The In-Center Hemodialysis Unit, Yet Another Obstacle to Home Dialysis

We extracted data from the French Speaking Registry of Peritoneal Dialysis and retrospectively studied peritonitis and the outcome of 30 patients with polycystic kidney disease firstly treated with peritoneal dialysis within our dialysis unit since 1997. There were 15 men and 15 women with a mean age of 54 years. Eighty-five per-cent of the patients had hepatic impairment. Ten patients did not suffer from comorbidities. Charlson comorbidity index was greater than or equal to 4 in five patients. Most of the patients was treated with automated peritoneal dialysis during the night. Only one patient was not autonomous with peritoneal dialysis. The whole medical monitoring lasted 836 months, representing an average of 28 months per patient. Eleven patients had a total of 24 peritonitis, 9 with gram negative bacillus. The incidence of peritonitis was one episode every 35 months-patient. Peritonitis was responsible for sudden admission in hemodialysis unit in two cases and death in one case. Fifteen patients (50%) benefited from renal transplantation. Only one patient had to undergo nephrectomy prior to renal transplantation. Seven patients were admitted to hemodialysis unit (the median duration time on peritoneal dialysis was 36 months). Four patients died. Four patients are currently treated with peritoneal dialysis. In conclusion, this retrospective study points out that peritoneal dialysis, especially automated peritoneal dialysis, is a good option for patients with polycystic kidney disease necessitating dialysis.

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P1562IMPLEMENTATION FOR INTEGRATED PROGRAM OF HEMODIALYSIS VASCULAR ACCESS PUNCTURE TRAINING AND AN ALARM SYSTEM MAY REDUCE THE INCIDENT OF VENOUS NEEDLE DISLODGMENT AND BLEEDING

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1562 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Chi-Yang Hsin ◽

HsuanMing Lin ◽

KuanYu Chen ◽

YuChih Lin ◽

HsiangWei Hu

Keyword(s):

Incidence Rate ◽

Vascular Access ◽

Large Scale ◽

Control Period ◽

Care Program ◽

Alarm System ◽

Home Dialysis ◽

Control Phase ◽

Hemodialysis Unit ◽

Integrated Program

Abstract Background and Aims A puncture of vascular access is commonly used in clinical treatment, such as hemodialysis or central venous catheters. At this time, leakage or infection associated with Venous needle dislodgement(VND) is a high risk of fatality, especially for patients with restlessness, impaired cognition, isolation, or home dialysis. In general dialysis procedures, medical personnel relies on patient reports and caregivers to manually inspect the site of dialysis puncture and detect the occurrence of needle removal and blood transfusion. There are some devices for detecting the presence of needle dislodgement in the market. Still, there are no large-scale reports for the integrated program for nursing training and device implantation. This study aims to conduct a program for an integrated training course and the VND device and hopes to reduce the incidence of needle removal and blood leakage. Method This study was divided into two phases, the control phase, and the study period. In the first phase, the abnormal events of ou venous needle dislodgement and blood leakage was recorded in the hemodialysis unit room during the first three months. Before the study period, we introduced an integrated program, including the standard process of fistula puncture, care during hemodialysis, an inspection of the venous puncture site, and an alarm system. In the study period, we also conducted the standard program and collected the data of the events of venous dislodgement or bleeding. Results The control phase was conducted during the three months from July 2019 to September 2019, and the study period was performed in November 2019. A total of 62 patients completed the study. During the control period, there were a total of 2087 dialysis treatments, of which 30 patients had venous needle dislodgement or bleeding. There were a total of 70 events of venous needle dislodgement or bleeding occurred, and the incidence rate was 3.3 events per 100 sessions. After the conduction of the integrated program and implantation of the alarm system in November 2019, there were a total of 682 dialysis sessions, and 15 events of venous needle dislodgement or bleeding occurred. The incidence rate was 2.2 events per 100 courses. Conclusion This study introduced venous needle dislodgement or bleeding alarm system in the hemodialysis unit. Compared with the traditional method, after the integrated care program, including fistula puncture, care, inspection, introduction, and use of the alarm system, venous needle dislodgement or bleeding dropped from 3.3 to 2.2 per 100 sessions. Therefore, through standardized training and program, it may be related to the decrease in the incidence of venous needle dislodgement or bleeding. This training mode can be worth promoting to more dialysis units to improve the quality of patient care. More follow-up studies are needed to provide multiple evidence.

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396 Home Dialysis and Kidney Transplant Assessments in the ESRD Treatment Choices Payment Model

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2020.02.398 ◽

2020 ◽

Vol 75 (4) ◽

pp. 651-652

Keyword(s):

Kidney Transplant ◽

Payment Model ◽

Home Dialysis ◽

Treatment Choices

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Body Composition Monitor Among Daily Home Dialysis With Low Flow Dialysate

Case Medical Research ◽

10.31525/ct1-nct03994133 ◽

2019 ◽

Author(s):

Keyword(s):

Body Composition ◽

Low Flow ◽

Home Dialysis ◽

Body Composition Monitor

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Telehealth for Home Dialysis in COVID-19 and Beyond: A Perspective From the American Society of Nephrology COVID-19 Home Dialysis Subcommittee

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2020.09.005 ◽

2021 ◽

Vol 77 (1) ◽

pp. 142-148 ◽

Cited By ~ 1

Author(s):

Susie Q. Lew ◽

Eric L. Wallace ◽

Vesh Srivatana ◽

Bradley A. Warady ◽

Suzanne Watnick ◽

...

Keyword(s):

Home Dialysis ◽

American Society

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Health literacy level in a various nephrology population from Québec: predialysis clinic, in-centre hemodialysis and home dialysis; a transversal monocentric observational study

BMC Nephrology ◽

10.1186/s12882-021-02464-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Annabel Boyer ◽

Yannick Begin ◽

Julie Dupont ◽

Mathieu Rousseau-Gagnon ◽

Nicolas Fernandez ◽

...

Keyword(s):

Health Literacy ◽

Observational Study ◽

Health Information ◽

Healthcare Providers ◽

Significant Proportion ◽

Good Health ◽

Sufficient Information ◽

Home Dialysis ◽

Limited Health Literacy ◽

Limited Health

Abstract Background Health literacy refers to the ability of individuals to gain access to, use, and understand health information and services in order to maintain a good health. It is especially important in nephrology due to the complexity of chronic kidney disease (CKD). The present study sought to define health literacy levels in patients followed in predialysis clinic, in-center dialysis (ICHD), peritoneal dialysis (PD) and home hemodialysis (HHD). Methods This transversal monocentric observational study analysed 363 patients between October 2016 and April 2017. The Brief Health Literacy Screen (BHLS) and the Health Literacy Questionnaire (HLQ) were used to measure health literacy. Multivariate linear regressions were used to compare the mean scores on the BHLS and HLQ, across the four groups. Results Patients on PD had a significantly higher BHLS’score than patients on ICHD (p = 0.04). HLQ’s scores differed across the groups: patients on HHD (p = 0.01) and PD (p = 0.002) were more likely to feel understood by their healthcare providers. Compared to ICHD, patients on HHD were more likely to have sufficient information to manage their health (p = 0.02), and patients in the predialysis clinic were more likely to report high abilities for health information appraisal (p < 0.001). Conclusion In a monocentric study, there is a significant proportion of CKD patients, especially in predialysis clinic and in-centre hemodialysis, with limited health literacy. Patients on home dialysis (HHD and PD) had a higher level of health literacy compared to the other groups.

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Covid-19 Pandemic Era: Is It Time To Promote Home Dialysis And Peritoneal Dialysis?

Clinical Kidney Journal ◽

10.1093/ckj/sfab023 ◽

2021 ◽

Author(s):

Mario Cozzolino ◽

Ferruccio Conte ◽

Fulvia Zappulo ◽

Paola Ciceri ◽

Andrea Galassi ◽

...

Keyword(s):

Severe Infection ◽

Human Interaction ◽

World Health ◽

Older Individuals ◽

Home Dialysis ◽

Renal Replacement Therapies ◽

Home Based ◽

Immunologic Diseases ◽

Novel Coronavirus ◽

Health Organization

ABSTRACT The novel coronavirus, called SARS-CoV-2 has been declared a pandemic on March 2020, by the World Health Organization. Older individuals and patients with comorbid conditions such as hypertension, heart disease, diabetes, lung disease, chronic kidney disease (CKD), and immunologic diseases are at higher risk of contracting this severe infection. In particular, patients with advanced CKD constitute a vulnerable population and a challenge in the prevention and control of the disease. Home-based renal replacement therapies offer opportunity to manage patients remotely, thus reducing the likelihood of infection due to direct human interaction. Patients are seen less frequently, limiting the close interaction between patients and healthcare workers who may contract and spread the disease. On the other hand, while home dialysis is reasonable selection at his time due to the advantage of isolation of patients, measures must be assured to implement the program. Despite its logistical benefits, outpatient hemodialysis also presents certain challenges during times of crises such as COVID 19 pandemic and potentially future ones.

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Quantifying Missed Opportunities for Recruitment to Home Dialysis Therapies

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358121993250 ◽

2021 ◽

Vol 8 ◽

pp. 205435812199325

Author(s):

Krishna Poinen ◽

Lee Er ◽

Michael A. Copland ◽

Rajinder S. Singh ◽

Mark Canney

Keyword(s):

Health Care ◽

British Columbia ◽

Health Care System ◽

Selection Process ◽

Chronic Dialysis ◽

Home Therapy ◽

Missed Opportunities ◽

Home Dialysis ◽

Missed Opportunity ◽

Care System

Background: Despite the recognized benefits of home therapies for patients and the health care system, most individuals with kidney failure in Canada continue to be initiated on in-center hemodialysis. To optimize recruitment to home therapies, there is a need for programs to better understand the extent to which potential candidates are not successfully initiated on these therapies. Objective: We aimed to quantify missed opportunities to recruit patients to home therapies and explore where in the modality selection process this occurs. Design: Retrospective observational study. Setting: British Columbia, Canada. Patients: All patients aged >18 years who started chronic dialysis in British Columbia between January 01, 2015, and December 31, 2017. The sample was further restricted to include patients who received at least 3 months of predialysis care. All patients were followed for a minimum of 12 months from the start of dialysis to capture any transition to home therapies. Methods: Cases were defined as a “missed opportunity” if a patient had chosen a home therapy, or remained undecided about their preferred modality, and ultimately received in-center hemodialysis as their destination therapy. These cases were assessed for: (1) documentation of a contraindication to home therapies; and (2) the type of dialysis education received. Differences in characteristics among patients classified as an appropriate outcome or a missed opportunity were examined using Wilcoxon rank-sum test or χ2 test, as appropriate. Results: Of the 1845 patients who started chronic dialysis during the study period, 635 (34%) were initiated on a home therapy. A total of 320 (17.3%) missed opportunities were identified, with 165 (8.9%) having initially chosen a home therapy and 155 (8.4%) being undecided about their preferred modality. Compared with patients who chose and initiated or transitioned to a home therapy, those identified as a missed opportunity tended to be older with a higher prevalence of cardiovascular disease. A contraindication to both peritoneal dialysis and home hemodialysis was documented in 8 “missed opportunity” patients. General modality orientation was provided to most (71%) patients who had initially chosen a home therapy but who ultimately received in-center hemodialysis. These patients received less home therapy–specific education compared with patients who chose and subsequently started a home therapy (20% vs 35%, P < .001). Limitations: Contraindications to home therapies were potentially under-ascertained, and the nature of contraindications was not systematically captured. Conclusions: Even within a mature home therapy program, we discovered a substantial number of missed opportunities to recruit patients to home therapies. Better characterization of modality contraindications and enhanced education that is specific to home therapies may be of benefit. Mapping the recruitment pathway in this way can define the magnitude of missed opportunities and identify areas that could be optimized. This is to be encouraged, as even small incremental improvements in the uptake of home therapies could lead to better patient outcomes and contribute to significant cost savings for the health care system. Trial Registration: Not applicable as this was a qualitative study.

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