Chronic kidney disease and support provided by home care services: a systematic review

Abstract

BackgroundChronic diseases, such as chronic kidney disease (CKD), are growing in incidence and prevalence, in part due to an aging population. Support provided through home care services may be useful in attaining a more efficient and higher quality care for CKD patients.MethodsA systematic review was performed to identify studies examining home care interventions among adult CKD patients incorporating all outcomes. Studies examining home care services as an alternative to acute, post-acute or hospice care and those for long-term maintenance in patients’ homes were included. Studies with only a home training intervention and those without an applied research component were excluded.ResultsSeventeen studies (10 cohort, 4 non-comparative, 2 cross-sectional, 1 randomized) examined the support provided by home care services in 15,058 CKD patients. Fourteen studies included peritoneal dialysis (PD), two incorporated hemodialysis (HD) and one included both PD and HD patients in their treatment groups. Sixteen studies focused on the dialysis phase of care in their study samples and one study included information from both the dialysis and pre-dialysis phases of care. Study settings included nine single hospital/dialysis centers and three regional/metropolitan areas and five were at the national level. Studies primarily focused on nurse assisted home care patients and mostly examined PD related clinical outcomes. In PD studies with comparators, peritonitis risks and technique survival rates were similar across home care assisted patients and comparators. The risk of mortality, however, was higher for home care assisted PD patients. While most studies adjusted for age and comorbidities, information about multidimensional prognostic indices that take into account physical, psychological, cognitive, functional and social factors among CKD patients was not easily available.ConclusionsMost studies focused on nurse assisted home care patients on dialysis. The majority were single site studies incorporating small patient populations. There are gaps in the literature regarding the utility of providing home care to CKD patients and the impact this has on healthcare resources.

UPLC-Q-TOF/MS-based screening and identification of two major bioactive components and their metabolites in normal and CKD rat plasma, urine and feces after oral administration of Rehmannia glutinosa Libosch extract

“…CKD is usually an irreversible, progressive disease, and if left untreated, can lead and in most cases will progress to end-stage kidney disease requiring renal replacement therapy such as dialysis and transplantation [1][2][3].…”

Effect of Perceived Social Support on the Levels of Anxiety and Depression of Hemodialysis Patients

“…Indeed, in 2009, half of Canadian patients initiating renal replacement were over 65 years old (1). According to estimates, incidence of chronic renal failure is 242 individuals per one million worldwide (2) while over $1 trillion is spent for end-stage renal disease care, globally (3).…”

“…Though, hemodialysis consists the most common treatment method for kidney failure, however, it is a stressful procedure that affects all dimensions of patients’ lives (1, 2, 3). …”

Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients

“…There are reports of staff-assisted home haemodialysis being offered to the frail elderly, albeit for brief periods of rehabilitation or end-of-life care [74,75]. Such support is more common for peritoneal dialysis patients [76].…”