Recruitment and Training for Home Hemodialysis

Pipkin, Mary; Eggers, Paul W.; Larive, Brett; Rocco, Michael V.; Stokes, John B.; Suri, Rita S.; Lockridge, Robert S.

doi:10.2215/cjn.02440310

Cited by 97 publications

(106 citation statements)

References 20 publications

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“…Residual confounding is best addressed by randomized trials. Unfortunately, large trials of intensive dialysis with adequate statistical power to examine mortality have not yet been feasible 17 nor have prospective observational studies comparing home conventional to home intensive dialysis. Thus, notwithstanding its limitations, our study represents the most rigorously conducted observational study in this field to date.…”

Section: Discussionmentioning

confidence: 99%

Intensive Hemodialysis Associates with Improved Survival Compared with Conventional Hemodialysis

Nesrallah

Lindsay

Cuerden

et al. 2012

Journal of the American Society of Nephrology

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192

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Patients undergoing conventional maintenance hemodialysis typically receive three sessions per week, each lasting 2.5-5.5 hours. Recently, the use of more intensive hemodialysis (.5.5 hours, three to seven times per week) has increased, but the effects of these regimens on survival are uncertain. We conducted a retrospective cohort study to examine whether intensive hemodialysis associates with better survival than conventional hemodialysis. We identified 420 patients in the International Quotidian Dialysis Registry who received intensive home hemodialysis in France, the United States, and Canada between January 2000 and August 2010. We matched 338 of these patients to 1388 patients in the Dialysis Outcomes and Practice Patterns Study who received in-center conventional hemodialysis during the same time period by country, ESRD duration, and propensity score. The intensive hemodialysis group received a mean (SD) 4.8 (1.1) sessions per week with a mean treatment time of 7.4 (0.87) hours per session; the conventional group received three sessions per week with a mean treatment time of 3.9 (0.32) hours per session. During 3008 patient-years of follow-up, 45 (13%) of 338 patients receiving intensive hemodialysis died compared with 293 (21%) of 1388 patients receiving conventional hemodialysis (6.1 versus 10.5 deaths per 100 personyears; hazard ratio, 0.55 [95% confidence interval, 0.34-0.87]). The strength and direction of the observed association between intensive hemodialysis and improved survival were consistent across all prespecified subgroups and sensitivity analyses. In conclusion, there is a strong association between intensive home hemodialysis and improved survival, but whether this relationship is causal remains unknown.

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Section: Discussionmentioning

confidence: 99%

Intensive Hemodialysis Associates with Improved Survival Compared with Conventional Hemodialysis

Nesrallah

Lindsay

Cuerden

et al. 2012

Journal of the American Society of Nephrology

Self Cite

192

170

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“…Furthermore, there are treatment-specific barriers to home HD, such as fear of self-cannulation, needle disconnect, or a catastrophic event (65). Nurse-directed cannulation training and home monitoring may help patients overcome these fears (69,70).…”

Section: Patient Perceptionsmentioning

confidence: 99%

How to Overcome Barriers and Establish a Successful Home HD Program

Young

Chan

Blagg

et al. 2012

Clinical Journal of the American Society of Nephrology

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Summary Home hemodialysis (HD) is an underused dialysis modality in the United States, even though it provides an efficient and probably cost-effective way to provide more frequent or longer dialysis. With the advent of newer home HD systems that are easier for patients to learn, use, and maintain, patient and provider interest in home HD is increasing. Although barriers for providers are similar to those for peritoneal dialysis, home HD requires more extensive patient training, nursing education, and infrastructure support in order to maintain a successful program. In addition, because many physicians and patients do not have experience with home HD, reluctance to start home HD programs is widespread. This in-depth review describes barriers to home HD, focusing on patients, individual physicians and practices, and dialysis facilities, and offers suggestions for how to overcome these barriers and establish a successful home HD program.

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“…7,8 In published reports and cumulative clinical experience, the number of sessions needed to complete training requirements is 20-40 sessions, but occasionally more may be needed (see the supplement article, "Patient Selection and Training for Home Hemodialysis"). [8][9][10][11][12][13][14][15] In the anecdotal experience of the authors, the duration of training tends to be consistent across countries: those with a lower prevalence of home HD, such as the United States, report a lower number of home HD training sessions (<30) than countries with a higher prevalence of home HD patients, such as New Zealand (>30). It is possible that this relates to the higher degree of patient selection in the United States (i.e., only the most capable and motivated patients undergo home HD) and the reduced availability of "ideal patients" in New Zealand, where training needs to accommodate a more educationally and medically diverse home HD patient population.…”

Section: Number Of Home Hd Training Stations To Support the Programmentioning

confidence: 99%

The home hemodialysis hub: Physical infrastructure and integrated governance structure

Marshall

Young

Fox

et al. 2015

Hemodialysis International

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An effective home hemodialysis program critically depends on adequate hub facilities and support functions and on transparent and accountable organizational processes. The likelihood of optimal service delivery and patient care will be enhanced by fit-for-purpose facilities and implementation of a well-considered governance structure. In this article, we describe the required accommodation and infrastructure for a home hemodialysis program and a generic organizational structure that will support both patient-facing clinical activities and business processes.

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Recruitment and Training for Home Hemodialysis

Cited by 97 publications

References 20 publications

Intensive Hemodialysis Associates with Improved Survival Compared with Conventional Hemodialysis

Intensive Hemodialysis Associates with Improved Survival Compared with Conventional Hemodialysis

How to Overcome Barriers and Establish a Successful Home HD Program

The home hemodialysis hub: Physical infrastructure and integrated governance structure

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