The case for dialy dialysis: Its impact on costs and quality of life

Mohr, Penny; Neumann, Peter J.; Franco, Sheila J.; Marainen, Jonas; Lockridge, Robert S.; Ting, George

doi:10.1016/s0272-6386(01)80127-x

Cited by 131 publications

(132 citation statements)

References 19 publications

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“…It seems obvious that widespread implementation of the WAK as the standard for renal replacement therapy would result in vast savings in labor and costs of operating a dialysis unit. This savings would be incremental on the savings in drug use and hospitalizations brought about already with daily dialysis (6). We are painfully aware that our efforts to build a WAK would be useless if the implementation of its use in practice is not affordable.…”

Section: Discussionmentioning

confidence: 99%

“…Growing evidence indicates that longer and more frequent dialysis may be conducive to biochemical as well as clinical improvements. However, implementation of daily dialysis is largely impractical (1)(2)(3)(4)(5)(6)(7). The development of a wearable artificial kidney (WAK) that would allow for longer and more frequent dialysis has been ongoing for decades, but has resulted in failure due almost entirely to insurmountable technical problems (8,9).…”

mentioning

confidence: 99%

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Technical Breakthroughs in the Wearable Artificial Kidney (WAK)

Gura¹,

Macy²,

Beizai³

et al. 2009

Clinical Journal of the American Society of Nephrology

107

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Background: The wearable artificial kidney (WAK) has been a holy grail in kidney failure for decades. Described herein are the breakthroughs that made possible the creation of the WAK V1.0 and its advanced versions V 1.1 and 1.2.Design: The battery-powered WAK pump has a double channel pulsatile counter phase flow. This study clarifies the role of pulsatile blood and dialysate flow, a high-flux membrane with a larger surface area, and the optimization of the dialysate pH. Flows and clearances from the WAK pump were compared with conventional pumps and with gravity steady flow.Results: Raising dialysate pH to 7.4 increased adsorption of ammonia. Clearances were higher with pulsatile flow as compared with steady flow. The light WAK pump, geometrically suitable for wearability, delivered the same clearances as larger and heavier pumps that cannot be battery operated. Beta 2 microglobulin (␤ 2 M) was removed from human blood in vitro. Activated charcoal adsorbed most ␤ 2 M in the dialysate. The WAK V1.0 delivered an effective creatinine clearance of 18.5 ؎ 3.2 ml/min and the WAK V1.1 27.0 ؎ 4.0 ml/min in uremic pigs.Conclusions: Half-cycle differences between blood and dialysate, alternating transmembrane pressures (TMP), higher amplitude pulsations, and a push-pull flow increased convective transport. This creates a yet undescribed type of hemodiafiltration. Further improvements were achieved with a larger surface area high-flux dialyzer and a higher dialysate pH. The data suggest that the WAK might be an efficient way of providing daily dialysis and optimizing end stage renal disease (ESRD) treatment.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Technical Breakthroughs in the Wearable Artificial Kidney (WAK)

Gura¹,

Macy²,

Beizai³

et al. 2009

Clinical Journal of the American Society of Nephrology

107

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“…An association between individual patients' use of more frequent HD and increased likelihood of employment has been suggested in reports of data from several small patient cohorts (12). Based on a multicenter study of 72 patients who used frequent HD from 1972 to 1996, Woods et al reported that the most common reason given for patients starting frequent HD was lifestyle or employment (24).…”

Section: Discussionmentioning

confidence: 99%

“…In 2004, the survey began to collect aggregate information on the number of patients aged 18 to 54 in the facility and the number of patients aged 18 to 54 who were employed at the end of the calendar year, in addition to counts of patients entering and leaving the facility and counts of patients in specific treatment modality categories at the end of the survey period. The survey also annually captures several facility characteristics that are recognized as potentially relevant for patient employment, i.e., availability of a late dialysis shift (10), availability of home dialysis treatment options (11), provision of frequent hemodialysis (HD) treatment (12), and level of social worker staffing (13).…”

mentioning

confidence: 99%

Dialysis Facility Characteristics and Variation in Employment Rates

Kutner¹,

Bowles²,

Zhang³

et al. 2008

Clinical Journal of the American Society of Nephrology

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Background: Investigation of factors associated with variation in dialysis patient employment has focused primarily on patient-level factors. Little is known about facility-level factors that may be associated with patient employment.Design, setting, participants, and measurements: The ESRD Facility Survey (CMS-2744A) began in 2004 to collect counts of employed patients aged 18 to 54, in addition to dialysis unit census, types and timing of treatments offered, and staffing. Using the 2004 ESRD Facility Survey File, we investigated dialysis unit characteristics and facility employment rate of patients aged 18 to 54 in a logistic regression analysis that included hospital-based chronic renal care facilities, nonhospital renal disease treatment centers, independent special purpose renal dialysis facilities, and renal disease treatment centers.Results: Across all facilities, 18.9% of prevalent patients aged 18 to 54 were employed, but facility employment rates ranged from 0 to 100%. Facility employment rate was positively associated independently with availability of a 5 p.m. or later dialysis shift (odds ratio (OR) 1.54, 95% confidence interval (CI) 1.42 to 1.68), availability of peritoneal dialysis or home hemodialysis (HD) training (OR 1.19, 95% CI 1.11 to 1.28), and provision of frequent HD (OR 1.26, 95% CI 1.07 to 1.49), after adjusting for patient/social worker ratio, rurality of unit location, and unit size. In addition, patient receipt of Vocational Rehabilitation (VR) services was more often reported in facilities with higher employment rates.Conclusions: Promoting gainful employment among ESRD patients continues to be a quality improvement need. A dataset that allows adjustment for patient-level variables would facilitate increased understanding of the contribution of dialysis facility variables to patient employment.

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“…Although there is considerable variability in analytic approaches and their results, it is generally accepted that home hemodialysis is associated with fewer human resources and lower facility management expenses. [6][7][8][9][10][11][12][13][14] However, when patients self-dialyze at home, some expenses (such as the utility costs of running the dialysis equipment) are transferred to the patient. The aim of this study was to measure utility consumption (water and electricity) required to perform various prescriptions of home hemodialysis, and estimate the associated costs.…”

mentioning

confidence: 99%

Estimating patient-borne water and electricity costs in home hemodialysis: a simulation

et al. 2017

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Background: Home hemodialysis is associated with lower costs to the health care system compared with conventional facility-based hemodialysis because of lower staffing and overhead costs, and by transferring the treatment cost of utilities (water and power) to the patient. The purpose of this study was to determine the utility costs of home hemodialysis and create a formula such that patients and renal programs can estimate the annual patient-borne costs involved with this type of treatment.Methods: Seven common combinations of treatment duration and dialysate flows were replicated 5 times using various combinations of home hemodialysis and reverse osmosis machines. Real-time utility (electricity and water) consumption was monitored during these simulations. A generic formula was developed to allow patients and programs to calculate a more precise estimate of utility costs based on individual combinations of dialysis intensity, frequency and utility costs unique to any patient.Results: Using typical 2014 utility costs for Edmonton, the most expensive prescription was for nocturnal home hemodialysis (8 h at 300 mL/min, 6 d/wk), which resulted in a utility cost of $1269 per year; the least expensive prescription was for conventional home hemodialysis (4 h at 500 mL/min, 3 d/wk), which cost $420 per year. Water consumption makes up most of this expense, with electricity accounting for only 12% of the cost. Interpretation:We show that a substantial cost burden is transferred to the patient on home hemodialysis, which would otherwise be borne by the renal program. Abstract ResearchResearch CMAJ OPEN E62CMAJ OPEN, 5(1)

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The case for dialy dialysis: Its impact on costs and quality of life

Cited by 131 publications

References 19 publications

Technical Breakthroughs in the Wearable Artificial Kidney (WAK)

Technical Breakthroughs in the Wearable Artificial Kidney (WAK)

Dialysis Facility Characteristics and Variation in Employment Rates

Estimating patient-borne water and electricity costs in home hemodialysis: a simulation

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