Home Hemodialysis Patients Research Articles

The Educational Programs in Home Hemodialysis: Scoping Review

Introduction. Home hemodialysis is an effective therapeutic option for patients with chronic kidney disease. As highlighted in the literature, its management requires good self-care abilities from the patient and adequate support for self-care from the caregiver. Therefore, the development of educational programs plays a fundamental role in patient care. Aim. The goal of this study is to map the educational programs aimed at caregivers and patients undergoing home hemodialysis treatment, in order to identify gaps in the literature regarding this focus. Methods. A Scoping Review was conducted following the Joanna Briggs Institute guidelines. Potentially relevant articles were identified through a selection process on major databases (PubMed, Scopus, CINAHL, EMBASE, Web of Science, and Google Scholar), without applying any time limits. Results. The educational programs available in the literature for home hemodialysis patients focus on both clinical and psychological aspects; training through a "practical" approach is the most commonly used strategy. Discussion and conclusions. The review highlights the crucial role that a multidisciplinary and multidimensional educational approach can provide to home hemodialysis patients. It is necessary to optimize educational strategies for this population to improve patient outcomes.

Mortality and Hospitalization and Associated Factors in Assisted Home Hemodialysis Patients in the State of Qatar: A Retrospective Study

Mortality and Hospitalization and Associated Factors in Assisted Home Hemodialysis Patients in the State of Qatar: A Retrospective Study

Transfers from home to facility-based dialysis: comparisons of HHD, assisted PD and autonomous PD.

Home dialysis therapies such as peritoneal dialysis (PD) and home hemodialysis (HHD) are beneficial for quality of life and patient empowerment. The short technique survival time partly explains their low prevalence. We aimed to assess the risk of transfer to facility-based hemodialysis in patients treated with autonomous PD, assisted PD and HHD. This was a retrospective study using data from the REIN registry of patients starting home dialysis in France from 2002 to 2019. The risks of transfer to facility-based hemodialysis (HD) were compared between three modalities of home dialysis (HHD, nurse-assisted PD, autonomous PD) using survival models with a propensity score (PS)-matched and unmatched cohort of patients. The study included 17909 patients: 628 in the HHD group, 10214 in the autonomous PD group, and 7067 in the assisted PD group. During the follow-up period, there were 5347 transfers to facility-based HD. The observed number of transfers was 2458 (13.7%) at 1 year and 5069 (28.3) at 5 years after the start of home dialysis, including 3272 (32%) on autonomous PD, 1648 (23.3%) on assisted PD, and 149 (23.7) on HHD. Owing to clinical characteristics differences, only 38% of HHD patients could be matched to patients from the others group. In the PS-matched cohort, the adjusted Cox model showed no difference in the risk of transfer for assisted PD (cs-HR 1.04, 95% CI 0.75-1.44) or HHD (cs-HR 1.07, 95% CI 0.77-1.48) compared with autonomous PD. Unlike results from other countries, where nurse assistance is not fully available for PD-associated care, there was no difference in technique survival between autonomous PD, nurse-assisted PD, and HHD in France. This discrepancy may be attributed to our inclusion of a broader spectrum of patients who derive significant benefits from assisted PD.

Nurse-assisted arterio-venous fistula cannulation during home hemodialysis: first results of the DIADIDEAL study

We have launched a pilot study, called DIADIDEAL, to propose nurse-assistance at home for arterio-venous fistula (AVF) cannulation in home hemodialysis (HHD) patients. The aim of the present study was to describe enrollment of the patients and their nurses. All prevalent HD patients on 30th November 2018 with no medical contraindication to HDD treatment and all incident patients on dialysis from the 30th November 2018 to the 21st April 2023 were eligible. Among 155 prevalent HD patients, 4 patients were included. Among the 276 incident patients on dialysis during the study period, 6 were included. We have phoned 23 nurse centers during the recruitment period. Eight of them agreed to learn in our unit how to cannulate AVF; 27 private nurses were enrolled. The results of the DIADIDEAL study will be available in 2024; we hope it will lead to a reimbursement of nurse-AVF cannulation at home in HDD.

#83 Cardiovascular outcomes in home hemodialysis and peritoneal dialysis patients

Abstract Background and Aims Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage kidney disease. Little is known about differences in cardiovascular outcomes between home hemodialysis (HHD) and peritoneal dialysis (PD). Methods We evaluated 68 645 patients who initiated home dialysis between 1/1/2005 and 12/31/2018 using the United States Renal Data System with linked Medicare claims. Rates for incident cardiovascular events of acute coronary syndrome, heart failure, and stroke hospitalizations were determined. Using adjusted time-to-event models, the associations of type of home dialysis modality with the outcomes of incident cardiovascular events, cardiovascular death, and all-cause death were examined. Results The mean age of patients in the study cohort was 64 ± 15 years, and 42.3% were women. Mean time of follow up was 1.8 ± 1.6 years. The unadjusted cardiovascular event rate was 95.1 per thousand person-years [PTPY] (95% CI, 93.6-96.8), with a higher rate in patients on HHD than on PD (127.8 PTPY; 95% CI, 118.9-137.2 vs. 93.3 PTPY; 95% CI, 91.5-95.1). However, HHD was associated with a slightly lower adjusted risk of cardiovascular events than PD (HR, 0.92; 95% CI, 0.85 to 0.997). Compared to PD patients, HHD patients had 42% lower adjusted risk of stroke (HR, 0.58; 95% CI, 0.48-0.71), 17% lower adjusted risk of acute coronary syndrome (HR, 0.83; 95% CI, 0.72-0.95), and no difference in risk of heart failure (HR, 1.05; 95% CI, 0.94-1.16). HHD was associated with 22% lower adjusted risk of cardiovascular death (HR, 0.78; 95% CI, 0.71-0.86) and 8% lower adjusted risk of all-cause death (HR, 0.92; 95% CI, 0.87-0.97) as compared to PD. Conclusion Relative to PD, HHD is associated with decreased risk of stroke, acute coronary syndrome, cardiovascular death, and all-cause death. Further studies are needed to better understand the factors associated with differences in cardiovascular outcomes by type of home dialysis modality in patients with kidney failure.

#1562 Longitudinal changes in quality of life—a comparison between institutional hemodialysis, home-hemodialysis and peritoneal dialysis

Abstract Background and Aims Quality of life is an important factor for patients when planning for future dialysis care and for some individuals, it might be even more important than a prolonged life. Knowledge about differences between dialysis modalities is essential for patients making informed decisions. Most previous research on differences in quality of life between dialysis modalities have been cross-sectional and subjected to selection bias; few large contemporary studies have investigated the changes in quality of life between the three dialysis modalities; institutional hemodialysis (IHD), home hemodialysis (HHD) and peritoneal dialysis. The aim of the present study was to compare longitudinal changes in health-related physical and mental quality of life between patients on IHD, PD, and HHD. Method Patients on dialysis with at least two Research and Development 36 (RAND-36) questionnaires between 2017-2021 in the Swedish Renal Registry (SRR) were eligible for inclusion. Information on dialysis modality, patient characteristics and medication were obtained from the SRR and other national registries. Patients were followed for three years and remained in their designated dialysis modality in the analysis until end of the follow-up (intention-to-treat). Changes in physical (PCS) and mental (MCS) component summary score were analyzed in adjusted linear mixed models and joint models where informative censoring due to mortality and kidney transplantation was considered. Results 930 patients (IHD 714, HHD 88, PD 128), were followed for 1.8 years (IQR 1.0–2.1). Patients on HHD were younger, had lower Charlson comorbidity index (CCI) and higher serum albumin compared with IHD and PD (Table 1). At baseline, patients on IHD had a mean PCS 30.7 (95% CI 29.9–31.4) and MCS 45.6 (95% CI 44.7–46.5). The unadjusted PCS at baseline was higher in HHD patients (4.5 [95% CI 2.2–6.9]) and PD patients (2.5 [95% CI 0.5–4.5]) compared with patients on IHD but showed no difference in the adjusted models. Both unadjusted and adjusted MCS was similar at baseline. The PCS declined over time in all modalities; faster for patients on PD compared with IHD (−1.2 per year [95% CI −2.1 – −0.3]; Fig. 1). MCS decreased similarly for both PD and IHD over time, while patients on HHD had an improving MCS (1.5 per year [95% CI 0.1–2.8]) compared with patients on IHD (Fig. 2). Conclusion There are differences in the development of physical and mental quality of life over time for patients on different dialysis modalities. The dialysis modality with the overall most positive development was HHD. Offering HHD to more patients could potentially improve the quality-of-life for patients on dialysis.

Cardiovascular Outcomes in Patients on Home Hemodialysis and Peritoneal Dialysis.

Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage kidney disease. Little is known about differences in cardiovascular outcomes between home hemodialysis (HHD) and peritoneal dialysis (PD). We evaluated 68,645 patients who initiated home dialysis between 1/1/2005 and 12/31/2018 using the United States Renal Data System with linked Medicare claims. Rates for incident cardiovascular events of acute coronary syndrome, heart failure, and stroke hospitalizations were determined. Using adjusted time-to-event models, the associations of type of home dialysis modality with the outcomes of incident cardiovascular events, cardiovascular death, and all-cause death were examined. The mean age of patients in the study cohort was 64±15 years, and 42.3% were women. Mean time of follow up was 1.8±1.6 years. The unadjusted cardiovascular event rate was 95.1 per thousand person-years [PTPY] (95% CI, 93.6-96.8), with a higher rate in patients on HHD than on PD (127.8 PTPY; 95% CI, 118.9-137.2 vs. 93.3 PTPY; 95% CI, 91.5-95.1). However, HHD was associated with a slightly lower adjusted risk of cardiovascular events than PD (HR, 0.92; 95% CI, 0.85 to 0.997). Compared to PD patients, HHD patients had 42% lower adjusted risk of stroke (HR, 0.58; 95% CI, 0.48-0.71), 17% lower adjusted risk of acute coronary syndrome (HR, 0.83; 95% CI, 0.72-0.95), and no difference in risk of heart failure (HR, 1.05; 95% CI, 0.94-1.16). HHD was associated with 22% lower adjusted risk of cardiovascular death (HR, 0.78; 95% CI, 0.71-0.86) and 8% lower adjusted risk of all-cause death (HR, 0.92; 95% CI, 0.87-0.97) as compared to PD. Relative to PD, HHD is associated with decreased risk of stroke, acute coronary syndrome, cardiovascular death, and all-cause death. Further studies are needed to better understand the factors associated with differences in cardiovascular outcomes by type of home dialysis modality in patients with kidney failure.

Patient Training and Patient Safety in Home Hemodialysis.

The success of a home hemodialysis program depends largely on a patient safety framework and the risk tolerance of a home dialysis program. Dialysis treatments require operators to perform dozens of steps repeatedly and reliably in a complex procedure. For home hemodialysis, those operators are patients themselves or their care partners, so attention to safety and risk mitigation is front of mind. While newer, smaller, and more user-friendly dialysis machines designed explicitly for home use are slowly entering the marketplace, teaching patients to perform their own treatments in an unsupervised setting hundreds of times remains a foundational programmatic obligation regardless of machine. Just how safe is home hemodialysis? How does patient training affect this safety? There is a surprising lack of literature surrounding these questions. No consensus exists among home hemodialysis programs regarding optimized training schedules or methods, with each program adopting its own approach on the basis of local experience. Furthermore, there are little available data on the safety of home hemodialysis as compared with conventional in-center hemodialysis. This review will outline considerations for training patients on home hemodialysis, discuss the safety of home hemodialysis with an emphasis on the risk of serious and life-threatening adverse effects, and address the methods by which adverse events are monitored and prevented.

A Current State of the Art and Science of Exercise in Dialysis: A Narrative Review.

The purpose of the review is to discuss current proven benefits and problems of integrating exercise in the care of people receiving dialysis by reviewing literature from the last few years and identifying important questions that still need to be asked and answered. A focused review and appraisal of the literature were done. Original peer-reviewed articles, review articles, opinion pieces and guidelines were identified from PubMed and Google Scholar databases. Only sources in English were accessed. Search terms "exercise" and "dialysis" were used to find active recruiting randomized trials in various clinical trial registry platforms. Numerous studies have demonstrated the benefits of exercise training in individuals receiving dialysis, limited by factors such as short duration of follow-up and inconsistent adverse event reporting and outcomes selected. Notable gaps in exercise research in dialysis include ways to maintain programs and patient motivation, studies in peritoneal dialysis and home hemodialysis patients, and how best to define and measure outcomes of interest. This review summarizes the current state of exercise in people receiving dialysis and serves as a call to action to conduct large, randomized controlled trials to improve the quality of evidence needed to implement and sustain innovative, exercise interventions, and programs for this population.

A GVNS-based approach for periodic consumables delivery to home hemodialysis patients: a case study

A GVNS-based approach for periodic consumables delivery to home hemodialysis patients: a case study

A GVNS-based approach for periodic consumables delivery to home hemodialysis patients: a case study

A GVNS-based approach for periodic consumables delivery to home hemodialysis patients: a case study

Predictors of Long-Term Patient and Technique Survival in Home Hemodialysis Patients

Predictors of Long-Term Patient and Technique Survival in Home Hemodialysis Patients

Management of Serum Phosphorus over a Six-Month Follow-Up in Home Hemodialysis Patients Prescribed Sucroferric Oxyhydroxide as Part of Routine Clinical Care

Management of Serum Phosphorus over a Six-Month Follow-Up in Home Hemodialysis Patients Prescribed Sucroferric Oxyhydroxide as Part of Routine Clinical Care

The Effects of Negotiation on Discordant Home Hemodialysis Patients

The Effects of Negotiation on Discordant Home Hemodialysis Patients

A Case of a Home Hemodialysis Patient With Infective Endocarditis Complicated by Cerebral Infarction and Septic Pulmonary Embolism, Most Likely Caused by Frequent Shunt Punctures

We report a case of home hemodialysis with infectious endocarditis complicated by cerebral infarction and septic pulmonary embolism, most likely due to frequent shunt punctures. The patient, a 52-year-old man, was introduced to hemodialysis at our hospital 11 years ago due to reduced renal function caused by polycystic kidney disease and was transferred to home hemodialysis in the same year. Fever and general weakness appeared four days before he was urgently admitted to our department. Two blood culture sets revealed methicillin-susceptible Staphylococcus aureus (MSSA), brain MRI revealed multiple cerebral infarctions, and transesophageal echocardiography revealed infective endocarditis. The patient was transferred to the cardiology department of an affiliated hospital, treated with antimicrobials (for a total of 58 days), and discharged home on the 63rd day after admission. Frequent shunt punctures were considered to be the cause of the bloodstream infection leading to multiple complications.

Outcomes of Integrated Home Dialysis Care: Results From the Canadian Organ Replacement Register

The integrated home dialysis model proposes the initiation of kidney replacement therapy (KRT) with peritoneal dialysis (PD) and a timely transition to home hemodialysis (HHD) after PD ends. We compared the outcomes of patients transitioning from PD to HHD with those initiating KRT with HHD. Observational analysis of the Canadian Organ Replacement Register (CORR). All patients who initiated PD or HHD within the first 90 days of KRT between 2005 and2018. Patients transitioning from PD to HHD (PD+HHD group) versus patients initiating KRT with HHD (HHD group). (1) A composite of all-cause mortality and modality transfer (to in-center hemodialysis or PD for 90 days) and (2) all hospitalizations (considered as recurrent events). A propensity score analysis for which PD+HHD patients were matched 1:1 to (1) incident HHD patients ("incident-match" analysis) or (2) HHD patients with a KRT vintage at least equivalent to the vintage of PD+HHD patients at the transition time ("vintage-matched" analysis). Cause-specific hazards models (composite outcome) and shared frailty models (hospitalization) were used to compare groups. Among 63,327 individuals in the CORR, 163 PD+HHD patients (median of 1.9 years in PD) and 711 HHD patients were identified. In the incident-match analysis, compared to the HHD patients, the PD+HHD group had a similar risk of the composite outcome (HR, 0.88 [95% CI, 0.58-1.32]) and hospitalizations (HR, 1.04 [95% CI, 0.76-1.41]). In the vintage-match analysis, PD+HHD patients had a lower hazard for the composite outcome (HR, 0.61 [95% CI, 0.40-0.94]) but a similar hospitalization risk (HR, 0.85 [95% CI, 0.59-1.24]). Risk of survivor bias in the PD+HHD cohort and residual confounding. Controlling for KRT vintage, the patients transitioning from PD to HHD had better clinical outcomes than the incident HHD patients. These data support the use of integrated home dialysis for patients initiating home-based KRT. The integrated home dialysis model proposes the initiation of dialysis with peritoneal dialysis (PD) and subsequent transition to home hemodialysis (HHD) once PD is no longer feasible. It allows patients to benefit from initial lifestyle advantages of PD and to continue home-based treatments after its termination. However, some patients may prefer to initiate dialysis with HHD from the outset. In this study, we compared the long-term clinical outcomes of both approaches using a large Canadian dialysis register. We found that both options led to a similar risk of hospitalization. In contrast, the PD-to-HHD model led to improved survival when controlling for the duration of kidney failure.

RDPLF 2022 annual report: Profile of home hemodialysis patients in Belgium and Francel (synthetic raw results)

We present primary descriptive data in the form of tables and graphs for patients treated with home hemodialysis in France and French-speaking Belgium in 2022. These data were recorded in the database of the French-speaking Register of Peritoneal Dialysis and Home Hemodialysis (RDPLF).
 The average age of the patients is similar in both countries: 52.7 years in France and 54.7 years in Belgium. The percentage of patients with diabetes is 25.6% in Belgium and 18.5% in France.
 The majority of patients undergo daily hemodialysis 5 to 7 times per week.
 Of the patients, 11% have received peritoneal dialysis in the past. Of these, 23.5% transitioned to home hemodialysis less than 3 months after stopping peritoneal dialysis, while 23.6% transitioned after 2 years of center-based or self-administered hemodialysis.
 Practices differ between Belgium and France. In Belgium, a central catheter is used in 57.5% of cases, compared to 8.5% in France. For arteriovenous fistula puncture, the buttonhole technique is used in 91% of cases in Belgium and 47.8% of cases in France.
 In Belgium, 70% of patients dialyze independently, while in France, 71% of patients dialyze in the presence of a family member.
 The main cause of treatment discontinuation is transplantation (44% of technical dropout).

Severe infections in peritoneal dialysis and home hemodialysis patients: An inception cohort study.

Infections are the most common non-cardiovascular cause of death among dialysis patients. Earlier studies have shown similar or higher risk of infectious complications in peritoneal dialysis (PD) compared to hemodialysis (HD) patients, but comparisons to home HD patients have been rare. We investigated the risk of severe infections after start of continuous ambulatory PD (CAPD) and automated PD (APD) as compared to home HD. All adult patients (n = 536), who were on home dialysis at day 90 from starting kidney replacement therapy (KRT) between 2004 and 2017 in Helsinki healthcare district, were included. We defined severe infection as an infection with C-reactive protein of 100 mg/l or higher. Cumulative incidence of first severe infection was assessed considering death as a competing risk. Hazard ratios were estimated using Cox regression with propensity score adjustment. The risk of getting a severe infection during the first year of dialysis was 35% for CAPD, 25% for APD and 11% for home HD patients. During five years of follow-up, the hazard ratio of severe infection was 2.8 [95% CI 1.6-4.8] for CAPD and 2.2 [95% CI 1.4-3.5] for APD in comparison to home HD. Incidence rate of severe infections per 1000 patient-years was 537 for CAPD, 371 for APD, and 197 for home HD patients. When excluding peritonitis, the incidence rate was not higher among PD than home HD patients. CAPD and APD patients had higher risk of severe infections than home HD patients. This was explained by PD-associated peritonitis.

#3940 RISK OF MAJOR ADVERSE CARDIOVASCULAR EVENTS ACCORDING TO DIALYSIS MODALITY

Abstract Background and Aims Among dialysis patients, cardiovascular events are the leading cause of death. Little is known about difference in the frequency of cardiovascular events between various dialysis modalities. Glucose load may contribute to a metabolic burden in peritoneal dialysis (PD). On the other hand, hemodialysis can cause intradialytic hypotension, cardiac stunning, and arrhythmias, which are associated with increased risk of death. We compared risk of major cardiovascular events in patients who started continuous ambulatory PD (CAPD), automated PD (APD) and home HD with in-center HD patients. Method We included 968 patients who entered dialysis in the Helsinki-Uusimaa healthcare district in Finland from 2004 to 2017, of whom 162 were on CAPD, 229 on APD, 145 on home HD and 432 on in-center HD at day 90 from the start of dialysis. Patients were followed up for 5 years or until the end of 2019. Major adverse cardiovascular event (MACE) was defined as acute myocardial infarction, stroke or death due to cardiovascular disease. The cumulative incidence of the first MACE was calculated by taking other causes of death into account as competing risk events and censoring at time of kidney transplantation. Cox regression was used to compare risk of MACE between dialysis modalities with adjustment for age, gender, primary renal disease, prior comorbidities (coronary heart disease, left ventricular hypertrophy, heart failure and stroke), and laboratory data (plasma albumin, phosphate and ionized calcium). Imputation was performed to replace missing values of comorbidities and laboratory data. Results Of all 968 patients, 195 (20%) experienced a MACE during the entire follow-up and 62 (6.4%) during the first year of follow-up. The cumulative incidence of first MACE was similar in in-center HD and CAPD patients and higher than that in APD and home HD patients (Figure 1). Without adjustments, the hazard ratio of MACE was 0.83 [95% CI 0.56–1.2] for CAPD, 0.49 [95% CI 0.31–0.77] for APD and 0.42 [95% CI 0.23–0.78] for home HD in comparison to in-center HD. After adjustment for possible confounders, the hazard ratio of MACE was 1.1 [95% CI 0.70–1.6] for CAPD, 0.88 [95% CI 0.53–1.5] for APD and 0.80 [95% CI 0.41–1.6] for home HD and not statistically significantly different in comparison to in-center HD. Conclusion We observed a lower risk of MACE among patients who entered APD or home hemodialysis compared to in-center hemodialysis, but after adjusting for potential confounding factors, the difference diminished and was no longer statistically significant.

#3792 COVID-19 INFECTION AMONG HAEMODIALYSIS PATIENTS - EXPERIENCE FROM A HONG KONG COHORT

Abstract Background and Aims Many haemodialysis patients were infected by COVID-19 during a severe wave of outbreak due to the Omicron variant in Hong Kong in 2022, which had a great impact on the hospital haemodialysis service. To better prepare for future outbreaks, the patient characteristics and outcomes were examined in this study. Method This was a retrospective cohort study of all haemodialysis patients infected with COVID-19 from February to April 2022 in our hospital. The infection rates of in-centre and home haemodialysis were analysed. The mortality rate and the rate of moderate to severe disease (as defined by requiring 2L of oxygen or above) were recorded. Factors affecting mortality and disease severity were analysed using Fisher's exact test and independent t test. Results There were ninety-nine haemodialysis patients infected with COVID-19 during the study period (Table 1). The infection rate of in-centre haemodialysis patients was 98/232 (42.2%) compared with 1/19 (5.3%) of home haemodialysis patients. The mortality rate was 7.1%, and the rate of moderate to severe disease was 10.1%. A higher Charlson Comorbidity Index was identified as the only significant factor associated with mortality (6.7 ± 3.4 vs. 4.9 ± 2.0) and disease severity (6.5 ± 3.0 vs. 4.9 ± 2.0). Age, gender, presence of diabetes mellitus and vaccination status did not correlate with the outcome in this cohort. Conclusion Home haemodialysis had the benefit of a lower infection rate during the COVID-19 outbreak. A higher burden of comorbidities increased the risk of mortality and the severity of COVID-19. Close monitoring is warranted in these group of haemodialysis patients.