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survival home hemodialysis

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
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
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
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
Helena Rydell, Naomi Clyne, Mårten Segelmark
BACKGROUND/AIMS: Survival for dialysis patients is poor. Earlier studies have shown better survival in home-hemodialysis (HHD). The aims of this study are to compare survival for matched patients with HHD and institutional hemodialysis (IHD) and to elucidate the effect on factors related to survival such as hyperphosphatemia, fluid overload and anemia. METHODS: In this retrospective, observational study, incident patients starting HHD and IHD were matched according to sex, age, comorbidity and date of start...
2016: Kidney & Blood Pressure Research
Louise M Moist, Ahmed A Al-Jaishi
Patients with Stages 4 and 5 CKD are optimally managed within a multidisciplinary care setting. This provides an opportunity to create a "patient centered" approach to renal replacement modality options and conservative care. The care team engages with the patient and caregivers to assist with the understanding of their health status, modality and vascular access selection, and overall living with the comorbidity of chronic illness. A systematic approach to provision of education, modality, and access selection, are in part, driven by the patient's expected survival and need for dialysis, the risks and benefits with different modalities, and access and adaptation to their preferences and home situations...
July 2016: Advances in Chronic Kidney Disease
Jun Miyahara, Masaki Yamamoto, Kyoko Motoshige, Naoya Fujita, Shigeru Ohki
Recent advances in neonatal cardiorespiratory management and neonatal renal replacement therapy have led to occasional reports of favorable short-term and long-term outcomes for Potter sequence, once thought to be fatal. The present patient was a girl born at a gestational age of 34 weeks 4 days with a birthweight of 1398 g. She was diagnosed with Potter sequence complicated by pulmonary hypoplasia due to left renal agenesis and small right kidney. Hemodialysis was started because anuria persisted even after persistent pulmonary hypertension receded and cardiorespiratory status improved...
July 2016: Pediatrics International: Official Journal of the Japan Pediatric Society
Robert Ekart, Radovan Hojs
Obesity is a chronic disease that is increasingly prevalent around the world and is a well-recognized risk factor for type 2 diabetes and hypertension, leading causes of end-stage renal disease (ESRD). The obese diabetic patient with ESRD is a challenge for the nephrologist with regard to the type of renal replacement therapy that should be suggested and offered to the patient. There is no evidence that either peritoneal dialysis or hemodialysis is contraindicated in obese ESRD patients. In the literature, we can find a discrepancy in the impact of obesity on mortality among hemodialysis vs...
July 2016: European Journal of Internal Medicine
Antonia Kaltsatou, Christina Karatzaferi, Georgia I Mitrou, Konstantina P Poulianiti, Giorgos K Sakkas
BACKGROUND: Chronic Kidney Disease (CKD) is considered a silent epidemic with a continuously growing prevalence around the world. Due to uremia many functional and morphological abnormalities occur in almost all systems. Mostly affected, the cardiovascular system, leads to diminished cardiac function that affects patients' functional capacity and physical activity levels, reducing survival and increasing all-cause mortality. Systematic exercise training ameliorates uremia induced body deficits and significantly improves the survival of CKD patients...
2016: Current Pharmaceutical Design
Almudena Vega, María José Sequí, Soraya Abad, Claudia Yuste, Alba Santos, Nicolás Macías, Juan M López-Gómez
The objective of the present study was to analyze the characteristics and survival of patients from our hospital who started home hemodialysis. We analyzed all patients receiving home hemodialysis from 1969 to 2015 (51 patients; age 45 ± 23 years; men 77%). We collected characteristics, hospital admission, and mortality. After a median follow-up of 43 (22-76) months, we found 0-1 hospital admissions per year. Sixty-nine percent received a kidney transplant, and the global mortality was 10%. Survival at 5 years was 96%...
August 2016: Therapeutic Apheresis and 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
Rebecca Kurnik Seshasai, Nandita Mitra, C Michael Chaknos, Jiaqi Li, Christopher Wirtalla, Dan Negoianu, Joel D Glickman, Laura M Dember
BACKGROUND: Home hemodialysis (HHD) is associated with improved clinical and quality-of-life outcomes compared to in-center hemodialysis, but remains an underused modality in the United States. Discontinuation from HHD therapy may be an important contributor to the low use of this modality. This study aimed to describe the rate and timing of HHD therapy discontinuation, or technique failure, and identify contributing factors. STUDY DESIGN: Retrospective cohort study...
April 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Clémence Béchade, Thierry Lobbedez, Per Ivarsen, Johan V Povlsen
Older people are the largest and fastest growing group of patients with end-stage renal disease (ESRD), and, due to advanced age and a heavy burden of comorbidities, they are usually not candidates for renal transplantation or home-based dialysis treatment. Some of the barriers for home treatment are non-modifiable, but the majority of physical disabilities and psychosocial problems can be overcome provided that assistance is offered to the patients at home.In the present review, we describe the programs for assisted peritoneal dialysis (PD) in France and Denmark, respectively...
November 2015: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Miklos Z Molnar, Vanessa Ravel, Elani Streja, Csaba P Kovesdy, Rajnish Mehrotra, Kamyar Kalantar-Zadeh
BACKGROUND: Previous studies have indicated that patients on maintenance hemodialysis have worse survival compared with kidney transplant (KTx) recipients. However, none of these studies have compared mortality of the US patients using alternative dialysis modalities such as home hemodialysis (HHD) with KTx recipients. METHODS: Comparing patients who started HHD with those who received kidney transplantation in the United States between 2007 and 2011, we created a 1:1 propensity score-matched cohort of 4000 patients and examined the association between treatment modality and all-cause mortality using Cox proportional hazard models...
October 2016: Transplantation
Alex Yang, Wen-ya Lee, Kathy Hocking
Nursing home patients on dialysis are higher-acuity compared to the broader end-stage renal disease population, and historically have poor outcomes. The objective of this epidemiological study was to compare outcomes in ESRD patients in the nursing home setting treated with daily home hemodialysis versus conventional three-day-a-week hemodialysis. Health status was evaluated for 3,919 patients (n=3391 conventional, n=528 daily home dialysis; April 2007 to June 2013 for conventional; April 2011 to June 2013 for daily home hemodialysis)...
February 2015: Nephrology News & Issues
Jeffrey Perl, Sharon J Nessim, Louise M Moist, Ron Wald, Yingbo Na, Karthik K Tennankore, Christopher T Chan
BACKGROUND: While central venous catheter (CVC) use has expanded home hemodialysis (HHD) eligibility to many patients who may be unable to self-cannulate an arteriovenous (AV) access, the association between CVC use and mortality has not been directly examined among HHD patients. STUDY DESIGN: Registry-based retrospective observational cohort study. SETTING & PARTICIPANTS: Incident HHD patients in The Canadian Organ Replacement Register who had information for vascular access type (CVC vs AV access) within the first year of HHD therapy initiation...
February 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Marya D Zilberberg, Andrew F Shorr, Scott T Micek, Marin H Kollef
BACKGROUND: With decreasing mortality in sepsis, attention has shifted to longer-term consequences associated with survivorship. Thirty-day readmission as a component of healthcare utilization is an important outcome. OBJECTIVE: To examine the frequency of and risk factors for 30-day readmission among patients surviving sepsis. DESIGN: Single-center retrospective cohort. METHODS/SETTING: We examined 30-day readmission risk among survivors of hospitalization with culture-positive severe sepsis or septic shock...
October 2015: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Karlien François, Rose Faratro, Céline d'Gama, Elizabeth Wong, Stella Fung, Christopher T Chan
We conducted a retrospective cohort study in a university hospital-based home hemodialysis (HHD) program to evaluate the effectiveness of a home visit audit tool. We aimed to delineate safety risk in HHD patients and to ascertain whether this is associated with clinical outcomes. All incident HHD patients between July 18, 2008, and June 30, 2013 with follow-up until December 31, 2013, were included in the cohort. Primary outcome was the description of the presence of safety risk evaluated by the home visit audit at the start of HHD...
November 2015: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Annie-Claire Nadeau-Fredette, Carmel M Hawley, Elaine M Pascoe, Christopher T Chan, Philip A Clayton, Kevan R Polkinghorne, Neil Boudville, Martine Leblanc, David W Johnson
BACKGROUND AND OBJECTIVES: Home dialysis is often recognized as a first-choice therapy for patients initiating dialysis. However, studies comparing clinical outcomes between peritoneal dialysis and home hemodialysis have been very limited. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This Australia and New Zealand Dialysis and Transplantation Registry study assessed all Australian and New Zealand adult patients receiving home dialysis on day 90 after initiation of RRT between 2000 and 2012...
August 7, 2015: Clinical Journal of the American Society of Nephrology: CJASN
Biruh Workeneh, Danielle Guffey, Charles G Minard, William E Mitch
Background. Peritoneal dialysis (PD) is an underutilized dialysis modality in the United States, especially in urban areas with diverse patient populations. Technique retention is a major concern of dialysis providers and might influence their approach to patients ready to begin dialysis therapy. Methods. Records from January 2009 to March 2014 were abstracted for demographic information, technique duration, and the reasons for withdrawal. Results. The median technique survival of the 128 incident patients during the study window was 781 days (2...
2015: International Journal of Nephrology
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