IntroductionEnd-stage kidney disease (ESKD) affects many Americans, with higher risks in certain subgroups of the US population. Differential kidney health outcomes may stem from non-medical social drivers of health, cognitive difficulties, and functional limitations. Recommendations for individuals with ESKD are often standardized and may not account for unique challenges and access barriers that individuals face. These challenges lead to preventable differences in access to treatments such as home dialysis and kidney transplantation. This study examines the prevalence of unmet social, cognitive, and functional needs amongst patients receiving dialysis and evaluates the intersection of these barriers to inform strategies to improve kidney health outcomes for all patients.MethodsIn a cross-sectional study, a convenience sample of 962 patients from diverse backgrounds, currently undergoing dialysis from multiple dialysis centers across the United States (aged 21–95 years), were surveyed. Descriptive, Spearman's correlation, logistic regression, and Chi-Square Test analyses conducted.ResultsFrom our large sample, 45.1% reported memory challenges, 19.6% required assistance with activities of daily living (ADLs), and 51.0% experienced two or more mobility limitations. Additionally, 20.4% reported difficulty accessing healthcare, while 16.3% faced challenges obtaining medications. A subset (12.2%) of participants experienced overlapping social, cognitive, and functional barriers. Unmet needs were disproportionately higher amongst public insurance participants compared to those with private insurance, with 33.0% of Dual-eligible participants reporting three or more unmet needs.DiscussionThis study highlights the significant intersection of social, cognitive, and functional barriers faced by patients receiving dialysis with ESKD, particularly those from vulnerable populations. Addressing these multifaceted needs through person-centered interdisciplinary care models and policy interventions is critical to reducing disparities and improving outcomes in kidney health outcomes.

To assess differences in SARS-CoV-2 infection rates between patients receiving hemodialysis in outpatient centers (in-center) and those receiving dialysis in their homes (hemodialysis and peritoneal dialysis) from December 29, 2020, through May 9, 2023. Retrospective cohort study. Outpatient dialysis facilities in the United States reporting to the Centers for Disease Control and Prevention's National Healthcare Safety Network. Maintenance dialysis patients that received hemodialysis treatment at or were affiliated with outpatient dialysis facilities. SARS-CoV-2 infection rates were assessed by dialysis setting (in-center and home). Weeks were categorized as surge (rate of infection > median) and non-surge (rate of infection ≤ median) and by variant predominance. A negative binomial regression model with generalized estimating equations was constructed to examine differences in rates of infection among patients. A total of 7,974 dialysis facilities reported 171,338 SARS-CoV-2 infections among patients. In-center hemodialysis patients had higher average rates of SARS-CoV-2 infection at 2.85 infections per 1000 patient-weeks than home patients at 1.69 infections per 1000 patient-weeks. During surge weeks, the differences in rates of infection between in-center and home patients were more pronounced than during non-surge weeks for all variant predominance categories: Delta (relative rate ratio (RRR) = 1.20, CI: 1.09-1.32), B.1 and Other (RRR = 1.11, CI: 1.02-1.22), and Omicron (RRR = 1.07, CI: 1.01-1.12). Rates of SARS-CoV-2 infection among patients receiving outpatient hemodialysis were persistently higher than rates among patients receiving dialysis treatments at home; these differences were more pronounced during surge weeks.

Patient and Center Factors in Home Dialysis Therapy Uptake: Analysis of a UK Renal Registry Cohort and a National Dialysis Center Survey.

Poor quality of sleep is a frequent problem among patients on dialysis. The aim of this study was to investigate the association of sociodemographic factors with sleep quality in patients on dialysis. The present study was conducted with 402 patients on dialysis using the Athens Insomnia Scale for the assessment of sleep disorders and a questionnaire about demographic characteristics. The results showed that 41% of the participants had difficulty in falling asleep, 40.3% waking up during the night, 35.6% waking up earlier than desired, 33.3% found the duration of sleep insufficient, 31.8% had a diminished sense of well-being during the day, 24.4% had reduced functioning, and 26.4% had daytime sleepiness problems. Overall, 72.1% of patients suffered from insomnia. Participants undergoing hemodialysis had significantly greater percentage of having a problem with awakenings during the night compared to participants under peritoneal dialysis (p=0.020). Additionally, women had 1.88 times greater probability of suffering from insomnia compared to men (p=0.019).Thus, sleep hygiene education programs and intradialytic resistance exercises programs along with early diagnosis of sleep disorders and home dialysis can lead to an improvement of sleep quality in dialysis population.

BackgroundHome-based dialysis, including peritoneal dialysis (PD) and home hemodialysis (HHD), has been suggested to reduce SARS-CoV-2 infection rates and improve outcomes compared to in-center dialysis, yet evidence from China remains scarce.ObjectiveTo investigate the risk and prognosis of Omicron infection among patients receiving home-based dialysis versus in-center dialysis during the Omicron surge in Shanghai, China.MethodsThis single-center retrospective cohort study included patients undergoing maintenance dialysis (home-based dialysis or in-center dialysis) at Ren Ji Hospital from December 1, 2022, to January 31, 2023. The primary endpoint was Omicron infection rate; secondary endpoints included infection timeline, all-cause mortality, and associated risk factors. Logistic regression was used to identify independent predictors.ResultsA total of 465 patients were included: 267 in the home-based dialysis group (263 PD, 4 HHD) and 198 in the in-center dialysis group. The infection rate was significantly lower in the home-based dialysis group than in the in-center dialysis group (52.1% vs. 88.4%, P < .001). Home-based dialysis was an independent protective factor against infection. No significant difference was found in all-cause mortality between home-based dialysis and in-center dialysis groups (5.2% vs. 7.6%, P = .304). Advanced age, heart failure, and low serum albumin were associated with increased risk of death following infection.ConclusionsHome-based dialysis significantly reduced the risk of Omicron infection without adversely affecting survival outcomes. Expanding home-based dialysis may have public health implications for dialysis care during future pandemics.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12882-025-04453-0.

Chronic kidney disease (CKD) represents a major global public health challenge, affecting nearly 850 million people and ranking among the fastest-growing causes of premature mortality. In the French West Indies and Guiana region, end-stage renal disease (ESRD) places a disproportionate burden on healthcare systems, exacerbated by low medical density, geographic dispersion, and cultural diversity. Home dialysis, including peritoneal dialysis and hemodialysis, is an essential tool that improves quality of life, autonomy, and continuity of care. However, its adoption remains limited due to human, organizational, and medical barriers. Artificial intelligence (AI) emerges as a strategic lever to overcome these limitations, enabling the prediction of complications, personalized treatment optimization, and proactive telemonitoring. Its implementation requires careful attention to ethical issues, data protection, professional training, and adaptation to local cultural contexts. International experiences demonstrate that such approaches improve safety, adherence, and technical survival. In overseas territories, AI can transform home dialysis into a scalable, equitable, and sustainable solution, addressing both healthcare challenges and organizational constraints, while placing the patient and their cultural context at the heart of care management.

Trajectories of Experiences and Health-Related Quality of Life of Informal Caregivers of Home and In-Center Dialysis Patients: A Multicenter Longitudinal Cohort Study.

Home sweet home dialysis.

The Importance of the Patient Perspective and Real-World Experience in Home Dialysis Training.

Staff-assisted peritoneal dialysis (PD) is commonly used in many countries but remains largely unavailable in the United States. This limits access to PD for patients with physical, cognitive, and psycho-social barriers to self-care - the group of patients who may benefit the most from home dialysis. This review explores the global experiences, the limited U.S. implementations, and proposes a pathway for national adoption. Published reports demonstrate that assisted PD is safe and effective. It is comparable to self-care PD and in-center hemodialysis in outcomes such as peritonitis, hospitalization, and mortality. Assisted PD facilitates PD uptake and retention, thus increasing PD utilization and supporting growth of home dialysis. International models vary in scope, services, and staffing, showing flexibility in design. In the United States, limited programs have demonstrated feasibility. Widespread adoption faces barriers including reimbursement and regulatory challenges. Using the diffusion of innovations lens, assisted PD is still at the "innovator" stage, hindered by perceived complexity, limited trialability, and lack of visibility. Assisted PD is supported by strong clinical evidence and allows more equitable care. Demonstration projects, standardized templates, supportive reimbursement models, and leadership from nephrology societies and policy makers are critical to help the US nephrology community move from evidence to practice.

Women with kidney failure have impaired fertility challenges due to disruption of the hypothalamic gonadal axis and hormonal dysregulation, with pregnancy rates on home dialysis being much lower than those with normal kidney function. Pregnant women on dialysis are at high risk of hypertensive disorders, preterm birth, and fetal growth restriction, but intensified dialysis can mitigate these risks. Home dialysis offers advantages like flexibility, better hemodynamic stability, and improved fetal outcomes, but logistical and training challenges remain. Hybrid approaches combining hemodialysis and peritoneal dialysis may benefit select women during pregnancy. Effective management of pregnancy on dialysis requires treatment of anemia, optimized nutrition, close obstetric monitoring, and multi-disciplinary care. Postpartum care should focus on breastfeeding support, home dialysis prescription adjustment, and contraception counseling. Systematic capacity-building in home dialysis can lead to better pregnancy outcomes while alleviating in-center dialysis burdens.

Purpose of reviewThe healthcare system is increasingly burdened by the rising number of patients with end-stage kidney disease (ESKD), alongside a parallel surge in obesity. However, use of peritoneal dialysis in patients with obesity has been met with caution despite increasing recognition of advantages of home dialysis. This review addresses these concerns and outlines evidence-based guidelines for effective management.Recent findingsContemporary analysis of peritoneal dialysis cohorts demonstrates that catheter-related complications are not higher in patients with obesity compared to normal weight using basic or advanced laparoscopic methods, and even percutaneously placed catheters can achieve good outcomes using technical advancements. A meticulously identified and well placed exit site facilitates infection free peritoneal dialysis delivery in patients with obesity. It is important to recognize that adipocytes have a significantly lower water content; therefore, adjusted body weight is proposed to estimate the volume of distribution and the clearance of small solutes more accurately. The practice of incremental dialysis and use of Icodextrin for long dwells help limit glucose exposure and manage related metabolic complications. Recent evidence does not support the notion that peritoneal dialysis modality alters the impact of obesity on likelihood of transplantation or overall survival.SummaryObesity is associated with adverse outcomes in dialysis patients; however, these effects are comparable between hemodialysis and peritoneal dialysis, and are not more pronounced in peritoneal dialysis. With careful technical and clinical considerations, peritoneal dialysis therapy can be effectively delivered to patients with obesity without imposing undue burden. Therefore, obesity should not be viewed as a contraindication to peritoneal dialysis.

Abstract Background and Aims Home hemodialysis (HD) offers several advantages over conventional in-center 3-times-weekly HD, with better preservation of health-related quality of life and treatment flexibility, but its true costs are poorly understood. We therefore aimed to compare the real costs of daily home hemodialysis versus in-center hemodialysis in France. Method Design: National, population-based, cohort study with propensity score matching (PSM) to mitigate selection bias on patient profiles. Setting Individual healthcare data from the French National Health Data System for patients with end-stage kidney disease undergoing dialysis cross-referenced with the French National Cost Scale of the health ministry. Participants A total of 72 358 patients receiving HD were identified and their data collected for the 24-month inclusion period, from January 2016 to December 2017. After exclusion of patients treated &amp;lt; 90 days, and those without a treatment schedule or incomplete data for a social disadvantage score, 42 605 patients were selected (28 317 prevalent and 14 288 incident HD patients). After PSM, 265 incident patients (in-center HD, n = 212; daily home HD, n = 53) and 765 prevalent patients (in-center HD, n = 612; daily home HD, n = 153) were analyzed. Main outcome and measure Global costs of in-center versus daily home HD for incident and prevalent patients after PSM. Results The global cost of daily home HD for incident patients was lower than in-center HD (€1403/week vs. €1652/week, respectively), resulting in annual costs of €72 956 vs. €85 904, respectively. We found similarly lower costs for prevalent patients (€1360/week vs. €1456/week, respectively). For daily home HD, 55% of the costs were directly related to patient renal care compared with 30% for in-center HD. Conversely, in-center HD allocated a larger proportion to transportation (18% (in-center HD) vs. 2% (daily home HD)), and hospitalization (16% (in-center HD) vs. 6% (daily home HD)). Conclusion Daily home HD is a more cost-effective and patient-centered treatment option than in-center HD.

Abstract Background and Aims Home hemodialysis (HD) offers several advantages over conventional 3-times-weekly in-center HD, with better preservation of health-related quality of life and treatment flexibility, but its effect on mortality is poorly understood. We therefore aimed to compare daily home hemodialysis with in-center hemodialysis in France for the risk of death in incident patients (to minimize the risk of bias). Method Design: National, population-based, cohort study with propensity score matching (PSM) to mitigate selection bias on patient profiles. Setting Individual healthcare data from the French National Health Data System for patients with end-stage kidney disease undergoing dialysis cross-referenced with the French National Cost Scale of the health ministry. Participants A total of 72 358 patients receiving HD were identified and their data collected for the 24-month inclusion period, from January 2016 to December 2017. After exclusion of patients treated &amp;lt; 90 days, and those without a treatment schedule or incomplete data for a social disadvantage score, 42 605 patients were selected (28 317 prevalent and 14 288 incident HD patients). After PSM, 265 incident patients (in-center HD, n = 212; daily home HD, n = 53) were analyzed for mortality after two years of a follow-up. Main outcome and measure Crude mortality in incident patients after PSM and the potential factors influencing death in daily home HD and in-center HD. Results The gross death rate after 2 years of follow-up in incident patients treated with in-center HD was 10.4% vs. 1.9% in patients treated with daily home HD (P = 0.049, Chi2 test; relative risk (RR)=5.5 [95% CI, 1.003 to 31.97]. Survival analysis using the Kaplan–Meier curve showed no censoring case and a significant difference in the cumulative risk of death between incident patients receiving in-center HD and patients receiving daily home HD (W = 5140, P = 0.03, Wilcoxon–Mann–Whitney test). Multivariate analysis using the Cox proportional hazards model showed that the hazard ratio (HR) for death was increased 7-fold by in-center HD compared with daily home HD. Similarly, diabetes mellitus and disability strongly increased the HR for death (approximately 3-fold) in incident patients in the multivariate analysis. Conclusion Daily home hemodialysis improves outcomes for French incident dialysis patients and significantly prolongs life expectancy compared to in-center hemodialysis.

Abstract Background and Aims By 2030, approximately 5.439 million people will suffer from end-stage kidney disease, leading to increased need for kidney replacement therapy (KRT). Kidney transplantation, followed by home dialysis treatments, offers the best outcomes for mortality, quality of life and costs. However, rates of kidney transplantation and use of home dialysis vary greatly between countries, and the reason for this is not well known. Our aim was to estimate the association between healthcare expenditure per capita and the adoption of early home KRT that is home dialysis and kidney transplantation. Method We retrieved data from the ERA Registry Annual Report 2021 on the proportion of patients on home dialysis (peritoneal dialysis or home hemodialysis) or having received a kidney transplant at 91 days from start of KRT. Data on healthcare expenditure per capita were retrieved from the World Bank 2021 database. 31 European countries had all required data and were included. Linear regression was used to estimate the association between healthcare expenditure per capita and home KRT at day 91 from start of KRT. Results Healthcare expenditure per capita ranged from 387 USD to 11,207 USD. A higher healthcare expenditure was correlated with an increased proportion of early home dialysis and transplantation. An increase of 1000 USD in healthcare expenditure was associated with a 3.05 (95% CI 1.83–4.25) percentage point increase in the proportion of home dialysis and transplantation. The countries in the lowest quartile (&amp;lt;1000 USD) of healthcare expenditure per capita showed a low average proportion of home KRT of 4%, whereas in the countries in the highest quartile (&amp;gt;6000 USD) the proportion was 30%. Conclusion Adoption of early home dialysis and transplantation was higher in countries with greater healthcare expenditure per capita. Further research is needed to find out why countries with lower healthcare expenditure experience lower adoption rates for home dialysis and transplantation.

Abstract Background and Aims Starting dialysis not only has a major impact on patients themselves, but also on their informal caregivers. To properly inform patients with kidney failure and their caregivers about starting dialysis and the choice of dialysis location (i.e., home or in-centre dialysis), it is important to also discuss what the caregiver may expect. However, available evidence regarding the course of caregivers’ experiences—both positive and negative—and health-related quality of life (HRQoL) after dialysis initiation is limited. Therefore, we aimed to: (1) assess the trajectory of experiences and HRQoL of caregivers of dialysis patients during the first year of dialysis, and (2) assess whether differences in these trajectories exist between caregivers of home dialysis patients and caregivers of in-centre dialysis patients. Method We conducted a multicentre, observational cohort study in adult informal caregiver-incident dialysis patient dyads. Measurements were performed at baseline (i.e. dialysis initiation), 6 months and 12 months. Outcomes included: (1) caregivers’ positive experiences measured with the Positive Experiences Scale (where higher scores indicate less positive experiences), (2) caregiver burden measured with the Self-Perceived Pressure from Informal Care questionnaire, (3) depressive symptoms measured with the Center for Epidemiologic Studies Depression Scale, (4) mental HRQoL measured with the 12-item Short Form (SF-12), (5) physical HRQoL measured with the SF-12, and (6) general HRQoL measured with the EuroQoL-5D-5L. Dialysis location was defined as either home dialysis, consisting of peritoneal dialysis (PD) and home haemodialysis (HHD), or in-centre haemodialysis (ICHD). For the first aim, we assessed the trajectories of all outcomes using linear mixed models with random intercepts. For the second aim, we compared the trajectories of caregivers of home dialysis patients and caregivers of in-centre dialysis patients using linear mixed models with random intercepts and confounder adjustment. Results In total, 202 informal caregiver-dialysis patient dyads participated in the study. Caregivers’ mean age was 60.4 ± 14.4, 71.3% was female, and 77.7% cared for a spouse on dialysis. The mean age of patients was 64.8 ± 14.1, 33.2% was female, and 64.4% initiated ICHD. All but one of the caregiver outcomes deteriorated over the first year of dialysis. The change over time (β, 95% CI) was significant for positive experiences (1.31, 0.32; 2.31), caregiver burden (0.82, 0.05; 1.60), depressive symptoms (4.43, 2.11; 6.76), physical HRQoL (−5.48, −9.48; −1.48), and general HRQoL (−0.11, −0.19; −0.04), but not for mental HRQoL (−2.26, −5.84; 1.32). No differences between caregivers of home dialysis patients and caregivers of in-centre dialysis patients were found over time for all outcomes, as shown in Fig. 1. Conclusion Our study demonstrates that informal caregivers experience significant challenges during the first year of dialysis treatment, marked by a notable decline in positive experiences, physical HRQoL and general HRQoL, alongside an increase in caregiver burden and depressive symptoms. Importantly, these negative trajectories were consistent regardless of the dialysis location (home versus in-centre). These findings underscore an urgent need for targeted support for informal caregivers in dialysis care.

Abstract Background and Aims There is limited evidence surrounding the long-term glycaemic benefits from continuous glucose monitoring (CGM) in people with diabetes (PwD) on dialysis. The aim of this study was to establish the potential benefits of CGM use on glycaemic control, guiding insulin therapy regimen, and improving clinical outcomes in PwD on dialysis. Method A retrospective, cross-sectional study was conducted across all dialysis units within University Hospitals Birmingham (UHB) NHS Foundation Trust, United Kingdom. Patients aged &amp;gt;18 years, with known diagnosis of diabetes receiving regular dialysis—including haemodialysis (HD), peritoneal dialysis (PD), and home haemodialysis (HHD)—who used CGM (FreeStyle Libre or Dexcom) for more than 3 months were included. Patients not sharing CGM data were excluded. Data was extracted by accessing electronic patient records and CGM (LibreView or Dexcom Clarity) Portals. The demographic characteristics, insulin treatment, and CGM metrics (time in range [TIR], time above range [TAR], time below range [TBR], glucose variability [GV], HbA1C levels and number of hypoglycaemia events) were recorded. Results A total of 55 adult patients were included. 76.4% (n = 42/55) of patients were on HD; 21.8% (n = 12/55) on PD; and 1.8% (n = 1/55) on HHD. The median number of months on CGM was 26 (IQR = 19.31). All patients were on insulin therapy. 29.1% (n = 16/55) patients had their insulin therapy regimen changed following CGM use. 63.6% (n = 35/55) patients were on basal-bolus regimen. 4.65% (n = 2/43) of HD and HHD patients had required different insulin doses between their dialysis and non-dialysis days. There was no difference between measured baseline and latest HbA1C following CGM introduction (68.22 ± 21.86 vs 63.38 ± 17.96 [mmol/mol], P = 0.757). Furthermore, there was also no difference between the mean glucose on CGM over the last 14-days and 90-days period (11.94 ± 3.31 vs 12.08 ± 3.26 [mmol/L], P = 0.586). The latest median TIR for our patients remained suboptimal at 38.0%. The hyperglycaemic burden was excessive, with a median TAR-very high of 26.0% and TAR-high of 28.0%. Of the 48 patients who were on FreeStyle Libre, 77.1% (n = 37/48) had at least one prolonged hypoglycaemia event of &amp;gt;15 minutes over the last-90-days. 29.7% (n = 11/37) did not have any further hypoglycaemia event over the last 14-days (P &amp;lt; 0.001). Conclusion While significant improvements in overall glycaemic control were not observed, our findings underscore the complexity of glycaemic management in this population and the need for tailored interventions. We strongly advocate for large-scale randomised controlled trials to explore how CGM technology can be further optimised to achieve meaningful improvements in glycaemic and clinical outcomes for this challenging patient group.

Abstract Background and Aims Chronic kidney disease associated pruritus (CKD-aP) is rarely assessed by health care providers and potentially under-reported by patients despite the potential negative impact on health-related quality of life (HRQoL). Our aim was to investigate the prevalence of CKD-aP in a large cohort of Danish dialysis patients based on validated patient-reported outcome (PRO) instruments. A secondary aim was to investigate CKD-aP awareness among renal physicians including current treatment practices. Method The study was designed as a non-interventional, cross-sectional multicentre study. Chronic dialysis patients from four different regions in Denmark were invited to participate. CKD-aP was assessed with a one-page questionnaire containing Danish versions of two validated PRO instruments. The worst itch numeric rating scale (WI-NRS) was used for itch severity within the previous 24 hours (ranging from 0 to 10 with CKD-aP defined as WI-NRS score &amp;gt;4). The 5-D itch scale was used as a multidimensional measure of itching and HRQoL. The five dimensions of the 5-D itch scale (degree, duration, direction, disability, and distribution) were summed together to obtain total score ranging from 5 (no pruritus) to 25 (most severe). CKD-aP awareness and treatment practices among doctors from participating hospitals were investigated with a simple self-developed questionnaire. Results We recruited 642 chronic dialysis patients of which 83% were treated with haemodialysis (HD), 13% with peritoneal dialysis (PD) and 4% with home HD (HHD). Median age (min-max) was 68 (18–93) years and 66% were males. CKD-aP prevalence (based on WI-NRS score &amp;gt;4) was 21% (all patients regardless of dialysis modality) and tended to be higher among PD patients (28%) in comparison with HD (20%) and HHD (17%) as shown in Fig. 1. No pruritus (WI-NRS score = 0) was found in 59% of patients and 21% had mild pruritus (WI-NRS score ≤4). Median 5-D itch score (IQR) was 5 (5–10) (all patients regardless of dialysis modality). Itch intensity over the past 2 weeks was rated moderate to unbearable by 23% and not present in 52% of patients. Itch duration was less than 6 hours in 89% of patients and 30% of patients had no change in itching over the past 2 weeks. Overall, the impact of CKD-aP on daily activities (leisure/social, housework/errands and work/school) was minimal in most patients but sleep disability (score &amp;gt;1) was found in 20%. Sleep disability correlated with higher WI-NRS score (P &amp;lt; 0.001 X2-test). Perceived CKD-aP prevalence was 41%–60% by most physicians (41%) with uraemia as the most probable cause (64%) based on 75 questionnaires from 46 trained nephrologists, 25 residents and 4 medical students (Fig. 2). Dialysis was the preferred treatment (42/11% as first/second option) followed by topical therapy with fatty cream (34/20% as first/second option) and treatment of hyperphosphataemia (21/24% as first/second option). Gabapentinoids (gabapentin and pregabalin) were rated third choice by most, but nephrologist prescribed pregabalin more than residents as their first or second treatment choice (P = 0.03 X2-test). Difelikefalin was not chosen (90%) or rated as fourth choice by 4% of nephrologists in our survey. Conclusion Roughly one out of five patients on chronic dialysis treatment suffers from CKD-aP. HRQoL is negatively affected by CKD-aP primarily manifested as sleep disturbance. Most physicians tend to overestimate CKD-aP prevalence and use dialysis and fatty cream as their preferred treatment.

Abstract Background Patient-centered care includes therapeutic education, participation, information, and patient experience (XPA). XPA refers to the interactions of individuals throughout their disease process across various healthcare services, influencing their perceptions. Enhancing patient care improves self-management and fosters engagement in the continuum of their healthcare journey. Multiple tools are available to quantify XPA, the IEXPAC (Instrument to Evaluate Chronic Patient Experience) is a validated tool designed to assess the patient experience in chronic disease care. It focuses on three key dimensions: productive interactions, the new relational model, and patient self-management. Using 11 core and 4 optional Likert-scale questions, IEXPAC provides a comprehensive evaluation of patient-centered care, emphasizing shared decision-making, communication, and care continuity. In chronic kidney disease (CKD) clinics, IEXPAC enables the identification of areas for improvement, promoting enhanced patient satisfaction and engagement. This tool offers valuable insights to refine healthcare delivery and support self-care management for CKD patients. Understanding XPA is not just important, but crucial in the context of advanced chronic kidney disease (CKD) and shared decision-making for renal replacement therapies (RRT). It's time to move beyond outdated concepts like satisfaction and focus on the patient's experience throughout their disease process. Aims Describe the results obtained using the IEXPAC questionnaire in a CKD unit. Define actions to implement in an CKD consultation based on XPA evaluation with the IEXPAC tool. Method This descriptive study of XPA was conducted at a tertiary hospital in January/February 2024. The study population included all patients who completed follow-up in the joint CKD consultation in 2023 and initiated RRT in the same year. Exclusion criteria were refusal to participate and inability to complete the questionnaire. The IEXPAC tool, available online and in a phone version, was used. It assesses three dimensions: productive interactions, new relational models, and patient self-management. The questionnaire includes 11+4 Likert-scale questions. An independent interviewer administered the questionnaires in the CKD consultation. The hospital's ethics committee approved the study, and verbal consent was obtained from participants. Results The sample included 66 patients, 60.6% male, with a mean age of 67.4 ± 15.7 years. Of these, 44% were prefrail, 33% were frail, and 28% required a caregiver. RRT modalities: 65% hemodialysis, 3% home hemodialysis, 12% peritoneal dialysis, and 19% kidney transplantation (living/cadaveric donor). Patients completed 92% of the questionnaires. Global XPA score: 7.13 ± 0.86. Subscores: productive interactions 7.87 ± 4.2; new relational model 4.7 ± 2.2; patient self-management 8.19 ± 1.37. Conclusion The overall XPA score for CKD patients was satisfactory. However, the "new relational model" dimension scored the lowest, highlighting the need to strengthen peer-mentoring programs and integrate new technologies into XPA. Implementing these programs in CKD consultations is essential to address patient needs, including launching group classes with expert patients and incorporating access to technological tools.

Abstract Background and Aims Patients with end-stage renal disease are dependent on renal replacement therapy, which most often entails hemodialysis. Home hemodialysis provides the possibility to use non-conventional treatment schedules such as short frequent hemodialysis (SFHD; ≥4 sessions per week, ≤180 min per session). Currently available SFHD machines are relatively heavy (24–36 kg) and use around 20–30 L of dialysate per session. Patient mobility is an important factor for quality of life. Therefore, there is a need for a more portable SFHD device. NeokidneyTM is a portable device (∼13 kg in weight) which only uses 4.5 L of dialysate per session thanks to sorbent-based dialysate regeneration. The device has previously been tested in vitro and in vivo. This study aimed to evaluate the safety and efficacy in a small number (n = 4) of patients treated with SFHD. Method In this prospective, single-arm, monocenter first-in-human trial, five adult patients treated with SFHD were included between March and May, 2024, at the University Medical Center Caen, France. Four patients were treated with the device (1 patient was excluded due to screening failure). Patients were treated 2 times in the hospital with their own SFHD machine for 135–150 min with dialysate flow rates (QD) of 150–200 mL/min (baseline) and 4–8 times with the Neokidney device for 120 min with QD of 300 mL/min during a 3-week period. All adverse events (AEs) were evaluated and graded based on the Common Terminology Criteria for Adverse Events (CTCAE). Blood samples were taken before and after each treatment, and blood point-of-care measurements and influent/effluent dialysate samples were taken at various timepoints throughout the treatment. Laboratory outcomes were used to calculate solute removal and to evaluate dialysate and plasma biochemistry. Ultrafiltration volume and ultrafiltration rate were also determined. Descriptive statistics were performed on the obtained safety and efficacy data. Results Four patients received a total of 25 treatments with the Neokidney device. No device-related serious adverse events occurred. Median [Q1–Q3] spKt/VUrea was 0.78 [0.67–1.06] for Neokidney compared to 0.72 [0.68–0.74] during baseline. Median [Q1–Q3] reduction percentages were also comparable for Neokidney and baseline, viz., for urea: 49 [44–59]% vs 45 [43–47]%; creatinine: 48 [45–60]% vs 44 [42–47]%; phosphate: 55 [49–66]% vs 47 [45–54]%; uric acid: 57 [53–69]% vs 54 [52–57]%; and beta-2 microglobulin: 48 [46–58]% vs 46 [42–50]%. An ultrafiltration volume up to ∼2 L could be reached with the Neokidney device with a median [Q1–Q3] ultrafiltration rate of 11.4 [8.6–12.8] mL/min compared to 6.9 [5.2–9.2] mL/min at baseline. Plasma sodium concentration remained stable over one session: median [Q1–Q3] difference between end and start concentration (Δ plasma sodium) was −1.0 [−2.0–0] mmol/L for Neokidney vs 1.5 [1.0–2.3] mmol/L at baseline. Plasma buffer (bicarbonate + lactate) levels reduced during a Neokidney treatment with a median [Q1–Q3] Δ plasma buffer of −2.8 [−4.1 to −1.3] mmol/L vs 7.1 [6.5–8.0] mmol/L at baseline. A slow gradual reduction of plasma bicarbonate and pH over consecutive therapies was seen in all participants. 6 AEs were recorded with a causal relationship to the device which were all considered mild (grade 1): five concerned asymptomatic hyperammonemia (&amp;lt;100 µM) which resolved spontaneously 30 min after treatment, and one concerned metabolic acidosis for which sodium bicarbonate suppletion was given. Conclusion This trial has shown the potential of the Neokidney device as a safe and efficient new system for SFHD. Based on the safety data, a small design adjustment of the sorbent cartridge will take place prior to the next trial to address the short-term hyperammonemia and a slightly modified composition of additive solution will be used to prevent metabolic acidosis. Efficacy data are promising, indicating adequate dialysate regeneration by the Neokidney device. This new device offers the possibility for patients to gain mobility, which could improve overall quality of life.