Home HD is cost-effective vs. in-center

A review of six studies of dialysis costs between 2000 and 2014 found that contemporary home HD options (short daily HD and nocturnal HD) may have higher short-term costs, but offer long-term cost savings compared to in-center HD, due to lower staff costs and better health outcomes.

Read the abstract » | (added 2014-08-04)

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HD recovery time predicts survival (DOPPS)

In a finding with important implications for longer and/or more frequent HD, 6,040 in-center HD patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS) were asked “How long does it take you to recover from a dialysis session.” The shorter the recovery time, the lower the risk of hospitalization and death.

Read the abstract » | (added 2014-08-04)

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First-year outcomes of incident US PD patients

Among 1,677 incident PD patients from Fresenius, 367 switched to HD within the first 90 days. Of those who continued with PD, first-year mortality was 10 per 100 patient-years, with 42 episodes of peritonitis and 128 hospitalizations per 100 patient-years. About 2/3 of the hospitalizations occurred in the first 6 months of PD therapy. Of those who switched to HD, 81.4% began treatment with a central venous catheter—and 78.3% still had one 90 days later.

Read the abstract » | (added 2014-07-07)

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Fewer hospital days with home HD

Is home HD really better—or does it just look better because younger, healthier people choose to do it? Researchers looked at hospital days of 25 people on home HD vs. 25 standard in-center HD patients who were healthy enough to be on the transplant list. Across the group, home HD patients spent 71 days in the hospital, and standard in-center HD patients spent 85 (P<0.005). The authors concluded that this study “confirms the superiority of the HHD treatment option in improving patient outcomes.

Read the abstract » | (added 2014-07-07)

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Cost of in-center vs. home HD

Home HD has better clinical and patient centered outcomes than standard in-center HD. Does it cost less, too? A systematic literature review from 2000-2014 found six relevant studies and concluded that home HD (including short daily and nocturnal) is more cost effective; higher start-up costs are recouped over the long term. In-center HD has higher staff costs and poorer outcomes.

Read the abstract » | (added 2014-05-06)

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Japanese strategy to prevent encapsulating peritoneal sclerosis (EPS)

EPS is a rare and severe complication of PD. Japanese clinicians offer a multidisciplinary approach to avoid EPS and improve outcomes for those who have it. Icodextrin and combination PD/HD treatment is used, and high-risk patients have planned PD stoppage. Between 2008 and 2012, the incidence of EPS was 0.3% for PD < 3 years, 0.6% for PD = 5 years, 2.3% for PD = 8 years, and 1.2% for PD > 8 years. Prednisone (n=11) and surgery (n=2) were used to treat EPS; remission occurred in 12 of the patients (85.7%), while 3 died (21.4%).

Read the abstract » | (added 2014-03-07)

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Nephrologist perspectives on dialysis: An international study

Among 324 practicing nephrologists, 90% had patients using standard in-center HD, 8% had patients on PD, and 2% had some on home HD. Most believed that quality of life was superior on home HD, and that doing more treatments than 3 per week and making them longer would lead to "significantly better clinical outcomes" than than standard treatments.

Read the abstract » | (added 2014-02-06)

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PD fluid: Does less sugar lead to better outcomes?

A recent randomized, controlled trial with 251 patients combined two studies of standard vs. low-glucose PD fluids. The study looked at hemoglobin A1c levels. In the low-glucose fluid group, A1c and triglyceride levels dropped and lipid profiles improved. But...there were more serious events and deaths in this group due to fluid overload. So, the low-glucose fluid was better for blood sugar and lipids, but with a higher risk of fluid problems. The authors suggest that if low-glucose fluids (like icodextrin) are used, it is vital to watch fluid levels closely.

Read the abstract » | (added 2013-12-10)

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Home HD: A good start's the key

A look at 95 home HD patients found that those who started treatment in the hospital or with a catheter had far higher rates of hospital stays, changing to another treatment, or death than those who had better starts. For both new patients and those coming to dialysis from a failed transplant, a planned home HD start with a permanent access led to better outcomes.

Read the abstract » | (added 2013-12-10)

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PD First. It makes sense!

Why is the default US dialysis standard in-center HD, when it doesn't offer the best outcomes, costs more, and offers a poor quality of life? That's the question asked in a new review article that points out the benefits of a PD first strategy. Rather than allowing ease of HD initiation to drive treatment "choice," it makes sense to change the default initiation option to PD.

Read the abstract » | (added 2013-11-06)

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