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home hemodialysis quality indicators

Javier Ferreira, Ivan Pau, Kaj Lindecrantz, Fernando Seoane
In recent years, many efforts have been made to promote a healthcare paradigm shift from the traditional reactive hospital-centered healthcare approach towards a proactive, patient-oriented, and self-managed approach that could improve service quality and help reduce costs while contributing to sustainability. Managing and caring for patients with chronic diseases accounts over 75% of healthcare costs in developed countries. One of the most resource demanding diseases is chronic kidney disease (CKD), which often leads to a gradual and irreparable loss of renal function, with up to 12% of the population showing signs of different stages of this disease...
September 2017: IEEE Journal of Biomedical and Health Informatics
Ikuto Masakane, Norio Hanafusa, Tomoyuki Kita, Kenji Maeda
BACKGROUND: Home hemodialysis (HHD) is rapidly becoming more widespread because HHD programs enable patients to receive a sufficient dialysis dose to improve their quality of life and survival rate without compromising their lifestyle. SUMMARY: Although HHD in Japan has a long history, the 529 dialysis patients being treated with HHD as of the end of 2014 account for only 0.17% of all dialysis patients. HHD is well indicated for patients who are younger, male, and nondiabetic...
2017: Contributions to Nephrology
Kathryn S Agarwal, Rabia Kazim, Jiaqiong Xu, Soo Borson, George E Taffet
OBJECTIVES: To determine whether 30-day readmissions were associated with presence of cognitive impairment more in elderly adults with heart failure (HF) than in those with other diagnoses and whether medical teams recognized cognitive impairment. DESIGN: One-year prospective cohort quality improvement program of cognitive screening and retrospective chart review of documentation and outcomes. SETTING: Academic tertiary care hospital medical unit with a cardiovascular focus and an enhanced discharge program of individualized patient education...
November 2016: Journal of the American Geriatrics Society
Anna Trisia Beby, Tom Cornelis, Raymund Zinck, Frank Xiaoqing Liu
INTRODUCTION: In the Netherlands, the current standard of care for treating patients with end-stage renal disease is three sessions of in-center hemodialysis (conventional ICHD). However, the literature indicates that high dose hemodialysis (high dose HD) may provide better health outcome such as survival and quality of life. The objective of this study was to determine the cost-effectiveness of high dose HD, both in-center and at home, in comparison to conventional ICHD from a Dutch payer's perspective over a 5 year period...
November 2016: Advances in Therapy
Mark L Unruh, Brett Larive, Paul W Eggers, Amit X Garg, Jennifer J Gassman, Fredric O Finkelstein, Paul L Kimmel, Glenn M Chertow
BACKGROUND: Many patients who receive maintenance hemodialysis experience poor sleep. Uncontrolled studies suggest frequent hemodialysis improves sleep quality, which is a strong motivation for some patients to undertake the treatment. We studied the effects of frequent in-center ('daily') and nocturnal home hemodialysis on self-reported sleep quality in two randomized trials. METHODS: Participants were randomly assigned to frequent (six times per week) or conventional (three times per week) hemodialysis in the Frequent Hemodialysis Network Daily (n = 245) and Nocturnal (n = 87) Trials...
June 2016: Nephrology, Dialysis, Transplantation
Rose Faratro, Janine Jeffries, Gihad E Nesrallah, Jennifer M MacRae
Creating and maintaining a healthy vascular access is a critical factor in successful home hemodialysis (HD). This article aims to serve as a "how-to manual" regarding vascular access issues for both patients and health-care providers in a home HD program. This document outlines cannulation options for patients with arteriovenous access and describes troubleshooting techniques for potential complications; strategies are suggested to help patients overcome fear of cannulation and address problems associated with difficult cannulation...
April 2015: Hemodialysis International
Mustafa Younis, Samer Jabr, Abdallah Al-Khatib, Dana Forgione, Michael Hartmann, Adnan Kisa
This study provides a cost analysis of kidney replacement therapy options in Palestine. It informs evidence-based resource allocation decisions for government-funded kidney disease services where transplant donors are limited, and some of the common modalities, i.e., peritoneal dialysis (PD) and home hemodialysis (HD), are not widely available due to shortages of qualified staff, specialists, and centers to follow the patient cases, provide training, make home visits, or provide educational programs for patients...
2015: Inquiry: a Journal of Medical Care Organization, Provision and Financing
Silvia Lai, Alessio Molfino, Gaspare Elios Russo, Massimo Testorio, Alessandro Galani, Georgie Innico, Nicla Frassetti, Valentina Pistolesi, Santo Morabito, Filippo Rossi Fanelli
INTRODUCTION: Mortality in dialysis patients is higher than in the general population, and cardiovascular disease represents the leading cause of death. Hypertension and volume overload are important risk factors for the development of left ventricular hypertrophy (LVH) in hemodialysis (HD) and peritoneal dialysis (PD) patients. Other factors are mainly represented by hyperparathyroidism, vascular calcification, arterial stiffness and inflammation. The aim of this study was to compare blood pressure (BP) and metabolic parameters with cardiovascular changes [cardiothoracic ratio (CTR), aortic arch calcification (AAC) and LV mass index (LVMI)] between PD and HD patients...
February 2015: Cardiorenal Medicine
Frank Xiaoqing Liu, Catrin Treharne, Murat Arici, Lydia Crowe, Bruce Culleton
OBJECTIVE: To investigate the cost-effectiveness of high-dose hemodialysis (HD) versus conventional in-center HD (ICHD), over a lifetime time horizon from the UK payer's perspective. METHODS: We used a Markov modeling approach to compare high-dose HD (in-center or at home) with conventional ICHD using current and hypothetical home HD reimbursement tariffs in England. Sensitivity analyses tested the robustness of the results. The main outcome measure was the incremental cost-effectiveness ratio (ICER) expressed as a cost per quality-adjusted life-year (QALY)...
January 2015: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Ignace Mpio, Christine Cleaud, Walid Arkouche, Maurice Laville
INTRODUCTION: Undernutrition (UN) in chronic hemodialysis (CHD) is a recurrent complication and constitutes a major public health problem. This work aims to evaluate the effects of our nutritional strategy (NS) developed among malnourished patients (pts) in CHD. This is a prospective observational study conducted for 12 months (M) in a cohort of 132 pts in CHD including 49 women, mean age 66 ± 16 years and the dialysis vintage 72 ± 74 months. This NS is based on the action of a multidisciplinary team; it provides for moderate UN pts one first phase of an optimization of protein and energy intake in the daily meals; then depending on the clinical course a second phase of oral supplementation at home...
April 2015: Néphrologie & Thérapeutique
Sema K Aydede, Paul Komenda, Ognjenka Djurdjev, Adeera Levin
BACKGROUND: Chronic diseases, such as chronic kidney disease (CKD), are growing in incidence and prevalence, in part due to an aging population. Support provided through home care services may be useful in attaining a more efficient and higher quality care for CKD patients. METHODS: A systematic review was performed to identify studies examining home care interventions among adult CKD patients incorporating all outcomes. Studies examining home care services as an alternative to acute, post-acute or hospice care and those for long-term maintenance in patients' homes were included...
2014: BMC Nephrology
Rhonda Shaw
New Zealand leads the world in rates of home dialysis use, yet little is known about the experience of home dialysis from the patient's perspective. This article contributes to the literature on the self-care of dialysis patients by examining the relevance of the concept of the machine-body and cyborg embodiment for the lived experience of people with end-stage renal failure. The article, which presents a discussion of 24 in-depth interviews undertaken between 2009 and 2012, shows that although dialysis therapy is disruptive of being and time, study participants experience home dialysis in terms of flexibility, control and independence...
May 2015: Health (London)
Blair S Grace, Philip A Clayton, Nicholas A Gray, Stephen P McDonald
BACKGROUND AND OBJECTIVES: Home dialysis creates fewer lifestyle disruptions while providing similar or better outcomes than in-center hemodialysis. Socioeconomically advantaged patients are more likely to commence home dialysis (peritoneal dialysis and home hemodialysis) in many developed countries. This study investigated associations between socioeconomic status and uptake of home dialysis in Australia, a country with universal access to health care and comparatively high rates of home dialysis...
May 2014: Clinical Journal of the American Society of Nephrology: CJASN
Baruch D Jakubovic, Andrew T Yan, Ron Wald
Dialysis intensification from conventional regimens (typically thrice weekly, 4 hours per session) is increasingly utilized with the intent of improving the cardiovascular health and quality of life of chronic dialysis recipients. While home nocturnal hemodialysis offers the opportunity for maximal intensification of dialysis, it is inaccessible to the majority of dialysis recipients who are unable to self-administer hemodialysis in their own homes. In-center nocturnal hemodialysis (INHD) permits the intensification of conventional hemodialysis with the benefits of nursing support and supervision in addition to freedom from dialysis during productive daytime hours...
March 2014: Seminars in Dialysis
Tsuneo Takenaka, Keita Sueyoshi, Jonde Arai, Yusuke Watanabe, Hiroshi Takane, Yoichi Ohno, Hiromichi Suzuki
Hypertension is a well-known cardiovascular risk. Patients with end-stage renal diseases frequently suffer hypertension. Furthermore, daily variations of blood pressure are relatively large in patients treated with hemodialysis, partly due to ultrafiltration. Twenty hypertensive patients with end-stage renal diseases whose blood pressure was controlled by a single antihypertensive agent, either angiotensin receptor antagonist (ARB) or calcium channel blocker (CCB), were enrolled into the study. Home blood pressure measurements were also performed...
2014: Clinical and Experimental Hypertension: CHE
Periklis Dousdampanis, Konstantina Trigka, Costas Fourtounas
Chronic kidney disease (CKD) is rather common in elderly adults who comprise the fastest growing subset of patients with end-stage renal disease (ESRD). At present, there are no specific guidelines and recommendations regarding early identification and management of elderly with CKD and the current CKD classification system may overestimate its exact prevalence. Screening strategies based either in a more accurate formula of estimation of GFR alone, or preferably in combination with proteinuria are urgently needed in order to raise awareness and to promote early diagnosis of CKD in the elderly...
October 2012: Aging and Disease
Khaled Abdel-Kader, Mark L Unruh
Many end-stage renal disease patients receive thrice-weekly hemodialysis (HD) and report impairments in health-related quality of life (HRQOL). Recent studies indicate that short daily HD may improve HRQOL. High-quality studies exploring the burdens and costs to patients, caregivers, and society are necessary before widespread adoption can be advocated. Further research exploring the mechanisms by which these benefits are realized is also important, as many patients are likely to opt out of short daily HD.
September 2012: Kidney International
Karthik K Tennankore, Christopher T Chan, Simon P Curran
Accumulating evidence of the benefits of intensive home haemodialysis has led to increased international interest in this modality as a viable option for renal replacement therapy. Until the late 1970s, haemodialysis was primarily performed at home; however, the development of in-centre and satellite dialysis units and the advent of peritoneal dialysis led to decreased numbers of patients being managed by home haemodialysis. Over the past decade, a move towards once again providing and supporting haemodialysis at home has emerged, due to a desire to offer a more convenient form of dialysis for the patient in a more cost-effective manner...
September 2012: Nature Reviews. Nephrology
Akira Saito, Yoriko Ohta, Kazuhiro Sato, Mayuri Ichinose, Tatsuro Arii, Katsuhide Toyama
Three times weekly home hemodialysis (HHD) was introduced shortly after the initiation of chronic hemodialysis (HD) treatment in 1960. HHD eliminates the need of transportation to and from the dialysis unit and by allowing patients to set their own dialysis schedule, decreases the burden of treatment on their personal and professional lives. HHD has been found more economical and more highly associated with better patient survival than in-center dialysis. Nevertheless, the global prevalence of HHD decreased between 1980 and 2000 due to the increased availability of dialysis units and continuous ambulatory peritoneal dialysis, advances in cadaveric kidney transplantation, and several other factors...
2012: Contributions to Nephrology
Eric D Weinhandl, Jiannong Liu, David T Gilbertson, Thomas J Arneson, Allan J Collins
Frequent hemodialysis improves cardiovascular surrogates and quality-of-life indicators, but its effect on survival remains unclear. We used a matched-cohort design to assess relative mortality in daily home hemodialysis and thrice-weekly in-center hemodialysis patients between 2005 and 2008. We matched 1873 home hemodialysis patients with 9365 in-center patients (i.e., 1:5 ratio) selected from the prevalent population in the US Renal Data System database. Matching variables included first date of follow-up, demographic characteristics, and measures of disease severity...
May 2012: Journal of the American Society of Nephrology: JASN
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