Patient selection and training for home hemodialysis

Rioux, Julien; Marshall, Mark R.; Faratro, Rose; Hakim, Raymond M.; Simmonds, Rosemary; Chan, Christopher T.

doi:10.1111/hdi.12254

Cited by 31 publications

(41 citation statements)

References 20 publications

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“…That introduction of Nx2me was associated with shorter time to train contrasts with an earlier study of simulation‐based teaching, which was not associated with shorter time to train . More research is necessary to understand the role of technology aids during HHD training …”

Section: Discussioncontrasting

confidence: 59%

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Relative risk of home hemodialysis attrition in patients using a telehealth platform

Weinhandl¹,

Collins

2017

Hemodialysis International

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Introduction: Home hemodialysis (HHD) facilitates increased treatment frequency, which may improve patient outcomes. However, attrition due to technique failure limits the clinical effectiveness of the modality. Nx2me Connected Health is a telehealth platform that enables ongoing assessment of HHD patients using NxStage equipment, and that may reduce patient burden. We aimed to assess whether use of Nx2me was associated with risk of HHD attrition. Methods:We compared risks of all-cause attrition, dialysis cessation (i.e., death or transplant), and technique failure in Nx2me users and matched control patients, using a retrospective cohort study. We also compared the likelihood of HHD training graduation in patients who initiated use of Nx2me during training with the likelihood in matched control patients. Matching factors included date of HHD initiation, NxStage treatment duration at initiation of follow-up, and prescribed treatment frequency. We used stratified Fine-Gray and Cox regression to compare risks, with adjustment for demographic factors and vascular access modality, and stratification by matched cluster. Findings:We identified 606 Nx2me users; 49.5% initiated use of Nx2me in <3 months after initiation of HHD with NxStage equipment. Adjusted hazard ratios (AHRs) of all-cause attrition, dialysis cessation, and technique failure were 0.80 (95% confidence interval, 0.68-0.95), 1.10 (0.86-1.41), and 0.71 (0.57-0.87), respectively, for Nx2me users vs. matched controls. AHRs were similar in patients who initiated use of Nx2me in <3 months after initiation of HHD. The AHR of HHD training graduation was 1.61 (1.10-2.36) in patients who initiated use of Nx2me within 2 weeks of training initiation vs. matched controls.Discussion: Use of Nx2me was associated with lower risk of all-cause attrition, lower risk of technique failure, and higher likelihood of HHD training graduation. Further studies are needed to identify the mechanisms by which use of a telehealth platform may improve clinical outcomes and reduce patient burden.

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Section: Discussioncontrasting

confidence: 59%

“…30 More research is necessary to understand the role of technology aids during HHD training. 31 This study has several limitations. First, it is an observational study, so all comparisons between Nx2me users and matched controls may suffer from residual confounding.…”

Section: Discussionmentioning

confidence: 92%

Relative risk of home hemodialysis attrition in patients using a telehealth platform

Weinhandl¹,

Collins

2017

Hemodialysis International

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“…Moreover, health care professionals in both high‐ and low‐performing services are also influenced by the same factors. Importantly, comorbidity and language barriers are not generally given much weight in the decision of health care professionals to recommend home dialysis in NZ, which is contrast to many of the published guidelines around patient selection . Overwhelmingly, the most important influencers are the degree to which home dialysis meets patients' lifestyle needs and improves their survival.…”

Section: Discussionsupporting

confidence: 67%

“Who matters most?”: Clinician perspectives of influence and recommendation on home dialysis uptake

et al. 2017

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“…Factors such as the duration and quality of home HD training and education, and the nature and degree of post home HD initiation care (including nursing follow-up, availability of respite, and frequency of clinic visits) could not be explored in this analysis. In Canada, approximately 6 weeks is the typical duration of home HD training across facilities, although training periods tends to be shorter in the United States, which may explain between-country differences in outcomes (20). In other countries with longer training times, such as Australia and New Zealand, rates of discontinuation of home HD are significantly lower at 25% after 2 years of follow-up (21).…”

Section: Differences Between Discontinuation Rates Of Home Hd Inmentioning

confidence: 99%

Temporal Trends and Factors Associated with Home Hemodialysis Technique Survival in Canada

Perl

Tennankore

et al. 2017

CJASN

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Patient selection and training for home hemodialysis

Abstract: Patient selection and training is arguably the most important step toward building a successful home hemodialysis (HD) program.

Cited by 31 publications

References 20 publications

Relative risk of home hemodialysis attrition in patients using a telehealth platform

Relative risk of home hemodialysis attrition in patients using a telehealth platform

“Who matters most?”: Clinician perspectives of influence and recommendation on home dialysis uptake

Temporal Trends and Factors Associated with Home Hemodialysis Technique Survival in Canada

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