Increasing home based dialysis therapies to tackle dialysis burden around the world: A position statement on dialysis economics from the 2nd Congress of the International Society for Hemodialysis

Li, Philip Kam-Tao; Cheung, Wai Lun; Lui, Sing Leung; Blagg, Christopher R.; Cass, Alan; Hooi, Lai Seong; Lee, Ho Yung; Locatelli, Francesco; Wang, Tao; Yang, Chih‐Wei; Canaud, Bernard; Cheng, Yuk Lun; Choong, Hui Lin; Francisco, Angel Lm De; Gura, Victor; Kaizu, Kazo; Kerr, Peter G.; Kuok, Un I; Leung, Chi Bon; Lo, Wai-Kei; Misra, Madhukar; Szeto, Cheuk‐Chun; Tong, Kwok Lung; Tungsanga, Kriang; Walker, Robert; Wong, Andrew K.; Yu, Alex W.

doi:10.1111/j.1440-1797.2010.01418.x

Cited by 27 publications

(13 citation statements)

References 22 publications

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“…As of February 2014, of 1,250 HD patients in Hong Kong, more than 230 (>18%) were recruited into the programme to receive HD treatment in the community. In addition to expanding the inpatient HD facilities, Hong Kong is also using the Nocturnal Home Haemodialysis Programme to increase the number of patients who can be put on HD, especially for those who are found to be high-risk PD patients [5,31,32]. …”

Section: How To Sustain the Pd-first Policy In Hong Kongmentioning

confidence: 99%

Sustainability of the Peritoneal Dialysis-First Policy in Hong Kong

Choy

2015

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In Hong Kong, the average annual cost of haemodialysis (HD) per patient is more than double of that of peritoneal dialysis (PD). As the number of patients with end-stage renal disease (ESRD) has surged, it has posed a great financial burden to the government and society. A PD-first policy has been implemented in Hong Kong for three decades based on its cost-effectiveness, and has achieved successful outcomes throughout the years. A successful PD-first policy requires medical expertise in PD, the support of dedicated staff and a well-designed patient training programme. Addressing patients' PD problems is the key to sustainability of the PD-first policy. In this article, we highlight three important groups of patients: those with frequent peritonitis, ultrafiltration failure or inadequate dialysis. Potential strategies to improve the outcomes of these groups will be discussed. Moreover, enhancing HD as back-up support and promoting organ transplantation are needed in order to maintain sustainability of the PD-first policy.

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Section: How To Sustain the Pd-first Policy In Hong Kongmentioning

confidence: 99%

Sustainability of the Peritoneal Dialysis-First Policy in Hong Kong

Choy

2015

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“…There are various interventions, such as promotion of home dialysis; telemedicine to access a nephrologists from a distance; mobile apps, and patient interaction portals for patient education and access to healthcare that can ameliorate the impact of the greater distance to care [12,33]. Establishing new facilities in areas where travel distance is high would certainly improve access and reduce time, but is only feasible if adequate patient volumes are present in the area.…”

Section: Discussionmentioning

confidence: 97%

Geographic disparities in mortality among the end stage renal disease patients: an analysis of the United States Renal Data System, 2007–08

2016

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The study was conducted to determine the association between mortality, rurality, and distance from the treatment facility of the patients with ESRD. The United States Renal Data System (USRDS) for the year 2007-08 was utilized to conduct analysis of 181,349 subjects. After adjusting for all other covariates, the odds of mortality were higher among patients in urban and isolated areas (18.1 miles or more from the dialysis facility), compared with those who were living closer (≤3.3 miles, OR 1.08, 95 % CI 1.05-1.12). Conversely, patients living in isolated rural (0-≤3.3 miles, OR 0.95, 95 % CI 0.81-0.96), small adjacent rural (8.1-≤18.1 miles, OR 0.90, 95 % CI 0.77-0.96) and Micropolitan rural quartiles (>18.1 miles, OR 0.96, 95 % CI 0.92-0.97) had lower odds of mortality than their urban counterparts. The Accountable Care Organizations must devise strategies to cater ESRD patients living in remote areas.

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“…Given the increasing costs associated with dialysis provision globally, home-based dialysis therapies are recommended as a consensus on the basis of cost-effectiveness as well as the clinical benefits discussed already and the degree of empowerment that they confer on patients 53. In a comparative assessment of nocturnal home HD versus conventional hospital HD, domiciliary therapy yielded a strikingly superior cost to utility ratio (£53 335/QALY vs £94 128/QALY) 40…”

Section: Discussionmentioning

confidence: 99%

Haemodialysis: hospital or home?

Power

Ashby

2013

Postgraduate Medical Journal

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Healthcare costs associated with the provision of dialysis therapy are escalating globally as the number of patients developing end-stage renal disease increases. In this setting, there has been heightened interest in the application and potential benefit of home haemodialysis therapies compared with the conventional approach of thrice weekly, incentre treatments. Increasingly, national healthcare systems are financially incentivising the expansion of home haemodialysis programmes with observational studies demonstrating better patient survival, superior control of circulating volume and blood pressure, greater patient satisfaction and lower running costs compared with incentre dialysis. Nonetheless, increasing the prevalence of home haemodialysis is challenged by the technological complexity of conventional dialysis systems, the need for significant adaptations to the home as well as suboptimal clinician and patient education about the feasibility and availability of this modality. In addition, enthusiasm about frequent as well as nocturnal (extended-hours) haemodialysis has been tempered by results from the recent Frequent Haemodialysis Network randomised controlled trials comparing these schedules with a conventional incentre regime. An increasing emphasis on empowering patient choice and promoting self-management of chronic illness is a powerful driver for the expansion of home haemodialysis programmes in the UK and internationally.

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Increasing home based dialysis therapies to tackle dialysis burden around the world: A position statement on dialysis economics from the 2nd Congress of the International Society for Hemodialysis

Cited by 27 publications

References 22 publications

Sustainability of the Peritoneal Dialysis-First Policy in Hong Kong

Sustainability of the Peritoneal Dialysis-First Policy in Hong Kong

Geographic disparities in mortality among the end stage renal disease patients: an analysis of the United States Renal Data System, 2007–08

Haemodialysis: hospital or home?

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