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ESRD, dialysis, home dialysis, hemodialysis, home hemodialysis, kidney disease, kidney

Matt Foy, C John Sperati
The End-Stage Renal Disease (ESRD) program now serves approximately 675,000 individuals in the United States at a cost of $26.1 billion to the Medicare system. Given the size of this population, healthcare providers from all disciplines will deliver care to patients on dialysis. Mortality remains high among patients on chronic dialysis, with 42.3% surviving 5 years. As this is a vulnerable population, it is important in the care of ESRD patients that non-nephrologists have a working knowledge of issues germane to dialysis...
March 2018: Seminars in Dialysis
S Treille, B Guillaume
The economic environment has pushed our political leaders to severely limit the health care spending. Belgian nephrologists have signed an agreement to attain more than 40 % of " alternative " dialysis techniques such as peritoneal dialysis (PD) and home hemodialysis (HHD). They will become unavoidable and major future therapy modalities. This article summarizes PD and HDD techniques in order to help health professionals and to inform them about innovative research in home dialysis techniques. It is a non exhaustive list of the many advantages, if not superiority, of the treatment of end stage renal disease (ESRD) at home instead of in-center HD...
2017: Revue Médicale de Bruxelles
Martin J Schreiber
The future growth of peritoneal dialysis (PD) will be directly linked to the shift in US healthcare to a value-based payment model due to PD's lower yearly cost, early survival advantage over in-center hemodialysis, and improved quality of life for patients treating their kidney disease in the home. Under this model, nephrology practices will need an increased focus on managing the transition from chronic kidney disease to end-stage renal disease (ESRD), providing patient education with the aim of accomplishing modality selection and access placement ahead of dialysis initiation...
March 2017: Seminars in Dialysis
Andre A Kaplan
In 2013, 88.4% of all incident end-stage renal disease (ESRD) patients began renal replacement therapy with hemodialysis (HD) while 9.0% began with peritoneal dialysis (PD). The remaining 2.6% received a preemptive kidney transplant. In the US, outpatient HD units are widely distributed and economy of scale has resulted in HD being the most common ESRD modality. Use of PD and preemptive kidney transplant were relatively more common in younger groups and relatively less common among Black and Hispanic patients...
2017: Contributions to 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...
October 2016: Journal of the American Geriatrics Society
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...
November 2016: Seminars in Dialysis
Martin B Lee, Joanne M Bargman
In light of the recent emphasis on patient-centered outcomes and quality of life for patients with kidney disease, we contend that the nephrology community should no longer fund, perform, or publish studies that compare survival by dialysis modality. These studies have become redundant; they are methodologically limited, unhelpful in practice, and therefore a waste of resources. More than two decades of these publications show similar survival between patients undergoing peritoneal dialysis and those receiving thrice-weekly conventional hemodialysis, with differences only for specific subgroups...
June 6, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Eric D Weinhandl, David T Gilbertson, Allan J Collins
BACKGROUND: Use of home dialysis is growing in the United States, but few direct comparisons of major clinical outcomes on daily home hemodialysis (HHD) versus peritoneal dialysis (PD) exist. STUDY DESIGN: Matched cohort study. SETTING & PARTICIPANTS: We matched 4,201 new HHD patients in 2007 to 2010 with 4,201 new PD patients from the US Renal Data System database. PREDICTOR: Daily HHD versus PD. OUTCOMES: Relative mortality, hospitalization, and technique failure...
January 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Naoka Murakami, Hira Babu Siktel, David Lucido, James F Winchester, Nikolas B Harbord
BACKGROUND AND OBJECTIVES: Patients with ESRD on dialysis live in a complex sociomedical situation and are dependent on technology and infrastructure, such as transportation, electricity, and water, to sustain their lives. Interruptions of this infrastructure by natural disasters can result in devastating outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Between November of 2013 and April of 2014, a cross-sectional survey was conducted of patients who received maintenance hemodialysis before and after the landfall of Hurricane Sandy on October 29, 2012 in lower Manhattan, New York...
August 7, 2015: Clinical Journal of the American Society of Nephrology: CJASN
Denis Allenbach, Ouarda Pereira
INTRODUCTION: Renal failure is defined as impairment of the excretory function of the kidney. Chronic Kidney Disease (CKD) gets progressively worse and end-stage renal disease (ESRD) constitutes thefinal stage. In France, overall spending generated by CKD in 2011 amounted to €3.3 billion. More than 80% of this cost was related to dialysis. Transport of patients in 2012 also cost €3.8 billion and 17% of this expenditure concerned patients with ESRD. METHODS: The aim of this study was to analyze reimbursement of transport expenses of dialysis patients in order to develop a regional action plan to optimize this reimbursement in Lorraine...
January 2015: Santé Publique: Revue Multidisciplinaire Pour la Recherche et L'action
Agnes Masengu, Jennifer B Hanko, Alexander P Maxwell
BACKGROUND: The elderly form an expanding proportion of patients with chronic kidney disease and end-stage renal disease worldwide. The increased physiological frailty and functional morbidity associated with the aging process pose unique challenges when planning optimal management of an older patient needing renal replacement therapy (RRT). AIMS: This position paper discusses current evidence regarding the optimal management of end-stage renal disease in the elderly with an emphasis on hemodialysis since it is the most common modality used in older patients...
November 2015: Journal of Vascular Access
Georgi Abraham, Santosh Varughese, Milly Mathew, Madhusudan Vijayan
Various modalities of renal replacement therapy (RRT) are available for the management of acute kidney injury (AKI) and end-stage renal disease (ESRD). While developed countries mainly use hemodialysis as a form of RRT, peritoneal dialysis (PD) has been increasingly utilized in developing countries. Chronic PD offers various benefits including lower cost, home-based therapy, single access, less requirement of highly trained personnel and major infrastructure, higher number of patients under a single nephrologist with probably improved quality of life and freedom of activities...
June 2015: Clinical Kidney Journal
Dragan Klarić, Ingrid Prkačin
According to the National Registry of Renal Replacement Therapy (RRT), the incidence of chronic kidney disease (end-stage renal disease) and the need of RRT have declined in the last decade renal. One of the reasons for this tendency certainly is transplantation as the best choice. However, transplant procedure has limitations in elderly patients due to the number of comorbidities. This study was designed as retrospective analysis of outcomes in patients treated with peritoneal dialysis for a period of eleven years...
April 2014: Acta Medica Croatica: C̆asopis Hravatske Akademije Medicinskih Znanosti
Kara Schick-Makaroff, Anita Molzahn
BACKGROUND: Electronic capture of patients' reports of their health is significant in clinical nephrology research because health-related quality of life (HRQOL) for patients with end-stage renal disease is compromised and assessment by patients of their HRQOL in practice is relatively uncommon. OBJECTIVE: The purpose of this study was to evaluate patient satisfaction with and time involved in administering HRQOL and symptom assessment measures using tablet computers in two outpatient home dialysis clinics...
2014: Canadian Journal of Kidney Health and Disease
Anna C Porter, Marian L Fitzgibbon, Michael J Fischer, Rani Gallardo, Michael L Berbaum, James P Lash, Sheila Castillo, Linda Schiffer, Lisa K Sharp, John Tulley, Jose A Arruda, Denise M Hynes
In the U.S., more than 400,000 individuals with end-stage renal disease (ESRD) require hemodialysis (HD) for renal replacement therapy. ESRD patients experience a high burden of morbidity, mortality, resource utilization, and poor quality of life (QOL). Under current care models, ESRD patients receive fragmented care from multiple providers at multiple locations. The Patient-Centered Medical Home (PCMH) is a team approach, providing coordinated care across the healthcare continuum. While this model has shown some early benefits for complex chronic diseases such as diabetes, it has not been applied to HD patients...
May 2015: Contemporary Clinical Trials
Peter Kotanko, Amit X Garg, Tom Depner, Andreas Pierratos, Christopher T Chan, Nathan W Levin, Tom Greene, Brett Larive, Gerald J Beck, Jennifer Gassman, Alan S Kliger, John B Stokes
Hypertension is a common complication of chronic kidney disease and persists among most patients with end-stage renal disease despite the provision of conventional thrice weekly hemodialysis (HD). We analyzed the effects of frequent HD on blood pressure in the randomized controlled Frequent Hemodialysis Network trials. The daily trial randomized 245 patients to 12 months of 6× ("frequent") vs. 3× ("conventional") weekly in-center hemodialysis; the nocturnal trial randomized 87 patients to 12 months of 6× weekly nocturnal HD vs...
July 2015: Hemodialysis International
Karlien François, Joanne M Bargman
Peritoneal dialysis (PD) is an effective renal replacement strategy for patients suffering from end-stage renal disease. PD offers patient survival comparable to or better than in-center hemodialysis while preserving residual kidney function, empowering patient autonomy, and reducing financial burden to payors. The majority of patients suffering from kidney failure are eligible for PD. In patients with cardiorenal syndrome and uncontrolled fluid status, PD is of particular benefit, decreasing hospitalization rates and duration...
2014: International Journal of Nephrology and Renovascular Disease
Yusuke Watanabe, Yoichi Ohno, Tsutomu Inoue, Hiroshi Takane, Hirokazu Okada, Hiromichi Suzuki
Health-related quality of life (HRQOL) is an important measure of how disease affects patients' daily life. Conventional in-center hemodialysis (CHD) patients have been found to have decreased HRQOL. Recent study reported that at-home hemodialysis (HHD) improved the long-term HRQOL compared with CHD; however, there have been no data from Japanese HHD patients. A sample of 80 Japanese hemodialysis patients (46 HHD and 34 CHD) was matched for age, sex, and cause of end-stage renal disease. Patient HRQOL was measured using two health surveys: Medical Outcomes Study 36 Item Short Form Health Survey-Version 2 and Kidney Disease Quality of Life-Short Form...
October 2014: Hemodialysis International
Matthew B Rivara, Rajnish Mehrotra
PURPOSE OF REVIEW: To discuss the changing landscape of home dialysis in the United States over the past decade, including recent research on clinical outcomes in patient undergoing peritoneal dialysis and home hemodialysis, and to describe the impact of recent payment reforms for patients with end-stage renal disease. RECENT FINDINGS: Accumulating evidence supports the conclusion that clinical outcomes for patients treated with peritoneal dialysis or home hemodialysis are as good as or better than for patients treated with conventional in-center hemodialysis...
November 2014: Current Opinion in Nephrology and Hypertension
Tom Cornelis, Karthik K Tennankore, Eric Goffin, Virpi Rauta, Eero Honkanen, Akin Őzyilmaz, Vijay Thanaraj, Anuradha Jayanti, Sandip Mitra, Frank M van der Sande, Jeroen P Kooman, Christopher T Chan
BACKGROUND: Home haemodialysis (HHD) is undergoing a significant revival. There is a global demographic shift with a rising mean age of dialysis patients. We postulated that intensive HHD may also benefit the older dialysis population. However, there is a lack of literature on the feasibility of HHD in older patients with end-stage renal disease (ESRD). The purpose of this study was to ascertain the feasibility of delivering HHD to older patients. METHODS: We conducted a multi-centre multinational retrospective cohort study of HHD patients ≥65 years of age at the time of HHD initiation; 79 patients were included...
December 2014: Nephrology, Dialysis, Transplantation
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