Prevalence-Based Targets Underestimate Home Dialysis Program Activity and Requirements for Growth

Bevilacqua, Micheli; Er, Lee; Copland, Michael A.; Singh, Ravail; Jamal, Abeed; Dunne, Orla M.; Brumby, Catherine; Levin, Adeera

doi:10.3747/pdi.2017.00171

Cited by 3 publications

(9 citation statements)

References 24 publications

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“…CVC = central venous catheter; AVF = arteriovenous fistula; ESRD = end-stage renal disease; HTN = hypertension; DM = diabetes mellitus; RAS = renal artery stenosis; GN = glomerulonephritis; PCKD = polycystic kidney disease; CHF = chronic heart failure; PVD = peripheral vascular disease; CVD = cardiovascular disease. [11,41] that failed training were more likely to be older (64.4 ± 11 years vs 56.7 ± 13 years, respectively, P = .007), have congestive heart failure (45.0% vs 15.6%, P = .004) or have two or more comorbidities (95.0% vs 62.6%, P = .009) as compared to those who successfully started on HHD (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…We describe a Canadian cohort of 167 incident patients on HHD in a single program who were followed from the onset of training and had a median time on HHD of 21 months. Amongst those who successfully completed training and went on to dialyze at home, the mean time on HHD was 23 [11,41] months, exceeding the 12-month threshold to achieve cost savings with ICHD. Transplant was responsible for most of the exits from HHD at 21% (consistent with 8.2% to 30% in other studies) 14,18,19 followed by technique failure at 14.4% (vs 10% to 25% reported by others).…”

Section: Discussionmentioning

confidence: 99%

“…The most common reasons for exit from the training program were patient preference and medical (see Table 3). Patients [11,41] that failed training were more likely to be older (64.4 ± 11 years vs 56.7 ± 13 years, respectively, P = .007), have congestive heart failure (45.0% vs 15.6%, P = .004) or have two or more comorbidities (95.0% vs 62.6%, P = .009) as compared to those who successfully started on HHD (Table 1). The proportion of patients who were not married or common-law was similar (15.0% vs 22.4%, P = .56).…”

Section: Home Hd Trainingmentioning

confidence: 99%

“…Of the 147 patients who successfully completed training, 80 (47.9%) remained in the program at the end of the study period. The primary outcome, median time to HHD exit, was 23 [11,41] months, when excluding the patients that failed training and 21 [9.7, 37.4] when including the train failures (Table 2). The most common reasons for exit from HHD were transplant (35; 21%), followed by technique failure (24; 14.4%) and death (8; 4.8%).…”

Section: Home Hd Outcomesmentioning

confidence: 99%

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Understanding Home Hemodialysis Patient Attrition: A Cohort Study

Paterson

Fox

Lee

et al. 2021

Can J Kidney Health Dis

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Background: Home hemodialysis (HHD) offers a flexible, patient-centered modality for patients with kidney failure. Growth in HHD is achieved by increasing the number of patients starting HHD and reducing attrition with strategies to prevent the modifiable reasons for loss. Objective: Our primary objective was to describe a Canadian HHD population in terms of technique failure and time to exit from HHD in order to understand reasons for exit. Our secondary objectives include the following: (1) determining reasons for training failure, (2) reasons for early exit from HHD, and (3) timing of program exit. Design: A retrospective cohort study of incident adult HHD patients between January 1, 2013—June 30, 2020. Setting: Alberta Kidney Care South, AKC-S HHD program. Participants: Patients who started training for HHD in AKC-S. Methods: A retrospective, cohort study of incident adult HHD patients with primary outcome time on home hemodialysis, secondary outcomes include reason for train failure, time to and reasons for technique failure. Cox-proportional hazard model to determine associations between patient characteristics and technique failure. The cumulative probability of technique failure over time was reported using a competing risks model. Results: A total of 167 patients entered HHD. Training failure occurred in 20 (12%), at 3.1 [2.0, 5.5] weeks; these patients were older ( P < .001) and had 2 or more comorbidities ( P < .001). Reasons for HHD exit after training included transplant (35; 21%), death (8; 4.8%), and technique failure (24; 14.4%). Overall, the median time to HHD exit, was 23 months [11, 41] and the median time of technique failure was 17 months [8.9, 36]. Reasons for technique failure included: psychosocial reasons (37%) at a median time 8.9 months [7.7, 13], safety (12.5%) at 19 months [19, 36], and medical (37.5%) at 26 months [11, 50]. Limitations: Small patient population with quality of data limited by the electronic-based medical record and non-standardized definitions of reasons for exit. Conclusions: Training failure is a particularly important source of patient loss. Reasons for exit differ according to duration on HHD. Early interventions aimed at reducing train failure and increasing psychosocial supports may help program growth.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Home Hd Trainingmentioning

confidence: 99%

Section: Home Hd Outcomesmentioning

confidence: 99%

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Understanding Home Hemodialysis Patient Attrition: A Cohort Study

Paterson

Fox

Lee

et al. 2021

Can J Kidney Health Dis

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“…HHD can offer numerous advantages to renal patients, even though the intake of HHD is still very low worldwide. On the other hand, the turnover rate in HHD is high in some countries such as the United States 18 …”

Section: Introductionmentioning

confidence: 99%

Exploring stakeholders and their requirements in the process of home hemodialysis: A literature review

Khan

Pintelon

Martin

et al. 2021

Seminars in Dialysis

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Providing home hemodialysis (HHD) therapy is a complex process that not only requires the use of a complex technology but also involves a diverse group of stakeholders, and each stakeholder has their requirements and may not share a common interest. Bringing them together will require the alignment of their interests. A process management perspective can help to accomplish the alignment of their interests. To align their interests, it is crucial to identify interest groups and understand their interests. The main objective of this paper is to identify the stakeholders and represents their interests as a list of requirements in the HHD process. An extensive literature review has been carried out and PubMed was used for literature extraction. In total, 1848 articles were retrieved of which 80 have fulfilled the inclusion criteria. A large array of actors is identified and their interests/requirements at different stages of the HHD process are represented in the form of a list. They have both common and conflicting requirements in the HHD process. If these requirements are aligned and balanced, a stakeholder's driven treatment process will be developed and a real improvement will be achieved in the treatment process.

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System-Level Strategies to Improve Home Dialysis

Watnick,

Blake,

Mehrotra

et al. 2023

CJASN

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Advocacy and policy change are powerful levers to improve quality of care and better support patients on home dialysis. While the kidney community increasingly recognizes the value of home dialysis as an option for patients who prioritize independence and flexibility, only a minority of patients dialyze at home in the United States. Complex system-level factors have restricted further growth in home dialysis modalities, including limited infrastructure, insufficient staff for patient education and training, patient-specific barriers, and suboptimal physician expertise. In this article, we outline trends in home dialysis use, review our evolving understanding of what constitutes high quality care for the home dialysis population (as well as how this can be measured), and discuss policy and advocacy efforts that continue to shape the care of US patients, and compare with experiences in other countries. We conclude by discussing future directions for quality and advocacy efforts.

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Prevalence-Based Targets Underestimate Home Dialysis Program Activity and Requirements for Growth

Cited by 3 publications

References 24 publications

Understanding Home Hemodialysis Patient Attrition: A Cohort Study

Understanding Home Hemodialysis Patient Attrition: A Cohort Study

Exploring stakeholders and their requirements in the process of home hemodialysis: A literature review

System-Level Strategies to Improve Home Dialysis

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