anderson ◽  
Jonathan Himmelfarb ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Content Validity ◽  
Cognitive Debriefing ◽  
Home Hemodialysis ◽  
Home Dialysis ◽  
Care Experience ◽  
Concept Elicitation ◽  
Experience Of Care ◽  
Patient Reported ◽  
Experience Measure

Background and objectivesThe population of patients with kidney failure in the United States using home dialysis modalities is growing rapidly. Unlike for in-center hemodialysis, there is no patient-reported experience measure for assessment of patient experience of care for peritoneal dialysis or home hemodialysis. We sought to develop and establish content validity of a patient-reported experience measure for patients undergoing home dialysis using a mixed methods multiple stakeholder approach.Design, setting, participants, & measurementsWe conducted a structured literature review, followed by concept elicitation focus groups and interviews among 65 participants, including 21 patients on home dialysis, 33 home dialysis nurses, three patient care partners, and eight nephrologists. We generated a list of candidate items for possible measure inclusion and conducted a national prioritization exercise among 91 patients on home dialysis and 39 providers using a web-based platform. We drafted the Home Dialysis Care Experience instrument and conducted cognitive debriefing interviews to evaluate item interpretability, order, and structure. We iteratively refined the measure on the basis of interview findings.ResultsThe literature review and concept elicitation phases supported 15 domains of home dialysis care experience in six areas: communication and education of patients, concern and helpfulness of the care team, proficiency of the care team, patient-centered care, care coordination, and amenities and environment. Focus groups results showed that domains of highest importance for measure inclusion were patient education and communication, care coordination, and personalization of care. Prioritization exercise results confirmed focus group findings. Cognitive debriefing indicated that the final measure was easily understood and supported content validity.ConclusionsThe Home Dialysis Care Experience instrument is a 26-item patient-reported experience measure for use in peritoneal dialysis and home hemodialysis. The Home Dialysis Care Experience instrument represents the first rigorously developed and content-valid English-language instrument for assessment of patient-reported experience of care in home dialysis.

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.

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