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Home hemodialysis

Denise M Hynes, Michael Fischer, Linda A Schiffer, Rani Gallardo, Ifeanyi Beverly Chukwudozie, Anna Porter, Michael Berbaum, Jennifer Earheart, Marian L Fitzgibbon
INTRODUCTION: Using a quasi-experimental design, we implemented the Patient-Centered Medical Home for Kidney Disease (PCMH-KD), a comprehensive, multidisciplinary care team to improve quality of life and healthcare coordination for adult chronic hemodialysis (CHD) patients. This paper highlights our experience in the first two years of the study.We focus on the process dimensions of Reach, Adoption, and Implementation within the context of the RE-AIM framework. MATERIALS AND METHODS: We established a new PCMH-KD model at two outpatient dialysis centers...
October 18, 2016: Contemporary Clinical Trials
Sarity Dodson, Tanya Osicka, Louis Huang, Lawrence P McMahon, Matthew A Roberts
Health literacy (HL) refers to a person's ability to engage effectively with health information and services. We aimed to describe the HL of people receiving dialysis and the factors associated with it. A cross-sectional design was used, with demographic and clinical data as predictors. Participants were people receiving dialysis at a metropolitan health service in Melbourne, Australia. Health consumers with conditions not requiring dialysis were included for comparison. The Health Literacy Questionnaire, Kidney Disease Quality of Life-36, and Depression Anxiety Stress Scales-21 were administered...
2016: Journal of Health Communication
Nigel D Toussaint, Lawrence P McMahon, Gregory Dowling, Stephen G Holt, Gillian Smith, Maria Safe, Richard Knight, Kathleen Fair, Leanne Linehan, Rowan G Walker, David A Power
♦ Background: Increased 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...
September 28, 2016: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Eric L Wallace, Janice Lea, Ninad Chaudhary, Russell Griffin, Eric Hammelman, Joshua Cohen, James A Sloand
♦ Background: United States Renal Data System (USRDS) data from 2014 show that African Americans (AA) are underrepresented in the home dialysis population, with 6.4% versus 9.2% utilization in the general populace. This racial disparity may be inaccurately ascribed to the nation as a whole if regional and inter-state variability exists. This investigation sought to examine home dialysis utilization by minority Medicare beneficiary populations across the US nationally, regionally, and by individual state. ♦ Methods: The 2012 Medicare 100% Outpatient Standard Analytic File was used to identify all Medicare fee-for-service (FFS) patients, with state of residence and race, receiving an outpatient dialysis facility bill type...
September 28, 2016: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
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...
September 27, 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...
September 23, 2016: Advances in Therapy
Catherine L Oberg, Robert J Hiensch, Hooman D Poor
OBJECTIVE: To report a case series of three patients with hepatitis C virus infection who all presented with severe type B lactic acidosis shortly after starting treatment with ombitasvir-paritaprevir-ritonavir-dasabuvir. DESIGN: Case series. SETTING: ICU. PATIENTS: Three patients, all who had HCV cirrhosis with mild hepatic impairment (Child-Pugh A) and had started taking ombitasvir-paritaprevir-ritonavir-dasabuvir within the preceding 2 weeks, presented with similar nonspecific symptoms of lethargy, fatigue, and nausea...
September 22, 2016: Critical Care Medicine
Emilie Trinh, Christopher T Chan
BACKGROUND: Left ventricular hypertrophy (LVH) is an independent risk factor for mortality and cardiovascular events in patients with end-stage renal disease. Studies have shown that frequent hemodialysis leads to LVH regression, but the impact of left ventricular mass (LVM) regression on clinical outcomes remains unknown. METHODS: This observational cohort study assessed the impact of LVH regression on the composite outcome of time to all-cause mortality, technique failure or cardiovascular hospitalization in patients on home hemodialysis...
2016: American Journal of Nephrology
Miklos Z Molnar, Vanessa Ravel, Elani Streja, Csaba P Kovesdy, Matthew B Rivara, Rajnish Mehrotra, Kamyar Kalantar-Zadeh
OBJECTIVES: To compare the mortality of elderly adults with end-stage renal disease (ESRD) treated with home hemodialysis (HD) with that of those receiving a kidney transplant (KTx). DESIGN: Prospective cohort. SETTING: Pertinent data for the two groups were obtained from electronic medical records from a large dialysis provider and the U.S. Renal Data System. PARTICIPANTS: Using data from elderly adults (aged ≥65) who started home HD and underwent KTx in the US between 2007 and 2011, a 1:1 propensity score (PS)-matched cohort of 960 elderly adults was created, and the association between treatment modality and all-cause mortality was examined using Cox proportional hazards and competing risk regression survival models using modality failure as a competing event...
September 9, 2016: Journal of the American Geriatrics Society
Ursel Heudorf, Sabine Albert-Braun, Klaus-Peter Hunfeld, Franz-Ulrich Birne, Jörg Schulze, Klaus Strobel, Knut Petscheleit, Volkhard A J Kempf, Christian Brandt
INTRODUCTION: The refugee crisis is a great challenge to the social and healthcare system in European countries, especially in Germany. An abundance of data has been published on the refugees' health problems (infections as well as physical diseases and psychiatric problems) and their prevention (i.e., sanitary and vaccination programs). However, data on prevalences of multidrug-resistant organisms (MDRO) in refugees are scarce, although it is known that most refugees are from or travelled through countries with high prevalences of MDRO...
2016: GMS Hygiene and Infection Control
Keren Ladin, Naomi Lin, Emily Hahn, Gregory Zhang, Susan Koch-Weser, Daniel E Weiner
BACKGROUND: Although shared decision-making (SDM) can better align patient preferences with treatment, barriers remain incompletely understood and the impact on patient satisfaction is unknown. METHODS: This is a qualitative study with semistructured interviews. A purposive sample of prevalent dialysis patients ≥65 years of age at two facilities in Greater Boston were selected for diversity in time from initiation, race, modality and vintage. A codebook was developed and interrater reliability was 89%...
August 30, 2016: Nephrology, Dialysis, Transplantation
Thomas A Golper
Incremental hemodialysis (incrHD) is not widely used nor is it well understood. In addition, and perhaps with more impact, governmental regulations in the United States and their consequential influences on dialysis provider organizations have made the practice of incrHD more difficult than traditional thrice weekly in-center HD. IncrHD is critically dependent on the amount of residual kidney function (RKF) as well as the individualized goals of end-stage renal disease (ESRD) management. RKF has to be assessed frequently and dialysis adjusted accordingly...
August 25, 2016: Seminars in Dialysis
Gregory S Schober, Julia B Wenger, Celeste C Lee, Jonathan Oberlander, Jennifer E Flythe
BACKGROUND: Health advocacy groups provide education, raise public awareness, and engage in legislative, scientific, and regulatory processes to advance funding and treatments for many diseases. Despite a high burden of chronic kidney disease (CKD) in the United States, public awareness and research funding lag behind those for other disease states. We undertook this study of patients receiving maintenance dialysis to describe knowledge and beliefs about CKD advocacy, understand perceptions regarding advocacy participation, and elicit ideas for generating more advocacy in the dialysis community...
August 20, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Andreas Pierratos, Melanie Tremblay, Gokulan Kandasamy, Graham Woodward, Peter Blake, Janet Graham, Marc Hebert, Rebecca Harvey
Introduction Despite improving clinical outcomes associated with the use of home hemodialysis (HD), its utilization is low in most countries. The inability or unwillingness of patients and their families to participate in their own treatment is one of the most important barriers to the adoption of home HD. Methods We hypothesized that paid helper-delivered home HD supported by public funds would be successful and welcomed by patients and be delivered at an affordable cost. We conducted a pilot project to dialyze six patients at home using Personal Support Workers (PSW) and resolve regulatory, organizational and financial constraints...
August 22, 2016: Hemodialysis International
Chiara Ralli, Patrizio Imperiali, Ennio Duranti
The home extracorporeal hemodialysis, which aroused a great interest in the past, has not kept its promises due to the complexity and expectations for family involvement in treatment management. In the United States NxStage One portable system was proposed and designed for home use. In this work we describe, starting from the history of home hemodialysis, the method with NxStage system by comparing it with the conventional HD in 5 patients. The dialysis efficiency was similar between the two treatments, even if home hemodialysis showed a reduction in serum urea, creatinine and phosphorus...
July 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Michael V Rocco
BACKGROUND: Chronic hemodialysis (HD) in the 1960s encompassed a wide variety of prescriptions from twice weekly to five times per week HD. Over time, HD prescriptions in the West became standardized at three times per week, 2.5-4 h per session, with occasional additional treatments for volume overload. SUMMARY: When clinical trials of dialysis dose failed to show significant benefit of extending time compared with the traditional dialysis prescription, interest in more frequent HD was renewed...
December 2015: Kidney Diseases
Dirk G Struijk
BACKGROUND: Peritoneal dialysis (PD) for the treatment of end-stage renal failure was introduced in the 1960s. Nowadays it has evolved to an established therapy that is complementary to hemodialysis (HD), representing 11% of all patients treated worldwide with dialysis. Despite good clinical outcomes and similar results in patient survival between PD and HD, the penetration of PD is decreasing in the Western world. SUMMARY: First the major events in the history of the development of PD are described...
December 2015: Kidney Diseases
Yu-Chu Chung, Mei-Ling Yeh, Yueh-Min Liu
AIMS AND OBJECTIVES: To determine the efficacy and safety of intradialytic exercises for hemodialysis (HD) patients, this study conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). BACKGROUND: Patients receiving HD have poor physical function, psychological status and quality of life than the general population. Exercise training may improve these parameters for HD patients. DESIGN: Systemic review and a meta-analysis was conducted...
August 17, 2016: Journal of Clinical Nursing
Katherine R Courtright, Vanessa Madden, Nicole B Gabler, Elizabeth Cooney, Jennifer Kim, Nicole Herbst, Lauren Burgoon, Jennifer Whealdon, Laura M Dember, Scott D Halpern
BACKGROUND: Evidence suggests that advance directives may improve end-of-life care among seriously ill patients, but improving completion rates remains a challenge. OBJECTIVE: This study tested the influence of increasing the number of options for completing an advance directive among seriously ill patients. METHODOLOGY: Outpatients (N = 316) receiving hemodialysis across 15 dialysis centers in the Philadelphia region between July 2014 and July 2015 were randomized to receive either the option to complete a brief advance directive form or expanded options including a brief, expanded, or comprehensive form...
August 10, 2016: Medical Decision Making: An International Journal of the Society for Medical Decision Making
Stephanie Metzger
In the United States, an increasing number of individuals are being diagnosed with end stage renal disease requiring renal replacement therapy. Home dialysis modalities are an available option in lieu of in-center hemodialysis therapy for these individuals, but are vastly underutilized in the U.S. for multiple reasons. Both healthcare providers and individuals requiring renal replacement therapy are frequently unaware these modalities are an available alternative to in-center hemodialysis and of the potential benefits related to home modality use...
May 2016: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
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