Home Dialysis: Better Outcomes at Lower Costs

Five years after starting dialysis, the population of Ontario, Canada over age 18 had mean 30-day PD costs 50% lower than in-center HD—and home HD costs 64% lower than in-center. After adjusting for covariates, home HD cost the least and had the highest survival (80%) vs. 52% on PD and 42% on in-center HD.

Read the abstract » | (added 2019-10-14)

Tags: Home Dialysis, PD Cost, HD Cost, HD Survival

The Role of Frailty in Home Dialysis

Evaluation of frailty among 109 home dialysis patients revealed a greater than 2-fold increase in risk of a composite outcome that included technique failure and all-cause death. Weakness and weight loss were both linked with higher risk. “Assessing frailty as part of the clinical evaluation for home dialysis therapies may be useful for prognostication and clinical management,” report the authors.

Read the abstract » | (added 2019-10-14)

Tags: Frailty, Home Dialysis, All cause Death

Home Dialysis Barriers Examined (Again)

Since the NKF-KDOQI is a latecomer to the home dialysis party (at least for home HD), they started at the beginning with a conference identifying barriers to starting and keeping patients at home. Not surprisingly, cursory education, and lack of exposure to home options or support for care partners were implicated.

Read the abstract » | (added 2019-01-11)

Tags: Home Dialysis, KDOQI, Barriers, Patient Support

Driving Home Dialysis Takes More Than Money

Are financial incentives enough to change nephrologist practice to favor home therapies? Only a little, finds a comprehensive literature review and an international workshop. Other levers, such as the framework of funding for clinics, nephrologist belief in home treatments, and direct costs to patients (e.g., utilities) may play a role as well.

Read the abstract » | (added 2018-08-13)

Tags: Home Dialysis, Financial Incentives, Nephrologist Practice

Who Matters Most for Modality Choice: Clinicians or Patients?

New Zealand has one of the highest rates of home dialysis use in the world—and they still believe there is room for improvement. An online study of all NZ dialysis clinics coupled with a measure of “decisional power” aimed to see who had the most influence on modality choice. While respondents believed that predialysis nurses were most influential, nephrologists still held the most decisional power—and a one point increase in nephrologist decisional power drove a 6.1% rise in home dialysis use.

Read the abstract » | (added 2017-12-14)

Tags: New Zealand, Home Dialysis, Modality Choice, Patients

Barriers to Intensive HD in Pediatrics

Why don’t more people choose intensive hemodialysis? Responses to a survey by 134 of the 221 pediatric dialysis centers in the International Pediatric Dialysis Network found that more than 2/3 were aware of evidence supporting the benefits of intensive HD and half believed it produced the best outcomes (just 2% favored conventional HD). Key barriers included lack of funding and staff, with lack of expertise and motivation as minor factors. Read the abstract.

Read the abstract » | (added 2017-11-13)

Tags: Children, Financial Barriers, Home Dialysis, Intensified Hemodialysis, Nocturnal Hemodialysis