Supplemented ERA-EDTA Registry data evaluated the frequency of dialysis, kidney transplantation, and comprehensive conservative management for patients with kidney failure in Europe

Stel, Vianda S.; Jong, Rianne W de; Kramer, Anneke; Andrusev, Anton; Baltar, José M.; Barbullushi, Myftar; Bell, Samira; Nuez, Pablo Castro de la; Čerņevskis, Harijs; Couchoud, Cécile; Meester, Johan De; Eriksen, Bjørn Odvar; Gârneaţă, Liliana; Golan, Eliezer; Helve, Jaakko; Hemmelder, Marc H; Hommel, Kristine; Ioannou, Kyriakos; Jarraya, F.; Kantaria, Nino; Kerschbaum, Julia; Komissarov, Kirill; Magaz, Ángela; Mercadal, Lucile; Ots-Rosenberg, Mai; Pálsson, Runólfur; Rahmel, Axel; Rydell, Helena; Savino, Manuela; Seyahi, Nurhan; Roblero, María Fernanda Slon; Stojceva-Taneva, Olivera; Tol, Arjan van der; Vazelov, Evgueniy; Žiginskienė, Edita; Zurriaga, Óscar; Vanholder, Raymond; Massy, Ziad A.; Jager, Kitty J.

doi:10.1016/j.kint.2020.12.010

Cited by 36 publications

(27 citation statements)

References 31 publications

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“…concerning severe comorbidities [ 26 ], reduced life expectancy [ 27 ], acute referrals [ 38 ], sex [ 40 ] or high numbers of transplanted patients [ 29 ]). The percentage of patients undergoing CC in the different studies varied widely (6–77%), illustrating differences in study populations and/or the delivery and acceptability of CC as a viable treatment option among countries [ 55 , 56 ].…”

Section: Discussionmentioning

confidence: 99%

Survival of patients who opt for dialysis versus conservative care: a systematic review and meta-analysis

Voorend

Oevelen

Verberne

et al. 2022

Nephrology Dialysis Transplantation

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Background Non-dialytic conservative care (CC) has been proposed as a treatment option for patients with kidney failure. This systematic review and meta-analysis aims to compare survival outcomes between dialysis and CC in studies where patients made an explicit treatment choice. Methods Five databases were systematically searched from origin up to February 25th, 2021 for studies comparing survival outcomes among patients choosing dialysis versus CC. Adjusted and unadjusted survival rates were extracted and meta-analysis performed where applicable. Risk of bias analysis was performed according to the Cochrane Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I). Results Twenty-two cohort studies were included covering 21,344 patients. Most studies were prone to selection bias and confounding. Patients opting for dialysis were generally younger, had less comorbid conditions, functional impairments and frailty than patients who chose CC. Unadjusted median survival from treatment decision or eGFR <15mL/min/1.73m2 ranged between 20-67 months for dialysis and 6-31 months for CC. Meta-analysis of twelve studies that provided adjusted hazard ratios (HRs) for mortality showed a pooled adjusted HR of 0.47 (95% CI 0.39-0.57) for patients choosing dialysis compared to CC. In subgroups of patients with higher age or severe comorbidities, the reduction of mortality risk remained statistically significant, although analyses were unadjusted. Conclusions Patients opting for dialysis have an overall lower mortality risk compared to patients opting for CC. However, high risk of bias and heterogeneous reporting preclude definitive conclusions and results cannot be translated to an individual level.

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Section: Discussionmentioning

confidence: 99%

Survival of patients who opt for dialysis versus conservative care: a systematic review and meta-analysis

Voorend

Oevelen

Verberne

et al. 2022

Nephrology Dialysis Transplantation

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“…Other studies have shown that when patients receive pre-dialysis modality education, 45–60% of patients express a preference for home instead of in-centre dialysis [ 40 ]. Despite these estimates, uptake of home dialysis (PD or HHD) remains low across the majority of European countries [ 41 ].…”

Section: Overview Of Current State Of Use/reimbursement Of Hhd In Polandmentioning

confidence: 99%

“…However, despite the huge growth of patients with ESRD in the last 50 years, the percentage of patients using home dialysis has decreased since the 1970s and remains surprisingly low [ 43 , 44 ]; the prevalence of HHD across European countries in 2019 was 2–19 patients per million population for HHD and 45–94 patients per million population for PD. By contrast, the prevalence of patients receiving ICHD was 265–521 patients per million population ( Figure 1 ) [ 41 , 45 ].…”

Section: Overview Of Current State Of Use/reimbursement Of Hhd In Polandmentioning

confidence: 99%

Main Barriers to the Introduction of a Home Haemodialysis Programme in Poland: A Review of the Challenges for Implementation and Criteria for a Successful Programme

Lima

Zawierucha²,

Busink

et al. 2022

JCM

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Introduction: Home dialysis in Poland is restricted to the peritoneal dialysis (PD) modality, with the majority of dialysis patients treated using in-centre haemodialysis (ICHD). Home haemodialysis (HHD) is an additional home therapy to PD and provides an attractive alternative to ICHD that combines dialysis with social distancing; eliminates transportation needs; and offers clinical, economic, and quality of life benefits. However, HHD is not currently provided in Poland. This review was performed to provide an overview of the main barriers to the introduction of a HHD programme in Poland. Main findings: The main high-level barrier to introducing HHD in Poland is the absence of specific health legislation required for clinician prescribing of HHD. Other barriers to overcome include clear definition of reimbursement, patient training and education (including infrastructure and experienced personnel), organisation of logistics, and management of complications. Partnering with a large care network for HHD represents an alternative option to payers for the provision of a new HHD service. This may reduce some of the barriers which need to be overcome when compared with the creation of a new HHD service and its supporting network due to the pre-existing infrastructure, processes, and staff of a large care network. Conclusions: Provision of HHD is not solely about the provision of home treatment, but also the organisation and definition of a range of support services that are required to deliver the service. HHD should be viewed as an additional, complementary option to existing dialysis modalities which enables choice of modality best suited to a patient’s needs.

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“…For example, the highest rate of PD utilization in the European Union is in Scandinavia (>28%), despite lower reimbursement than for in-hospital hemodialysis. 69,70 However, these governments reimburse real costs and not a flat sum, obviating financial benefit or loss to the clinical team. In addition, there are educational "home dialysis-first initiatives" led by national or local kidney health communities.…”

Section: Mitigation Of Institutional or Governmental Roadblocks To Home Dialysismentioning

confidence: 99%

Expanding Utilization of Home Dialysis: An Action Agenda From the First International Home Dialysis Roundtable

et al. 2021

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Supplemented ERA-EDTA Registry data evaluated the frequency of dialysis, kidney transplantation, and comprehensive conservative management for patients with kidney failure in Europe

Cited by 36 publications

References 31 publications

Survival of patients who opt for dialysis versus conservative care: a systematic review and meta-analysis

Survival of patients who opt for dialysis versus conservative care: a systematic review and meta-analysis

Main Barriers to the Introduction of a Home Haemodialysis Programme in Poland: A Review of the Challenges for Implementation and Criteria for a Successful Programme

Expanding Utilization of Home Dialysis: An Action Agenda From the First International Home Dialysis Roundtable

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