Journal Watch - Home HD
Home HD, Self-cannulation, and Survival
An observational study of all home HD patients at a single center from 2001 to 2020 examined treatment survival and mortality. Among 77 self-cannulating patients dialyzing for a median of 18 hours per week, there were 11 deaths, largely cardiovascular, and 19 technique failures after 100 months, largely due to vascular access issues.
Read the abstract » | (added 2024-06-14)
Tags: Home HD, Self Cannulation, Treatment Survival, Mortality, Cardiovascular, Technique Failure, Vascular Access
Patient Training and Safety with Home HD
Despite the paramount importance of safety with home HD, there is “a surprising lack of literature” about it and no consensus on optimal training techniques or schedules, contend the authors of a new study.
Read the abstract » | (added 2024-01-17)
Tags: Home HD, Training Techniques, Home HD Training Schedules
44 Years of Home HD Technique Survival in Valencia, Spain
In Valencia, 13.4% of patients on dialysis were using home HD in 2018. Researchers compared home HD data from two eras: “ancient” (1976-2000) and “modern” (2001-2020). Interestingly, 1- and 2-year patient survival were superior in the modern era (87.3% vs. 83.7% for 1-year; 83% vs. 77.4% for 2-year)—but 5-year survival was better in the ancient era (61% vs. 47.8%), as patients aged. Technique survival was better at every point in the modern era.
Read the abstract » | (added 2023-02-13)
Home HD Begins in Mainland China
Intrigued by observational studies suggesting better survival for home HD than in-center HD or PD—and reduced COVID exposure—a clinic in China established a training center and enrolled six patients. Patients were monitored by home visits, online, and by outpatient services. After an average of 16 months of training, three patients began independent dialysis at home, with no serious adverse events. Blood levels remained stable.
Read the abstract » | (added 2022-12-19)
Tags: Home HD, In center HD, PD, Infection, Mainland China
PD and home HD patients less stressed by COVID-19
Does the social isolation of PD or home HD contribute to a negative psychosical impact from COVID? Apparently not. Forty patients (85% on home HD) responded to a COVID impact survey sent to 98 home HD and 43 PD patients in Toronto. About 80% rated their dialysis satisfaction at 8/10 or higher, had infrequent anxiety or depression, felt dialysis had minimal impact on their lives, and were almost always happy with their family interactions. Just 9% were often worried about caregiver burden. The authors suggest that home is “the optimal form of dialysis.”
Read the abstract » | (added 2021-10-13)
Tags: Home HD, COVID 19, Coronavirus
Home HD Core Curriculum, 2021
COVID-19 and policy changes have revived interest in home HD, so nephrologists need to better understand the therapy. This article focuses on factors in successful training and retention, including benefits, pitfalls, challenges, new equipment, prescriptions, and more.
Read the abstract » | (added 2021-10-13)
Survival with PD vs. Home HD and When to Go Home
Using a national cohort of 1,993 patients transitioning to home HD and 16,514 to PD between 2007 to 2011, 1,195 home HD were matched to 1,195 using propensity scores and adjusting for demographics, comorbidities, dialysis duration, and BMI. Those on home HD had significantly better survival (9.6 vs. 12.9 deaths per 100 patient-years; p<0.001). However, when patients switched to PD within the first 12 months of starting dialysis, survival was comparable between PD and home HD: patients who transitioned after 12 months had an 83% higher risk of death.
Read the abstract » | (added 2020-02-19)
Tags: Home HD, PD, Comorbidities, Dialysis Duration, BMI, Survival
Home HD: Hospitalizations and Technique Survival
In a Swedish registry study, patients initiating PD (n=456), home HD (n=152), and in-center HD (IHD; n=608) were matched by age, sex, comorbidity, and start date. Patients using home HD had significantly lower hospital admissions and days than those doing PD or IHD (1.7, 12 days vs. 2.8, 20 days and 2.2, 14 days respectively). Home HD patients also had significantly fewer admissions for cardiovascular diagnoses or infectious disease, as well as significantly longer technique survival.
Read the abstract » | (added 2020-01-09)
Tags: PD, Home HD, In center HD, Hospital Admissions, Cardiovascular Diagnosis, Infectious Disease, Technique Survival
Home HD After PD Failure May Lead to More Transplants, Lower Mortality
Since PD failure can lead to hospitalization and death in those who switch to standard in-center HD (ICHD), would outcomes improve with home HD? A new analysis found 521 patients in the USRDS data who made the change. Compared to matched ICHD patients, the chance of transplant was nearly double (21% vs. 10.6%), while survival of home HD patients was 89.1% at 1 year and 80.5% at 2 years.
Read the abstract » | (added 2018-08-13)
Tags: PD Technique Failure, ICHD, Transplant, Home HD, Lower Mortality
Nephrology Fellows Need Home HD Training & Experience
Home HD offers research and quality improvement topics for fellows, but lack of training is a barrier to patient use of this option. Fellows should attend lectures and receive at least 6-12 months of outpatient clinical exposure that includes transitioning three or more patients to home, argues a new op ed. Having a passionate home HD expert and advocate is essential, as is exposure to home HD nurses.
Read the abstract » | (added 2018-02-15)