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Home haemodialysis

Josephine Sau Fan Chow, Kim Jobburn, Margaret Chapman, Michael Suranyi
BACKGROUND: An ageing population and geographical growth, along with an increase in the number of people that reside in specific location, are increasing the demand for renal replacement therapies. Hospital-based haemodialysis units are struggling to cope with the associated physical, staffing and cost demands. Home-based dialysis therapies are known to be more cost effective with superior social, physical health and survival outcomes. METHODS: 'RENEW, a renal redesign project, examined the pre-dialysis health care experience of renal patients to find opportunities to improve patient care outcomes and increase the uptake of home-based dialysis therapies...
October 2016: Clinical Kidney Journal
Sarah L Stevens, Sally Wood, Constantinos Koshiaris, Kathryn Law, Paul Glasziou, Richard J Stevens, Richard J McManus
OBJECTIVE:  To systematically review studies quantifying the associations of long term (clinic), mid-term (home), and short term (ambulatory) variability in blood pressure, independent of mean blood pressure, with cardiovascular disease events and mortality. DATA SOURCES:  Medline, Embase, Cinahl, and Web of Science, searched to 15 February 2016 for full text articles in English. ELIGIBILITY CRITERIA FOR STUDY SELECTION:  Prospective cohort studies or clinical trials in adults, except those in patients receiving haemodialysis, where the condition may directly impact blood pressure variability...
2016: BMJ: British Medical Journal
Natasha Lovell, Chris Jones, Dawn Baynes, Sarah Dinning, Katie Vinen, Fliss Em Murtagh
BACKGROUND: Meeting place-of-death preferences is an important measure of the quality of end-of-life care. Systematic review shows that 42% of end-stage kidney disease patients prefer home death. Little research has been undertaken on place of death. AIM: To understand patterns of place of death in patients with end-stage kidney disease known in one UK renal unit. DESIGN: A retrospective cohort study of all patients with chronic kidney disease stage 4-5, age ⩾75 and known to one UK renal unit, who died between 2006 and 2012...
August 5, 2016: Palliative Medicine
Steve Siu-Man Wong, Wai-Yan Lau, Ping-Kwan Chan, Ching-Kit Wan, Yuk-Lun Cheng
BACKGROUND: Low-molecular weight heparin (LMWH) is commonly used as an anticoagulant for haemodialysis by a single-bolus injection. However, its application in extended haemodialysis has been infrequently studied. In particular, for nocturnal home haemodialysis patients sleeping throughout treatment, the need for additional intradialytic bolus might render the use of LMWH impractical. To overcome this limitation, we changed traditional bolus injections to continuous infusion. We first tested our method among in-centre 4-h haemodialysis patients to establish a feasible and safe infusion regimen before utilizing it in extended dialyses at home...
August 2016: Clinical Kidney Journal
Anuradha Jayanti, Philip Foden, Alison Wearden, Sandip Mitra
BACKGROUND: Interest in self-care haemodialysis (HD) has increased because it improves patients'clinical and quality-of-life outcomes. Patients who undertake self-management for haemodialysis may hold illness beliefs differently to those choosing institutional care at the time of making the modality choice or moulded by their illness and dialysis treatment experience. Illness perceptions amongst predialysis patients and in those undertaking fully-assisted and self-care haemodialysis are being investigated in a combined cross-sectional and longitudinal study...
2016: PloS One
Camilla S Hanson, Jeremy R Chapman, Jonathan C Craig, David C Harris, Lukas K Kairaitis, Maryann Nicdao, Mary Mikaheal, Allison Tong
AIM: This study aims to describe patients' perspectives on the transition to home haemodialysis. METHODS: Up to three sequential semi-structured interviews were conducted with 20 patients during the transition to home haemodialysis at an Australian renal unit. Transcripts were analysed thematically. Participants completed a satisfaction questionnaire after commencing home haemodialysis. RESULTS: We identified six themes: persevering despite trepidations (diminishing intimidation of machinery, acquiescing to fatal risks, reconciling fears of cannulation, dispelling concerns of neglect, tolerating necessary concessions); optimising the learning pathway (practising problem solving, learning from mistakes, grasping technical complexity, minimising cognitive overload, progressing at own pace); developing confidence (believing in own abilities, adapting to independence, depending on caregiver partnership, faith in crisis support); interrupted transition momentum (lacking individual attention, language barriers, installation delays, interfering illness and complications, acclimatising to new conditions); noticing immediate gains (reclaiming lifestyle normality, satisfying self-sufficiency, personalising treatment regime, thriving in a positive environment); depleting resources and energy (exhaustion with gruelling routine, confronting medicalization of the home, draining financial reserves, imposing family burden)...
June 2, 2016: Nephrology
Bruce M Robinson, Tadao Akizawa, Kitty J Jager, Peter G Kerr, Rajiv Saran, Ronald L Pisoni
More than 2 million people worldwide are being treated for end-stage kidney disease (ESKD). This Series paper provides an overview of incidence, modality use (in-centre haemodialysis, home dialysis, or transplantation), and mortality for patients with ESKD based on national registry data. We also present data from an international cohort study to highlight differences in haemodialysis practices that affect survival and the experience of patients who rely on this therapy, which is both life-sustaining and profoundly disruptive to their quality of life...
July 16, 2016: Lancet
Amalric Montalibet, Walid Arkouche, Paco Bogónez Franco, Stéphane Bonnet, Antoine Clarion, Georges Delhomme, Claudine Géhin, Sadok Gharbi, Régis Guillemaud, Pierre Jallon, Bertrand Massot, Pascale Pham, Eva Ribbe-Cornet, Eric McAdams
A key clinical challenge is to determine the desired 'dry weight' of a patient in order to terminate the dialysis procedure at the optimal moment and thus avoid the effects of over- and under-hydration. It has been found that the effects of haemodialysis on patients can be conveniently monitored using whole-body bioimpedance measurements. The identified need of assessing the hydrational status of patients undergoing haemodialysis at home gave rise to the present Dialydom (DIALYse à DOMicile) project. The aim of the project is to develop a convenient miniaturised impedance monitoring device for localised measurements (on the calf) in order to estimate an impedimetric hydrational index of the home-based patient, and to transmit this and other parameters to a remote clinical site...
2016: Studies in Health Technology and Informatics
Annie-Claire Nadeau-Fredette, David W Johnson
Successful cannulation of arteriovenous fistulas (AVFs) using a safe and effective technique that minimizes patient harm is a crucial aspect of haemodialysis treatment. Although the current standard of care for many years has been the rope-ladder technique (using sharp needles to cannulate rotating sites across the entire AVF), a number of enthusiasts have recently advocated for the alternative method of buttonhole cannulation (using blunt needles to repeatedly cannulate the same site via a healed track) on the basis of putative, as yet unproven benefits...
April 2016: Nephrology, Dialysis, Transplantation
Rabiya Majeed-Ariss, A Jayanti, T Schulz, A Wearden, S Mitra
This qualitative study aimed to explore home haemodialysis and in-centre haemodialysis patients' experience, to illuminate barriers and facilitators in the uptake and maintenance of home haemodialysis. Thirty-two semi-structured interviews with patients receiving home haemodialysis or in-centre haemodialysis were analysed using framework analysis. Four themes emerged: 'perceptions of self'; 'impact of haemodialysis on family'; 'perceived advantages and disadvantages of home haemodialysis and in-centre haemodialysis' and 'practical issues and negotiating haemodialysis'...
March 8, 2016: Journal of Health Psychology
Jean-Pierre Grangier
Peritoneal dialysis was first used in the 1980s. Less well-known than haemodialysis, it represents an important treatment option for elderly patients at home.
January 2016: Soins. Gérontologie
T J Beaton, R Krishnasamy, N D Toussaint, R K Phoon, N A Gray
BACKGROUND: Advanced training programs in nephrology should provide broad exposure to all aspects of nephrology. In Australia and New Zealand (ANZ), the Advanced Training Committee (ATC) in Nephrology oversees training and recent increases in trainee numbers have led to concern about dilution of experience. AIM: To investigate early career paths of nephrologists in ANZ and determine adequacy of training by comparing self-determined competency and skill relevance among recently graduated nephrologists...
January 6, 2016: Nephrology
L-H Chen, C-F Mu, C-Y Hsu
BACKGROUND: The prevalence of end-stage renal disease in Taiwan is the highest in the world; haemodialysis accounts for about 7% of the expenditure of the National Health Insurance. Nursing home residents with chronic kidney disease (CKD) have not been identified yet in Taiwan, along with associated risk factors. The objective of this study is to investigate the risk factors of CKD in long-term care facilities in Taiwan and those significantly associated with the presence of CKD. SUBJECTS AND METHODS: The nursing home residents who received health examination between January and June 2012, age ≥ 55 years, were enrolled in this study...
December 1, 2015: West Indian Medical Journal
S Laplante, F X Liu, B Culleton, A Bernardo, Denise King, P Hudson
BACKGROUND: End-stage renal disease (ESRD) is fatal if untreated. In the absence of transplant, approximately 50 % of dialysis patients die within 5 years. Although more frequent and/or longer haemodialysis (high-dose HD) improves survival, this regimen may add to the burden on dialysis services and healthcare costs. This systematic review summarised the cost effectiveness of high-dose HD compared with conventional HD. METHODS: English language publications reporting the cost-utility/effectiveness of high-dose HD in adults with ESRD were identified via a search of MEDLINE, Embase, and the Cochrane Library...
April 2016: Applied Health Economics and Health Policy
Liviu Segall, Ionuţ Nistor, Wim Van Biesen, Edwina A Brown, James G Heaf, Elizabeth Lindley, Ken Farrington, Adrian Covic
The number of elderly patients on maintenance dialysis has rapidly increased in the past few decades, particularly in developed countries, imposing a growing burden on dialysis centres. Hence, many nephrologists and healthcare authorities feel that greater emphasis should be placed on the promotion of home dialysis therapies such as peritoneal dialysis (PD) and home haemodialysis (HD). There is currently no general consensus as to the best dialysis modality for elderly patients with end-stage renal disease...
December 15, 2015: Nephrology, Dialysis, Transplantation
Jernej Pajek
Peritoneal dialysis is troubled with declining utilisation as a form of renal replacement therapy in developed countries. We review key aspects of therapy evidenced to have a potential to increase its utilisation. The best evidence to repopulate PD programmes is provided for the positive impact of timely referral and systematic and motivational predialysis education: average odds ratio for instituting peritoneal dialysis versus haemodialysis was 2.6 across several retrospective studies on the impact of predialysis education...
2015: BioMed Research International
Anuradha Jayanti, Philip Foden, Julie Morris, Paul Brenchley, Sandip Mitra
INTRODUCTION: Prolonged recovery time (RT) affects patient's quality-of-life adversely. Shorter dialysis RT in home haemodialysis (HHD) noted in observational studies has been attributed to intensive dialysis regimens. Home patients adopt different haemodialysis (HD) schedules. There is insufficient literature on RT in HHD patients receiving different HD schedules. METHODS: Data was prospectively collected for BASIC-HHD study, a multicentre study of home and hospital HD across five tertiary centres in the UK...
December 2016: Nephrology
Jessica Kasza, Rory Wolfe, Stephen P McDonald, Mark R Marshall, Kevan R Polkinghorne
AIM: There remains debate on which dialysis modality offers better survival outcomes for patients. We compare the survival of patients undergoing home haemodialysis (HD) with a permanent vascular access, facility HD with a permanent vascular access, facility HD with a central venous catheter or peritoneal dialysis. METHODS: We considered adult patients from the Australia and New Zealand Dialysis and Transplant Registry who commenced dialysis between 1 October 2003 and 31 December 2011...
October 2016: Nephrology
Matthew P M Graham-Brown, Darren R Churchward, Alice C Smith, Richard J Baines, James O Burton
BACKGROUND: Extended periods of haemodialysis (HD) can improve patient outcomes. In-centre nocturnal haemodialysis (INHD) should be explored as a method of offering extended periods of HD to patients unsuitable for or unable to perform home therapy. METHODS: Ten self-selecting, prevalent HD patients started an INHD programme to assess feasibility and patient satisfaction. Quality-of-life (QOL) measures were evaluated at enrolment and after 4 months of INHD using the EQ-5D, the Hospital Anxiety and Depression Scale (HADS) and the SF-12 questionnaires...
December 2015: Clinical Kidney Journal
William S G Hayhurst, Aimun Ahmed
This study aimed to create a unique assessment tool to investigate the physical activity levels of patients suffering from chronic kidney disease (CKD). Previous studies have documented a lack of physical activity within patients living with CKD and patients on renal replacement therapy (RRT). Physical activity plays a key role in the prevention and management of cardiovascular disease (CVD). Patients with CKD are at high risk of developing CVD. Physical inactivity can be considered as a major modifiable risk factor for CVD in CKD patients...
2015: SpringerPlus
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