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.

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.

Continuous Ambulatory Peritoneal Dialysis (CAPD) in a Developing Country

1985 ◽  
Vol 5 (1) ◽  
pp. 56-58 ◽  
Author(s):  
Jorge Dominguez ◽  
Gladys Gonzalez ◽  
Lenin Figueroa ◽  
Jose Mendez
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
End Stage Renal Disease ◽  
Admission Rate ◽  
Home Hemodialysis ◽  
Hospital Admission Rate ◽  
Economic Problems ◽  
Stage Renal Disease ◽  
End Stage ◽  
Chronic Ambulatory Peritoneal Dialysis

This paper describes our experience during the first 39 months of the CAPD program at the Miguel Perez Carreno Hospital in Caracas, Venezuela. Forty-eight patients were started on CAPD and treated for a total of 767 patient/months. Mean age was 45.8 years. Average time in the program was 15.9 months. At 39 months 87% of patients were alive and 78% were still on CAPD. The peritonitis rate was one episode per 6.39 pt/month with a probability of peritonitis of 0.70 at 25 months. Incidence of sterile peritonitis was high (41 %). Our patients had a low hospital admission rate (0.5 days per patient month) and a high percentage were rehabilitated (81%). Chronic ambulatory peritoneal dialysis (CAPD) is a widely accepted therapy for end-stage renal disease (ESRD): in Venezuela, approximately 160 patients (37%) of all those under treatment for ESRD receive this form of therapy. The Nephrology Section of the Miguel Perez Carreno Hospital in Caracas manages the largest CAPD program in the country. Here 149 patients are receiving treatment for ESRD by different techniques -hospital hemodialysis, home hemodialysis, intermittent peritoneal dialysis, CAPD and renal transplantation, under the care of five nephrologists, four nephrology residents and 30 nurses. Our CAPD program started in January 1980. This paper, which describes our three years of experience, indicates that CAPD is feasible in a country such as ours which, because of economic problems, is limited in its ability to provide other forms of treatment for ESRD.

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 Assisted peritoneal dialysis across Europe: Practice variation and factors associated with availability

2021 ◽  
pp. 089686082110498
Author(s):  
Anita van Eck van der Sluijs ◽  
Brigit C van Jaarsveld ◽  
Jennifer Allen ◽  
Karmela Altabas ◽  
Clémence Béchade ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Online Survey ◽  
Healthcare Professionals ◽  
Practice Variation ◽  
Dialysis Patients ◽  
Home Dialysis ◽  
Factors Associated ◽  
Western European ◽  
End Stage ◽  
Dedicated Team

Background: In Europe, the number of elderly end-stage kidney disease patients is increasing. Few of those patients receive peritoneal dialysis (PD), as many cannot perform PD autonomously. Assisted PD programmes are available in most European countries, but the percentage of patients receiving assisted PD varies considerably. Hence, we assessed which factors are associated with the availability of an assisted PD programme at a centre level and whether the availability of this programme is associated with proportion of home dialysis patients. Methods: An online survey was sent to healthcare professionals of European nephrology units. After selecting one respondent per centre, the associations were explored by χ 2 tests and (ordinal) logistic regression. Results: In total, 609 respondents completed the survey. Subsequently, 288 respondents from individual centres were identified; 58% worked in a centre with an assisted PD programme. Factors associated with availability of an assisted PD programme were Western European and Scandinavian countries (OR: 5.73; 95% CI: 3.07–10.68), non-academic centres (OR: 2.01; 95% CI: 1.09–3.72) and centres with a dedicated team for education (OR: 2.87; 95% CI: 1.35–6.11). Most Eastern & Central European respondents reported that the proportion of incident and prevalent home dialysis patients was <10% (72% and 63%), while 27% of Scandinavian respondents reported a proportion of >30% for both incident and prevalent home dialysis patients. Availability of an assisted PD programme was associated with a higher incidence (cumulative OR: 1.91; 95% CI: 1.21–3.01) and prevalence (cumulative OR: 2.81; 95% CI: 1.76–4.47) of patients on home dialysis. Conclusions: Assisted PD was more commonly offered among non-academic centres with a dedicated team for education across Europe, especially among Western European and Scandinavian countries where higher incidence and prevalence of home dialysis patients was reported.[Formula: see text]

Comparing Patient Survival of Home Hemodialysis and Peritoneal Dialysis Patients

2020 ◽  
Vol 51 (3) ◽  
pp. 192-200 ◽  
Author(s):  
Soo Jeong Choi ◽  
Yoshitsugu Obi ◽  
Gang Jee Ko ◽  
Amy S. You ◽  
Rieko Eriguchi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Home Hemodialysis ◽  
Logistic Regression Models ◽  
Mortality Risks ◽  
Mortality Hazard ◽  
Survival Difference ◽  
National Cohort ◽  
Stage Renal Disease ◽  
End Stage ◽  
Mortality Hazard Ratio

Background: It is not clear whether peritoneal dialysis (PD) and home hemodialysis (HHD) have similar outcomes, and little is known about how mortality associated with HHD versus PD differs according to the duration of dialysis. Methods: We examined a national cohort of incident end-stage renal disease patients that was comprised of 1,993 and 16,514 patients transitioning to HHD and PD, respectively, from 2007 to 2011. The HHD patients were matched with PD patients using propensity score (PS). Demographics, comorbidities, duration of dialysis, and body mass index were adjusted for in logistic regression models using PS matching. We matched 1,915 HHD patients with 1,915 PD patients based on the PS. The patients were categorized by their vintage (duration of dialysis) at the time of the transition to HHD or PD (<3, 3 to <12, and ≥12 months). Results: In the matched cohort, 237 and 359 deaths occurred in the HHD and PD patients, respectively (cumulative incidence 9.6 vs. 12.9/100 patient-years, p < 0.001). PD patients who transitioned within 12 months of starting dialysis had similar mortality risks, while PD patients who transitioned >12 months after starting dialysis had an 83% higher risk for mortality (hazard ratio 1.83; 95% CI 1.33–2.52). Conclusions: Whereas there was no meaningful survival difference in the first 12 months between HHD and PD, patients who transitioned to PD after 12 months of dialysis had worse survival than their HHD counterparts. Additional studies are warranted to investigate clinical implications of these differences.

The Use of Community Nurses for Home Peritoneal Dialysis: Is it Cost -Effective?

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 479-482 ◽  
Author(s):  
Gillian Brunier ◽  
Barbara Gray ◽  
Nancy Coulis ◽  
Judy Savage ◽  
Arif Manuel ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Family Members ◽  
Cost Effective ◽  
Peritoneal Dialysis Patient ◽  
Severe Disabilities ◽  
Dialysis Patients ◽  
Home Dialysis ◽  
Complex Needs ◽  
Stage Renal Disease ◽  
End Stage

In the late 1970s, continuous ambulatory peritoneal dialysis was first introduced as a mode of treatment for patients with end-stage renal disease. Since that time many patients, themselves or with the help of family members, have routinely performed the therapy at home. There are now 2935 home peritoneal dialysis patients in Canada (36% of the total dialysis population}. Today, however, the average patient on dialysis is likely to be older and have other complicating illnesses; moreover, patients may live alone, or have family members who are working. Over the past three years, through the use of innovative assistive devices and strong educational links with community nursing agencies, we have been able to manage peritoneal dialysis patients with complex needs in the home. We performed a retrospective analysis of 18 patients, with severe comorbid conditions, who were managed in the home with the help of community nurses. We will show that this is an economic, efficient, and effective method of caring for home dialysis patients with severe disabilities. Home care agencies need our support so that they can continue to help us manage the complex peritoneal dialysis patient in the 1990s.

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.

Introduction of Renal Key Performance Indicators Associated with Increased Uptake of Peritoneal Dialysis in a Publicly Funded Health Service

2017 ◽  
Vol 37 (2) ◽  
pp. 198-204 ◽  
Author(s):  
Nigel D. Toussaint ◽  
Lawrence P. McMahon ◽  
Gregory Dowling ◽  
Stephen G. Holt ◽  
Gillian Smith ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Performance Indicator ◽  
The Elderly ◽  
Reduced Pressure ◽  
Home Dialysis ◽  
Technique Survival ◽  
Home Based ◽  
Australian State ◽  
Previous Decade ◽  
End Stage

BackgroundIncreased demand for treatment of end-stage kidney disease has largely been accommodated by a costly increase in satellite hemodialysis (SHD) in most jurisdictions. In the Australian State of Victoria, a marked regional variation in the uptake of home-based dialysis suggests that use of home therapies could be increased as an alternative to SHD. An earlier strategy based solely on increased remuneration had failed to increase uptake of home therapies. Therefore, the public dialysis funder adopted the incidence and prevalence of home-based dialysis therapies as a key performance indicator (KPI) for its health services to encourage greater uptake of home therapies.MethodsA KPI data collection and bench-marking program was established in 2012 by the Victorian Department of Health and Human Services, with data provided monthly by all renal units in Victoria using a purpose-designed website portal. A KPI Working Group was responsible for analyzing data each quarter and ensuring indicators remained accurate and relevant and each KPI had clear definitions and targets. We present a prospective, observational study of all dialysis patients in Victoria over a 4-year period following the introduction of the renal KPI program, with descriptive analyses to evaluate the proportion of patients using home therapies as well as home dialysis modality survival.ResultsFollowing the introduction of the KPI program, the net growth of dialysis patient numbers in Victoria remained stable over 4 years, at 75 – 80 per year (approximately 4%). However, unlike the previous decade, about 40% of this growth was through an increase in home dialysis, which was almost exclusively peritoneal dialysis (PD). The increase was identified particularly in the young (20 – 49) and the elderly (> 80). Disappointingly, however, 67% of these incident patients ceased PD within 2 years of commencement, 46% of whom transferred to SHD.ConclusionsIntroduction of a KPI program was associated with an increased uptake of PD but not home HD. This change in clinical practice restricted growth of SHD and reduced pressure on satellite services. The effect was offset by a modest PD technique survival. Many patients in whom PD was unsuccessful were subsequently transferred to SHD rather than home HD.

Abstract P151: Cardiovascular Effects Of Peritoneal Dialysis In The 5/6 Nephrectomy Rat Model

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Victoria Nasci ◽  
Alison J Kriegel
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Statistical Significance ◽  
Cardiovascular Effects ◽  
Heart Weight ◽  
Sprague Dawley ◽  
Home Dialysis ◽  
Post Surgery ◽  
Stage Renal Disease ◽  
End Stage

In the US more than 130,000 people are diagnosed with end stage renal disease (ESRD) each year. Of those only 3% receive a kidney transplant while the remaining 97% are reliant on dialysis for survival. Among dialysis patients, cardiovascular (CV) related events are the leading cause of death. Despite therapeutic advancements the continued CVD following the onset of dialysis poses an interesting clinical challenge that necessitates studies into the effects and effectiveness of dialysis. Furthermore, home dialysis, particularly peritoneal dialysis (PD), has been utilized increasingly in ESRD care (up 10% in 2018) thus the need to understand PD effects on the CV system is urgent. Based on clinical outcomes, we hypothesized that PD would have no effect on CV outcomes in chronic kidney disease (CKD). To study CKD, we performed 5/6 nephrectomy (5/6Nx) or sham surgery, on 10 week old male Sprague-Dawley rats. Peritoneal catheters were then implanted 6 weeks post-surgery and PD was initiated 2 days later in some of the 5/6Nx and sham animals (15ml [Baxter PD-2 2.5%] 1-hour dwell 3x/day for 9 days). Echocardiography was performed at baseline, 6-, and 7-weeks post-surgery. At week 7 pressure volume analysis was performed prior to serum and tissue collection. Statistical significance was determined by two-way ANOVA. 5/6Nx increased heart weight (5/6Nx 0.43±0.02 vs. Sham 0.34±0.01; p<0.05). PD had no effect on heart weight in sham rats, but attenuated the increase in 5/6Nx rats (5/6Nx 0.43±0.02 vs. 5/6Nx PD 0.40±0.01; p<0.05). 5/6Nx increased systolic blood pressure (5/6Nx 133.6±5.6 vs. Sham 111.1±5.9; p<0.05). PD had no effect on blood pressure in either sham or 5/6Nx rats. 5/6Nx increased cholesterol (5/6Nx 134.9±8.3 vs. Sham 104.3±11; p<0.05), but PD attenuated the rise in cholesterol in 5/6Nx rats (5/6Nx 134.9±8.3 vs. 5/6Nx PD 115.7±9; p<0.05), and greatly increased triglycerides (5/6Nx 65.6±11 vs. 5/6Nx PD 165.5±11.9; p<0.05). CV echocardiography parameters in sham animals and in 5/6Nx were unchanged by PD. These data combined suggests that PD may have little to no effects on some CV parameters while worsening others. These findings indicate more studies focused on the CV effects of dialysis are necessary to help improve outcomes in the ESRD population.

scholarly journals An Alternative Approach to Delivering Intensive Dialysis in Pregnancy

2016 ◽  
Vol 36 (5) ◽  
pp. 575-577 ◽  
Author(s):  
Louise E. Ross ◽  
Pauline A. Swift ◽  
Sandra M. Newbold ◽  
Kate Bramham ◽  
Anne Hurley ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Pregnancy Outcomes ◽  
End Stage Renal Disease ◽  
Recent Literature ◽  
Alternative Approach ◽  
Stage Renal Disease ◽  
End Stage ◽  
Intensive Hemodialysis ◽  
In Pregnancy

Pregnancy outcomes in patients with end-stage renal disease (ESRD) on dialysis are improving. Recent literature supports intensive hemodialysis (HD) as the modality of choice during pregnancy in ESRD. We report the successful delivery of a healthy infant at full term in a patient with ESRD by supplementing peritoneal dialysis (PD) with intermittent HD to achieve adequate dialysis intensity.

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