Expanding Utilization of Home Dialysis: An Action Agenda From the First International Home Dialysis Roundtable

Mendu, Mallika L.; Divino-Filho, José Carolino; Vanholder, Raymond; Mitra, Sandip; Davies, Simon; Jha, Vivekanand; Damron, Kelli Collins; Gallego, Daniel; Seger, Michelle

doi:10.1016/j.xkme.2021.04.004

Cited by 30 publications

(17 citation statements)

References 60 publications

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“…This finding is also consistent with what has been found in previous studies [ 12 , 13 ]. Additionally, these findings have prompted leading global kidney disease organisations to advocate for increased access and uptake of PD to minimise infection rates among dialysis patients, an especially vulnerable group to worse outcomes [ 14 ]. This would also hold true in the event of any pandemic that might hit in the future.…”

Section: Discussionmentioning

confidence: 99%

The vulnerability of maintenance dialysis patients with COVID-19: mortality and risk factors from a developing country

et al. 2022

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Patients on maintenance dialysis therapy are especially vulnerable to COVID-19 and its complications. This study aimed to assess the incidence, epidemiological characteristics, and mortality rate of COVID-19 among maintenance dialysis patients. This retrospective observational chart review study included 548 patients from all dialysis units in the West Bank of Palestine who acquired COVID-19 between 5 March 2020, and 11 August 2021. We collected data on patients' demographics, clinical features, and outcomes. A multivariable logistic regression model was used to assess independent risk factors for COVID-19-related mortality. The incidence of COVID-19 among maintenance dialysis patients was 35.3%, as 548 out of 1554 patients have tested positive during the study period. Patients on haemodialysis were three times riskier to get infected than those on peritoneal dialysis (37% vs 11.3%). Half (50.2%) of infected patients required hospitalisation, and 24.5% were admitted to an intensive care unit, while the mortality rate stood at 26.8%. Old age, male sex, central venous catheter use, comorbid diabetes, smoking, and having an RH negative blood group type were determined to be significantly associated with increased risk of mortality. In conclusion, the incidence of COVID-19 among Palestinian maintenance dialysis patients was notably high, especially among haemodialysis patients. High rates of hospitalisation, ICU admission, intubation and death were observed, and predictive factors for COVID-19-related mortality were identified. Therefore, the implementation of strict infection control measures and promotion of home dialysis are warranted to reduce the infection rate. KEY MESSAGES The incidence of COVID-19 among Palestinian maintenance dialysis patients was notably high; more than one-third of the total dialysis population acquired COVID-19, with haemodialysis patients being three times more likely to get infected compared to their peritoneal dialysis counterparts. The mortality rate among maintenance dialysis patients was 26.8%, more than 25 times higher than that of the general population. The risk of mortality was significantly increased with age, male sex, smoking, diabetes, and having central venous catheter as vascular access for haemodialysis. Strict infection control measures, as well as the promotion of home dialysis, are necessary to reduce the risk of infection.

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Section: Discussionmentioning

confidence: 99%

The vulnerability of maintenance dialysis patients with COVID-19: mortality and risk factors from a developing country

et al. 2022

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“…To better understand the global trends in PD catheter insertion procedures and the impact of COVID-19, an electronic questionnaire was administered to 82 nephrologists from 17 countries (Appendix B). The target audience of this voluntary survey was clinicians involved in starting patients on home dialysis taken from the mailing lists from the International Home Dialysis Roundtable [ 65 ] (Table 2 ).…”

Section: Practice Before and During Covid-19mentioning

confidence: 99%

Peritoneal catheter insertion: combating barriers through policy change

Jha

Abrahams

Al-Hwiesh

et al. 2022

Clinical Kidney Journal

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Barriers to accessing home dialysis became a matter of life and death for many patients with kidney failure during the COVID-19 pandemic. Peritoneal Dialysis (PD) is the more commonly used home therapy option. This paper provides a comprehensive analysis of PD catheter insertion procedures as performed around the world today, barriers impacting timely access to the procedure, the impact of COVID-19, and a roadmap of potential policy solutions. To substantiate the analysis, the paper includes a survey of institutions across the world, with questions designed to get a sense of the regulatory frameworks, barriers to conducting the procedure, and impacts of the pandemic on capability and outcomes. Based on our research, we found that improving patient selection processes, determining and implementing correct insertion techniques, creating multidisciplinary teams, providing appropriate trainings, and sharing decision-making among stakeholders will improve access to PD catheter insertion and facilitate greater uptake of home dialysis. Additionally, on a policy level, we recommend efforts to: improve the awareness and feasibility of PD among patients and the health care workforce; enhance and promulgate trainings for clinicians – both surgical and medical – to insert PD catheters; and fund personnel, pathways and physical facilities for PD catheter insertion.

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“…This underutilization can be explained by inadequate awareness of PD among physicians and patients, a dearth of trained medical personnel, and a lack of advocacy for it as a viable KRT modality [ 5 , 6 ]. Nevertheless, leading global kidney disease organizations have been increasingly advocating for increased access and uptake of PD [ 7 ], especially after the COVID-19 pandemic hit, as many studies have demonstrated lower infection rates among PD patients compared to their HD counterparts [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Growing a peritoneal dialysis program in Palestine from zero to 178 patients in 5 years: a single-center experience

et al. 2023

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Introduction Kidney failure is rapidly rising in Palestine, as the number of patients receiving maintenance dialysis has quadrupled in the last 15 years. In this study, we share an overview of our experience growing a peritoneal dialysis (PD) program from zero to 178 patients in 5 years at An-Najah National University Hospital in Palestine, presenting some challenges and ways to overcome them. Methods This was a single-center retrospective study of patients treated with PD from November 2016 to December 2021. Demographic and clinical data were obtained for each patient. In addition, PD discontinuation, peritonitis, and mortality rates were calculated and presented as the primary patient outcomes. Results A total of 158 patients were eligible for the study. The mean age was 51.8 ± 16.4 years, and 53.8% of patients were male. Diabetic nephropathy was the most common cause of kidney failure. 63 episodes of peritonitis were diagnosed in 48 patients (30.4%) for a rate of 1 episode/ 38.2 patient-months (0.31 episodes/ patient-years). 20 patients had their PD treatment discontinued, mainly due to psychosocial reasons and infectious and mechanical complications. Death was the fate of 27 patients, with cardiovascular disease and COVID-19 being the two main causes. Conclusion The outcomes of this experience proved favorable and showed that PD could serve as a viable option for kidney failure patients in Palestine. Moreover, this study can serve as an example for other places where circumstances are challenging to take the initiative of starting their PD programs.

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Expanding Utilization of Home Dialysis: An Action Agenda From the First International Home Dialysis Roundtable

Cited by 30 publications

References 60 publications

The vulnerability of maintenance dialysis patients with COVID-19: mortality and risk factors from a developing country

The vulnerability of maintenance dialysis patients with COVID-19: mortality and risk factors from a developing country

Peritoneal catheter insertion: combating barriers through policy change

Growing a peritoneal dialysis program in Palestine from zero to 178 patients in 5 years: a single-center experience

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