Prevalence of post-dialysis fatigue: a systematic review and meta-analysis

Dou, Jianfang; Liu, Huan; Ma, Yuanfang; Wu, Yingying; Tao, Xiubin

doi:10.1136/bmjopen-2022-064174

Cited by 2 publications

(1 citation statement)

References 30 publications

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“…1 Most patients are treated with in-center hemodialysis, a time-intensive modality requiring thrice-weekly, in-person treatments at dialysis centers followed by prolonged postdialysis symptoms. 2 Research has suggested that some patients and clinicians prefer dialyzing at home, 3 , 4 , 5 which allows for greater flexibility and independence, shorter recovery times, and some improved mortality outcomes. 6 , 7 As of 2021, about 14.1% of prevalent patients received home dialysis, 1 with higher use among White patients compared to Black or Hispanic patients, even though as many as 85% of patients are thought to be medically eligible for this service.…”

Section: Introductionmentioning

confidence: 99%

Pay-for-Performance Incentives for Home Dialysis Use and Kidney Transplant

Koukounas,

Kim,

Patzer

et al. 2024

JAMA Health Forum

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ImportanceThe Centers for Medicare &amp; Medicaid Services’ mandatory End-Stage Renal Disease Treatment Choices (ETC) model, launched on January 1, 2021, randomly assigned approximately 30% of US dialysis facilities and managing clinicians to financial incentives to increase the use of home dialysis and kidney transplant.ObjectiveTo assess the ETC’s association with use of home dialysis and kidney transplant during the model’s first 2 years and examine changes in these outcomes by race, ethnicity, and socioeconomic status.Design, Setting, and ParticipantsThis retrospective cross-sectional study used claims and enrollment data for traditional Medicare beneficiaries with kidney failure from 2017 to 2022 linked to same-period transplant data from the United Network for Organ Sharing. The study data span 4 years (2017-2020) before the implementation of the ETC model on January 1, 2021, and 2 years (2021-2022) following the model’s implementation.ExposureReceiving dialysis treatment in a region randomly assigned to the ETC model.Main Outcomes and MeasuresPrimary outcomes were use of home dialysis and kidney transplant. A difference-in-differences (DiD) approach was used to estimate changes in outcomes among patients treated in regions randomly selected for ETC participation compared with concurrent changes among patients treated in control regions.ResultsThe study population included 724 406 persons with kidney failure (mean [IQR] age, 62.2 [53-72] years; 42.5% female). The proportion of patients receiving home dialysis increased from 12.1% to 14.3% in ETC regions and from 12.9% to 15.1% in control regions, yielding an adjusted DiD estimate of −0.2 percentage points (pp; 95% CI, −0.7 to 0.3 pp). Similar analysis for transplant yielded an adjusted DiD estimate of 0.02 pp (95% CI, −0.01 to 0.04 pp). When further stratified by sociodemographic measures, including age, sex, race and ethnicity, dual Medicare and Medicaid enrollment, and poverty quartile, there was not a statistically significant difference in home dialysis use across joint strata of characteristics and ETC participation.Conclusions and RelevanceIn this cross-sectional study, the first 2 years of the ETC model were not associated with increased use of home dialysis or kidney transplant, nor changes in racial, ethnic, and socioeconomic disparities in these outcomes.

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