Clinical, patient-related, and economic outcomes of home-based high-dose hemodialysis versus conventional in-center hemodialysis

Mitsides, Nicos; Mitra, Sandip; Cornelis, T.

doi:10.2147/ijnrd.s89411

Cited by 8 publications

(3 citation statements)

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“…The advent of hemodialysis (HD) has provided a lifeline for more than 2 million survivors of end-stage renal disease worldwide [1]. However, despite increased uptake and technological advances, long-term survival remains worse than that of some major cancers [2].…”

Section: Introductionmentioning

confidence: 99%

Inflammatory and Angiogenic Factors Linked to Longitudinal Microvascular Changes in Hemodialysis Patients Irrespective of Treatment Dose Intensity

Mitsides

Cornelis

Broers

et al. 2017

Kidney Blood Press Res

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Background: Cardiovascular disease is a major contributor to the poor outcomes observed in hemodialysis. We investigated the relationship between hemodialysis intensity and vascular parameters in high-dose (HDHD; >12hrs/week) and Conventional (CHD; ≤12hrs/week) hemodialysis intensity over a 6-month period. Methods: We present the 6-month longitudinal analysis of a 2-year multicenter study investigating the effects of HDHD on cardiovascular parameters. We used pulse wave velocity, 24hr ambulatory blood pressure and sublingual dark field capillaroscopy measurements to assess macro- and microcirculation on 6-monthly basis. Pro-inflammatory and endothelial biomarkers were also measured at 6-monthly intervals. Results: 47 participants (21 HDHD, 26 CHD) were studied. CHD were older (63.5±14.2 vs 53.7±12.6 yr; p=0.018), with shorter dialysis vintage (median 23 vs 61 months; p=0.001). There was considerable variability in the degree and direction of change of circulatory measurements over a 6-month period. Hemodialysis intensity (hrs/week) did not correlate to these changes, when adjusted for age, dialysis vintage and comorbidity. Higher levels of Interleukin (IL)-8 measured at baseline independently predicted an increase in the Perfused Boundary Region (5-25μm) of the endothelial glycocalyx (p=0.010) whilst higher levels of soluble Flt-1 had a significant inverse effect (p=0.002) in an adjusted linear model. Conclusion: Hemodialysis intensity did not predict changes in either macro- or microvascular parameters. Inflammation mediated through the IL-8 pathway predicted microvascular injury while Flt-1, a potential marker of angiogenesis and endothelial repair, might have a significant protective role. Further understanding of these pathways will be necessary to improve dialysis outcomes.

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Section: Introductionmentioning

confidence: 99%

Inflammatory and Angiogenic Factors Linked to Longitudinal Microvascular Changes in Hemodialysis Patients Irrespective of Treatment Dose Intensity

Mitsides

Cornelis

Broers

et al. 2017

Kidney Blood Press Res

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“…The most common form of renal replacement therapy, haemodialysis, is most often provided in dialysis units several times a week for 3-to 5-h sessions, presenting a significant burden on patients, caregivers and healthcare systems (Palmer et al, 2014). Among the options of haemodialysis in many countries is home-based treatment, which is associated with improved outcomes such as survival, patient-reported quality of life and cost-effectiveness (Chan et al, 2019;Mitsides et al, 2016).…”

Section: Backg Rou N Dmentioning

confidence: 99%

Interest and perceived capability of self‐care in haemodialysis units

Kurtz

Geron

Shadmi

2020

Journal of Clinical Nursing

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Aims To (a) assess patients' interest and perceived capability of participating in haemodialysis; (b) assess nurses' perceptions of patients’ interest and perceived capability of participating in haemodialysis; and (c) examine associations between patient characteristics and interest and perceived capability of performing haemodialysis self‐care. Design Cross‐sectional, questionnaire‐based study. Methods Data were collected from dialysis patients and their nurses between October 2018–May 2019. Patients’ interest and perceived capability of participation were assessed by a 10‐item Likert‐type scale developed and tested for this study, with responses ranging from 1 (not interested/no perceived capability) to 5 (already doing task independently). Multivariate linear regression was used to assess the relationship between patient characteristics, including age, sex, education level and severity of illness to ratings of activation level and haemodialysis self‐care scale scores. The STROBE checklist was used as a guideline for this study. Results Ninety‐one patients and 31 nurses participated. Overall, patients expressed interest (2.43 ± 0.93) and perceived themselves capable (2.34 ± 0.9) of participating in various haemodialysis‐related tasks. Nurses assessed lower interest (2.19 ± 0.77) than patients, but similar average capability (2.31 ± 0.8). Both greater interest and perceived capability were correlated with more years of education and higher patient activation; additionally, interest was associated with disease severity and perceived capability was associated with age. Conclusion Haemodialysis patients are interested and perceive themselves capable of participating in the tasks involved in dialysis care. Nurses underestimate patient interest in participation. Relevance to clinical practice Self‐care behaviours among haemodialysis patients are important, as they may affect quality of life and survival. Determining interest and perceived capability of participation is a first step towards evaluating the feasibility of self‐care in a supervised haemodialysis setting.

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“…Conventional hemodialysis (HD) is typically performed thrice a week in a 4-hour per session regime (12 hours a week). Apart from how much time taking this regimen is, taking a big chunk out of patient' s week, it carries a 7-fold increased risk of mortality when compared to the general population [2]. Needless to say, the routine treatment leads to an array of physical and emotional disturbance which when met with economic burden further demeans the quality of life.…”

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confidence: 99%