Home hemodialysis technique survival: insights and challenges

Tran, Estelle; Karadjian, Oliver; Chan, Christopher T.; Trinh, Emilie

doi:10.1186/s12882-023-03264-5

Cited by 6 publications

(3 citation statements)

References 73 publications

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“…The risk factors for technique failure can be categorized into patient-, center-, and treatment-related [19]. Reported patient-related risk factors include older age [10,14,15,17], cardiac disease [12,16], diabetes [10,12,13,16,17], drug use [13], alcohol [13], and smoking [13,15,17].…”

Section: Discussionmentioning

confidence: 99%

Long-term survival of patients receiving home hemodialysis with self-punctured arteriovenous access

Tomori,

Inoue,

Sugiyama

et al. 2024

PLoS ONE

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Objective To determine the long-term survival of patients receiving home hemodialysis (HHD) through self-punctured arteriovenous access. Methods We conducted an observational study of all patients receiving HHD at our facility between 2001 and 2020. The primary outcome was treatment survival, and it was defined as the duration from HHD initiation to the first event of death or technique failure. The secondary outcomes were the cumulative incidence of technique failure and mortality. Cox proportional hazard models were used to identify the predictive factors for treatment survival. Results A total of 77 patients (mean age, 50.7 years; 84.4% male; 23.4% with diabetes) were included. The median dialysis duration was 18 hours per week, and all patients self-punctured their arteriovenous fistula. During a median follow-up of 116 months, 30 treatment failures (11 deaths and 19 technique failures) were observed. The treatment survival was 100% at 1 year, 83.5% at 5 years, 67.2% at 10 years, and 34.6% at 15 years. Age (adjusted hazard ratio [aHR], 1.07) and diabetes (aHR, 2.45) were significantly associated with treatment survival. Cardiovascular disease was the leading cause of death, and vascular access-related issues were the primary causes of technique failure, which occurred predominantly after 100 months from HHD initiation. Conclusion This study showed a favorable long-term prognosis of patients receiving HHD. HHD can be a sustainable form of long-term kidney replacement therapy. However, access-related technique failures occur more frequently in patients receiving it over the long term. Therefore, careful management of vascular access is crucial to enhance technique survival.

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Section: Discussionmentioning

confidence: 99%

Long-term survival of patients receiving home hemodialysis with self-punctured arteriovenous access

Tomori,

Inoue,

Sugiyama

et al. 2024

PLoS ONE

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“…Several studies detailed in Table 1 have compared patients dialyzing conventionally against those dialyzing more frequently. While these studies have generally shown an increased risk of access-related events in patients dialyzing frequently, 6,10,11 this is not universal, 12 and it remains unclear whether the HHD prescription itself modifies technique survival 13 ; indeed, it is plausible that a secular trend…”

Section: Hhd-clinical Outcome Data For Vascular Accessmentioning

confidence: 99%

Vascular Access Considerations in Home Hemodialysis

Chan,

Chan

2024

CJASN

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There is a global interest in expanding home dialysis utilization amongst patients with end-stage kidney disease. Home hemodialysis (HHD) is an appealing kidney replacement therapy option for this population due to its multiple clinical and quality of life benefits. Central to successful HHD is the establishment and maintenance of a functioning vascular access that serves as a patient’s lifeline while on therapy. While the selection of a vascular access type is influenced by individual patient circumstances, the arteriovenous fistula is generally the preferred access method. Training patients to utilize their dialysis access requires attention to safety, risk management, and monitoring for complications to minimize adverse events and technique failure. Policies incorporating systematic frameworks for quality improvement and assurance, in conjunction with the measurement of metrics relating to vascular access, are tools that should be employed by HHD programs to enhance the value of care delivered. In this Perspective, we aim to describe what is currently known about the various vascular access options in HHD and to elucidate what needs to be taken into consideration in the selection and care of this access.

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“…Uptake and access will be limited by local availability and practices, clinician and patient confidence and appetite for home therapies, patient concerns about self-management, health literacy, and clinical stability during pregnancy. 9 The fluctuating physiological demands of pregnancy, coupled with the need for meticulous monitoring and adjustments in dialysis prescriptions, create a complex scenario for home hemodialysis. Similarly, commencing or continuing peritoneal dialysis may be limited by catheter complications, restricted intraabdominal space as the gravid uterus enlarges, or inadequate clearances especially in women with less residual kidney function.…”

mentioning

confidence: 99%

Home hemodialysis technique survival: insights and challenges

Cited by 6 publications

References 73 publications

Long-term survival of patients receiving home hemodialysis with self-punctured arteriovenous access

Long-term survival of patients receiving home hemodialysis with self-punctured arteriovenous access

Vascular Access Considerations in Home Hemodialysis

Innovative Journeys to Motherhood: Option of Home Dialysis for Women With Advanced Kidney Disease or Kidney Failure

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