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Home haemodialysis

Anuradha Jayanti, Philip Foden, Alasdair Rae, Julie Morris, Paul Brenchley, Sandip Mitra
BACKGROUND: In the United Kingdom, socioeconomic disadvantage has been associated with lower use of home dialysis, mostly peritoneal dialysis. In this study, we explore the role of a patient's sociodemographic, socioeconomic differences and the centre's influence on home haemodialysis (HD) prevalence. METHODS: Data is derived from the cross-sectional arm of the UK multi-centre study investigating barriers and enablers of home HD (BASIC-HHD study). Centres were classified as low- (<3%), medium- (5-8%) and high-prevalence groups (>8%)...
February 9, 2017: Nephron
Javier Ferreira Gonzalez, Ivan Pau de la Cruz, 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...
November 15, 2016: IEEE Journal of Biomedical and Health Informatics
Steve Siu-Man Wong, Wai-Yan Lau, Man-Luen Ng, Shuk-Yin Chan, So-Fan Chan, Ping-Kwan Chan, Ching-Kit Wan, Yuk-Lun Cheng
AIM: This study was conducted to evaluate low-molecular weight heparin (LMWH) as anticoagulation for nocturnal home haemodialysis (NHHD). Whilst its longer half-life may cause drug accumulation in frequent dialysis, the essential need of a supplementary intra-dialytic bolus for the sleeping patients also renders LMWH's use impractical. METHODS: The recruited patients, who were on alternate-day 8-hour haemodialysis, were randomized to receive either nadroparin or unfractionated heparin (UFH) for a week...
January 4, 2017: Nephrology
Josanne S de Maar, Marjolein A J de Groot, Peter T Luik, Kwok Wai Mui, E Christiaan Hagen
BACKGROUND: Despite the many advantages it offers, the percentage of dialysis patients that receive home dialysis [peritoneal dialysis (PD) or home haemodialysis (HHD)] in the Netherlands has declined over the last decade. Pre-dialysis education could stimulate the use of home dialysis. This article presents the results of the pre-dialysis programme GUIDE, with regard to the following question: Does the implementation of a structured pre-dialysis programme with a home-focused approach increase the number of pre-dialysis patients that choose and receive home dialysis? METHODS: The GUIDE process starts when a patient has an eGFR of 15 mL/min/1...
December 2016: Clinical Kidney Journal
A Chahar, M Sharma, J Sharma
No abstract text is available yet for this article.
November 2016: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
K R N Pavan, S V Subhramanyam, A N Karopadi, K A Sinoj, K S Nayak
BACKGROUND: South Asian countries have a population of 1.7 billion and are classified as low-middle to poor income nations. Their health care systems cannot presently meet the growing need for renal replacement therapy (RRT), provided as haemodialysis or peritoneal dialysis (PD). Most patients cannot afford the treatment and quickly default. Furthermore, most of the population is located in rural areas, where there are few treatment centres; therefore, there is a huge gap between those treated and those in need...
2017: Contributions to Nephrology
Andrew Davenport
Home haemodialysis offers many advantages in that patients take active control of their own health care and have the ability to determine when and how they dialyse. However, in order to develop and maintain a viable home haemodialysis program there has to be a balance between overenthusiastic evangelism and being too conservative in offering patients home haemodialysis. Ideally, preparation for home haemodialysis takes place prior to the need to start dialysis, with educational sessions, discussion with current home haemodialysis patients, and creation of an established vascular access...
2017: Contributions to Nephrology
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...
August 9, 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...
March 2017: 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
Thomas J Beaton, Rathika Krishnasamy, Nigel D Toussaint, Richard K Phoon, Nicholas A Gray
BACKGROUND: Advanced training programmes in nephrology should provide broad exposure to all aspects of nephrology. In Australia and New Zealand (ANZ), the Advanced Training Committee 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 the adequacy of training by comparing self-determined competency and skill relevance among recently graduated nephrologists...
January 2017: 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
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