The Influence of Renal Centre and Patient Sociodemographic Factors on Home Haemodialysis Prevalence in the UK

Jayanti, Anuradha; Foden, Philip; Rae, Alasdair; Morris, Julie; Brenchley, Paul; Mitra, Sandip

doi:10.1159/000452927

Cited by 14 publications

(16 citation statements)

References 33 publications

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“…15,21 The attitudes of staff towards home therapies and the prevailing culture of a dialysis program with respect to dialysis modalities could contribute to the uptake of home therapies. 4,5 Further, the nurses' opinion of how well educated patients towards dialysis modalities likely varies with their experience with suboptimal dialysis start patients (i.e. those that start acute hemodialysis without the benefit of pre-dialysis education).…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, 27% of allied health staff and 12% of dialysis nurses did not feel that they educated patients about dialysis modalities. Respondents were asked to rank the impact of different individuals on a patient's choice of modality on a Likert scale from most (1) to least (5). Nephrologists were ranked most impactful in 41% of responses, followed by patients (28%) and pre-dialysis CKD nurses (19%).…”

Section: Perceived Impact On a Patient's Modality Selectionmentioning

confidence: 99%

“…1,2 This pattern has remained largely unchanged for the past decade, and is influenced by both medical and non-medical factors. [3][4][5] In the Canadian province of British Columbia, approximately 29% of the prevalent dialysis population are receiving a home therapy (24.7% PD and 3.7% home HD) and the majority of patients (71.6%) receive in-center HD. 2 Similar to other Canadian provinces, British Columbia has established a patient-centered, multidisciplinary approach to the care of individuals with kidney disease.…”

Section: Introductionmentioning

confidence: 99%

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Perceptions of Multidisciplinary Renal Team Members toward Home Dialysis Therapies

Poinen

Hoek²,

Copland

et al. 2021

Kidney360

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Background: Patients with end stage kidney disease are encouraged to pursue home dialysis therapy with the aims of improving quality of life, increasing patient autonomy and reducing cost to health care systems. In a multidisciplinary team setting, patients interact with nephrologists, nurses and allied health staff, all of whom may influence a patient's modality choice. Our objective was to evaluate the perceptions of all renal team members towards home dialysis therapies. Methods: Cross-sectional survey of multidisciplinary renal team members across five renal programs in British Columbia, Canada. The survey contained questions regarding primary work area, modality preference, patient and system factors that may influence modality candidacy, perceived knowledge of home therapies and need for further education. Results: A total of 334 respondents (22 nephrologists, 172 hemodialysis nurses, 49 home nurses, 20 pre-dialysis nurses, and 71 allied health) were included (48% response rate). All respondents felt that home dialysis was beneficial for patients who work or study, improved patients' quality of life, and provided cost-savings to the system. Compared to in-center hemodialysis nurses, home therapies nurses were between 5 and 9 times more likely to favor a home therapy for patients of older age, lower socioeconomic status, lower educational level, higher burden of comorbidities and those lacking social supports. Nephrologists and patients were felt to have the most impact on modality choice, while dialysis nurses were seen as having the least impact on modality choice. Most respondents felt the need for further education in home therapies. Conclusions: The majority of multidisciplinary team members, including allied health staff, acknowledged the benefits of home therapies. There were significant discrepancies amongst team members regarding patient/system-level factors that may impact home therapies candidacy. Structured, focused and repeated education sessions for all renal team members may help to address misperceptions around factors that influence modality candidacy.

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Section: Discussionmentioning

confidence: 99%

Section: Perceived Impact On a Patient's Modality Selectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Perceptions of Multidisciplinary Renal Team Members toward Home Dialysis Therapies

Poinen

Hoek²,

Copland

et al. 2021

Kidney360

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“…This would involve capturing microlevel (practitioner-level and patient-level), mesolevel (group and team factors, unit culture), and macro-level (process and resource barriers) information. 36 A total of 17% of the surveyed recipients were of First Nations heritage. The challenges faced by patients in First Nations reserves are different and well reported in the literature and were not the focus of our survey.…”

Section: Discussionmentioning

confidence: 99%

Barriers to Home Hemodialysis Across Saskatchewan, Canada: A Cross-Sectional Survey of In-Center Dialysis Patients

Diebel

Jafari

Shah

et al. 2020

Can J Kidney Health Dis

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Background: Despite clinical and lifestyle advantages of home hemodialysis (HHD) compared with in-center hemodialysis (ICHD), it remains underutilized in our province. The aim of the study was to explore the patients’ perception and to identify the barriers to use of HHD in Saskatchewan, Canada. Objectives: The primary objective of the study was to evaluate and explore patient perceptions of HHD and to identify the obstacles for adoption of HHD in Saskatchewan. The secondary objective was to examine variations in the patients’ perceptions and barriers to HHD by center (main dialysis units vs satellite dialysis units). Design: This is a cross-sectional observational survey study. Setting: Two major centers (Regina and Saskatoon) and 5 associated satellite units attached to each center across the province of Saskatchewan. Patients: We approached all prevalent ICHD patients across Saskatchewan, 398 agreed to participate in the study. Measurements: Self-reported barriers to HHD were assessed using a questionnaire. Methods: A questionnaire was designed to determine the patients’ perceived barriers to HHD. Descriptive statistics was used to present the data. Chi-square and Mann-Whitney U test were used to compare the patients’ responses between main and satellite units Results: Satisfaction with current dialysis care (91%), increase in utility bills (65%), fear of catastrophic events at home (59%), medicalization of one’s home (54%), and knowledge deficits toward treatment modalities (54%) were the main barriers to HHD uptake. Compared with patients dialyzing in our main units, satellite patients chose not to pursue HHD more frequently because they had greater satisfaction with their current dialysis unit care (97% vs 87%, P < .001), felt more comfortable dialyzing under the supervision of medical staff (95% vs 86%, P < .007), could not afford additional utility costs (92% vs 45%, P < .001), were unaware of the risks and benefits of HHD (83% vs 33%, P < .001), had concerns over time commitments for training to HHD (69% vs 32%, P < .001), and had concern for family burnout (60.8% vs 40.6%, P < .001). Limitations: We used questionnaires to quantify known barriers, and this prevents inclusion of additional barriers that individual patients may consider important. Cross-sectional data can only be used as a snapshot. Only 398 patients agreed to participate, and the results cannot be generalized to 740 prevalent HD patients. We did not capture data on demographics (age, income, and literacy level), comorbidities, and dialysis vintage, which would have been helpful in interpretation of the results. Conclusions: Satisfaction with in-center care, lack of awareness and education, specifically in the satellite population, concerns with family burnout, expenses associated with utilities, and training time will need to be addressed to increase the uptake of HHD. Trial Registration: The study was not registered on a publicly accessible registry as it did not involve any health care intervention on human participants.

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“…Daily HHD is associated with an increase in dialysis efficiency, as well as a better quality of life [ 4 , 5 ], but still has a very low prevalence worldwide (2% in USA [ 31 ], 0.3% in Canada [ 32 ], 0.7% in France [ 3 ] 1–2% in the UK [ 33 ]), with the exception of Australia and New Zealand with a prevalence of respectively 9.6 and 22.8% [ 30 , 34 ]. Large observational cohort studies generally report, at the clinical level, lower mortality and decreased hypertension and at the medico-economic level, decreased hospitalization duration [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of physical activity and quality of life in home haemodialysis (HHD) patients versus conventional in-centre haemodialysis (ICHD) patients: the observational, longitudinal, prospective, international, multicentric SeCoIA study protocol

et al. 2020

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Background Home haemodialysis (HHD), has shown improved clinical outcomes, as well as a better quality of life, compared to conventional in-centre haemodialysis (ICHD) but still has a global low prevalence among end-stage renal disease patients. Haemodialysis (HD) patients tend to be sedentary but only few studies, mainly in North American ICHD patients, have evaluated the level of activity in HD patients. Methods SeCoIA is an observational, longitudinal, prospective, international, multicentric, study, conducted in metropolitan France and Belgium. The main objective of the study is to quantify the physical activity measured by the total daily number of steps, in HHD patients compared to ICHD patients. The SeCoIA study will include 80 HHD patients and 80 ICHD patients,. Secondary objectives will be to characterize the HHD population and to confirm HHD efficiency on clinical parameters, as well as quality of life (QoL), in current practice. Physical activity will be measured by a 3-axis accelerometer. Accelerometers have been shown to provide accurate information, on both physical activity and sedentary behaviour. Patients will be instructed to wear the device and complete a patient diary 7 consecutive days after inclusion and the first week of each month for 12 months. Decision to undergo HDD or ICHD is independent of the study and follow-up frequency remains at the discretion of the physician/centre. QoL and quality of sleep will be respectively assessed by the Kidney Disease Quality of Life 1.2 (KDQOL™) and the Pittsburg Sleep Quality index (PSQI) questionnaires at inclusion, 6- and 12-month visits. Patients presenting a restless leg syndrome (RLS) will also complete the International Restless Legs Syndrome rating scale (IRLS) questionnaire. Discussion The SeCoIA study will be the first large cohort study (160 patients) evaluating physical activity, objectively measured with a 3-axis accelerometer, in HHD versus ICHD patients. The present study will also include a comparison of QoL with a focus on RLS between HHD and ICHD. It is anticipated that HHD patients will have an improved physical activity and QoL which should encourage physicians to further promote HHD. Trial registration Clinical trial NCT03737578 study registered on November 9, 2018 (Retrospectively registered).

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The Influence of Renal Centre and Patient Sociodemographic Factors on Home Haemodialysis Prevalence in the UK

Cited by 14 publications

References 33 publications

Perceptions of Multidisciplinary Renal Team Members toward Home Dialysis Therapies

Perceptions of Multidisciplinary Renal Team Members toward Home Dialysis Therapies

Barriers to Home Hemodialysis Across Saskatchewan, Canada: A Cross-Sectional Survey of In-Center Dialysis Patients

Comparison of physical activity and quality of life in home haemodialysis (HHD) patients versus conventional in-centre haemodialysis (ICHD) patients: the observational, longitudinal, prospective, international, multicentric SeCoIA study protocol

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