Optimization of Dialysis Modality Transitions for Improved Patient Care

Abstract

Purpose of review: Initial and subsequent modality decisions are important, impacting both clinical outcomes and quality of life. Transition from chronic kidney disease to dialysis and between dialysis modalities are periods were patients may be especially vulnerable. Reviewing our current knowledge surrounding these critical periods and identifying areas for future research may allow us to develop dialysis strategies beneficial to patients. Sources of information: We searched the electronic database PubMed and queried Google Scholar for English peer-reviewed articles using appropriate keywords (non-exhaustive list): dialysis transitions, peritoneal dialysis, home hemodialysis, integrated care pathway, and health-related quality of life. Primary sources were accessed whenever possible. Methods: In this narrative review, we aim to expose the controversies surrounding home-dialysis first strategies and examine the evidence underpinning home-dialysis first strategies as well as home-to-home and home-to-in-center transitions. Key findings: Diverse factors must be taken into consideration when choosing initial and subsequent dialysis modalities. Given the limitations of available data (and lack of convincing benefit or detriment of one modality over the other), patient-centered considerations may prime over suspected mortality benefits of one modality or another. Limitations: Available data stem almost exclusively from retrospective and observational studies, often using large national and international databases, susceptible to bias. Furthermore, this is a narrative review which takes into account the views and opinions of the authors, especially as it pertains to optimal dialysis pathways. Implications: Emphasis must be placed on individual patient goals and preferences during modality selection while planning ahead to achieve timely and appropriate transitions limiting discomfort and anxiety for patients. Further research is required to ascertain specific interventions which may be beneficial to patients.

A Systematic Approach To Promoting Home Hemodialysis during End Stage Kidney Disease

“…The concept of an integrated home dialysis model leverages the patient's home as the preferred site of disease management. 43 The sequence proposes that patients initiate dialysis with PD and, when a transition point is reached, shift to HHD, instead of in-facility hemodialysis. On average, patients who experience PD technique failure may benefit from switching to HHD.…”

Switch from Hemodialysis to Peritoneal Dialysis: Does the Time Spent on Hemodialysis Impact Outcomes in Peritoneal Dialysis?

“…As previous studies have mostly investigated the impact of early transfer that is driven by unplanned arrival, this may explain the difference with our study. Residual kidney function is modified by time spent on HD and would be an important factor to study in this context [26-31]. Unfortunately, we were not able to capture this information in the present study.…”

Quantifying Missed Opportunities for Recruitment to Home Dialysis Therapies

“… 2 Despite a concerted effort to promote home therapies, more than 70% of Canadian incident dialysis patients start on in-center HD. 3 , 4 To continue to foster the growth of home therapies, it is important to understand the reasons why a patient may not be recruited to either peritoneal dialysis (PD) or home HD. Although conceptual models have been proposed in the literature to delineate the steps involved, and thus guide the implementation of care pathways in renal programs, there is a paucity of contemporary real-world data describing the modality selection pathway.…”