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In Dr. Arshia Ghaffari’s study, reported in abstract form at the NKF Spring Clinicals, the clear winner was urgent start PD. Urgent start HD had a 43% higher rate of hospitalization and 4.3 times the number of catheter-related infections. The Bipartisan Chronic Care Working Group recommends allowing telehealth use for the required monthly clinical visit for home dialysis to provide greater flexibility and encourage patient independence.
Both researchers and clinicians will find sessions of interest to them. Extensive commercial exhibits give participants a chance to see for themselves what is new in PD and HD products and services. Transfers to hemodialysis among US patients initiating renal replacement therapy with peritoneal dialysis. The Home Dialysis Conference brought together health care professionals, carers and patients from Australia, New Zealand and the Pacific who focussed on building and developing home based dialysis therapies. Eight hour treatments three times a week at night don’t intrude on the work schedule and allow people to feel better. Among 121,623 patients starting dialysis, those who began with PD had a 25% lower chance of developing dementia than those who started with HD—even after adjusting for age, gender, and other factors.
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Home dialysis patients in parts of Canada will soon receive up to $650/year to help pay increased water bills due to home HD. Reliant Renal Care is committed to providing quality home dialysis—even when home is a Skilled Nursing Facility. Residents get short daily HD five times a week, and don’t have to take transport to a dialysis center. A new pre-dialysis program in the Netherlands called GUIDE increases the number of patients who choose and receive home dialysis. A Fresenius clinic in Grafton WV is pleased to offer PD as well as both daytime and nocturnal home HD, so patients can treat themselves in the comfort of their own homes.
Dr. Dawn Wolfgram and her team looked at USRDS data and claims data to rule out people who had dementia when they started treatment, though doctors may have steered cognitively impaired patients away from a self-care option like PD. NxStage addresses myths about kidney disease prevalence and treatment, assuring people that there are, in fact, technological breakthroughs and that dialysis treatments can be done in the home. A GAO report finds that the need to fill excess capacity due to an excess of dialysis clinics built over the past 25 years—along with better profit margins for in-center patients—has led providers to de-emphasize home dialysis. 2948, the Medicare Telehealth Parity Act, would remove some barriers for home dialysis patients to use telemedicine connections and remote monitoring to connect with their nephrologists. The Dorset County Hospital is funding a project to give more people the chance to do home HD—since independence and even health can be impaired by in-center treatments.
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Read the messages they give to patients in their newsletters on their home dialysis website. Dr. Karl Nolph, a pioneer in peritoneal dialysis, passed away in June, at age 77. Read the transcript of Dr. Dugan Maddux’s terrific interview with him on VoiceExpeditions.com. PD catheter placement practices are highly variable—but some are better than others. In a new study, 40 clinics from the US and Canada have taken a 29-item survey designed to identify factors in successful PD catheter placement and establish a framework for improvement. Read an interview with Dr. Marty Schreiber about his preferred sequence of ESRD options, causes of PD failure, future PD technology, best PD candidates, and thoughts about the Baxter solution shortage.
From identifying CKD patients in the ER and emergent start PD to policies that prioritize home and coordination of services, a shift is happening, and patients will be the beneficiaries of it. The £1.1M UK Inter-CEPt study will focus on determining why home therapies are not being optimally used across clinics or by minority or disadvantaged patients, and how to increase uptake, using a 5-stage approach. DaVita Kidney Care is expanding use of the Baxter HomeChoice Claria APD system to its home dialysis program. Baxter’s ShareSource supports remote patient monitoring, supporting two-way digital communication between patients and their care teams. A major shift to home dialysis is recommended by the authors of a new study that found fewer positive tests—and lower COVID-19 hospitalization rates—in home dialysis patients than in-center ones.
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“Is the patient actually ready when we’re talking to him or her about home dialysis? ” Both patients and physicians need to be prepared, if we are to grow PD and home HD, noted Chan, Director of Nephrology at University Health Network in Toronto, in a presentation at the International Conference on Dialysis. Baxter has launched an FDA-approved clinical trial of system that will use a small device to blend filtered water with concentrate to make tap water into PD fluid. The safety and efficacy trial, which will run for 12 weeks, has enrolled its first patient, and will be used to support a New Drug Application to the FDA.
Home dialysis therapy, including home hemodialysis and peritoneal dialysis, is underused as a modality for the treatment of chronic kidney failure. The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative sponsored a home dialysis conference in late 2017 that was designed to identify the barriers to starting and maintaining patients on home dialysis therapy. Clinical, operational, policy, and societal barriers were identified that need to be overcome to ensure that dialysis patients have the freedom to choose their treatment modality.
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The home dialysis work group plans to develop strategies to overcome these barriers to home dialysis therapy, which will be presented at a follow-up home dialysis conference. Home dialysis modalities are used in a minority of patients with kidney failure in the United States. During the 2018 National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) Home Dialysis Conference, numerous ideas were suggested to help minimize barriers for the uptake and retention of home dialysis therapies. First, educational tools are needed to increase knowledge about home dialysis modalities .
Michelle Pace, a Kidney Care Advocate and dialysis nurse talks with Lori Hartwell about the pros of home dialysis. A Canadian study of 39,318 patients between 2004 and 2012 found that the 8,170 who started dialysis with PD had more life years—and at a cost savings for PD ($83,762/year) vs. in-center HD ($104,880/year). Home dialysis thought leaders interviewed by Mark Neumann for Nephrology News & Issues report strategies and attitude changes that support growth of PD and home HD in light of the Advancing American Kidney Health Initiative.
To speed up the timeline, we need more home dialysis nurses, staff-assisted home treatments, telehealth, and user-friendly equipment. A leader and innovator, DeClaro has started nine home dialysis program in the Chicago area. ESKD patients doing PD or home HD or having a working transplant by 2025, things have to change—and the clock is ticking despite the ongoing pandemic.
Both are poised to guide the Administration’s push for more home dialysis to improve outcomes and reduce costs, noted Rob Blaser in a presentation at the recent RPA meeting. Last week, the FDA expanded approval of the Tablo hemodialysis machine to home use—just in time to offer a new option for COVID-19 related challenges. Nurse Shawna McMichael and her team at Washington University in St. Louis, MO made a rapid switch to telehealth to keep patients at home and safe while still delivering the same level of care.
If you are in the NYC area, you can learn more about PD and home HD from doctors, nurses, and your fellow patients at a free seminar in Queens. It’s worth a subway ride to learn how your life can be better—and they will serve light food and beverages. PD was quite a late-comer to Prince Edward Island, Canada, arriving in 2016.
Fresenius contracts with JMS to provide more dialysis choices to Japan’s aging population. Home treatments can better fit people’s lifestyles and improve their well-being. The 39th Annual Dialysis Conference 2019 brings together health professionals involved in established and developing dialysis programs. The only absolute clinical barrier to PD is the lack of a functioning peritoneal membrane.
The Chronic Care Act would lift the geographic limits, starting in 2019, and extend the originating sites for monthly clinical assessments to patient’s homes. Home dialysis patients would need to have a face-to-face visit with a nephrologist every 3 months. If seeing is believing, it makes sense to show people a treatment option they might not be able to imagine. Patients on PD demonstrated the technique for other patients and families in campers parked outside of a dialysis clinic.
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