Factors Associated With Discontinuation of Home Hemodialysis

Seshasai, Rebecca Kurnik; Mitra, Nandita; Chaknos, C. Michael; Li, Jiaqi; Wirtalla, Christopher; Negoianu, Dan; Glickman, Joel D.; Dember, Laura M.

doi:10.1053/j.ajkd.2015.11.003

Cited by 41 publications

(80 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Patients were followed from the date of first treatment in the home. The cumulative incidence of death was 8% at 1 year, while the cumulative incidence of technique failure was 25% at 1 year and 35% at 2 years . Both studies show that the incidence of HHD technique failure is roughly 2 times higher during the first vs. the second year at home.…”

Section: Discussionmentioning

confidence: 83%

“…Risk factors for HHD attrition necessarily reflect risk factors for each of death, transplant, and technique failure. Regarding technique failure, Seshasai et al listed female sex; hypertension (vs. diabetes) as primary cause of end‐stage renal disease; urban residence; diabetes; tobacco, alcohol, and drug use; and exclusion from the kidney transplant waitlist as nominally significant (P < 0.1) risk factors . Central venous catheter vs. arteriovenous fistula or graft for vascular access was associated with higher risk of technique failure in 2 studies .…”

Section: Discussionmentioning

confidence: 99%

“…Because HHD is associated with lower mortality than in‐center hemodialysis, primary emphasis on efforts to reduce technique failure risk is prudent. A recent US study reported that the cumulative incidence of technique failure was 25% at 1 year after HHD training graduation and 35% after 2 years …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Relative risk of home hemodialysis attrition in patients using a telehealth platform

Weinhandl¹,

Collins

2017

Hemodialysis International

View full text Add to dashboard Cite

Introduction: Home hemodialysis (HHD) facilitates increased treatment frequency, which may improve patient outcomes. However, attrition due to technique failure limits the clinical effectiveness of the modality. Nx2me Connected Health is a telehealth platform that enables ongoing assessment of HHD patients using NxStage equipment, and that may reduce patient burden. We aimed to assess whether use of Nx2me was associated with risk of HHD attrition. Methods:We compared risks of all-cause attrition, dialysis cessation (i.e., death or transplant), and technique failure in Nx2me users and matched control patients, using a retrospective cohort study. We also compared the likelihood of HHD training graduation in patients who initiated use of Nx2me during training with the likelihood in matched control patients. Matching factors included date of HHD initiation, NxStage treatment duration at initiation of follow-up, and prescribed treatment frequency. We used stratified Fine-Gray and Cox regression to compare risks, with adjustment for demographic factors and vascular access modality, and stratification by matched cluster. Findings:We identified 606 Nx2me users; 49.5% initiated use of Nx2me in <3 months after initiation of HHD with NxStage equipment. Adjusted hazard ratios (AHRs) of all-cause attrition, dialysis cessation, and technique failure were 0.80 (95% confidence interval, 0.68-0.95), 1.10 (0.86-1.41), and 0.71 (0.57-0.87), respectively, for Nx2me users vs. matched controls. AHRs were similar in patients who initiated use of Nx2me in <3 months after initiation of HHD. The AHR of HHD training graduation was 1.61 (1.10-2.36) in patients who initiated use of Nx2me within 2 weeks of training initiation vs. matched controls.Discussion: Use of Nx2me was associated with lower risk of all-cause attrition, lower risk of technique failure, and higher likelihood of HHD training graduation. Further studies are needed to identify the mechanisms by which use of a telehealth platform may improve clinical outcomes and reduce patient burden.

show abstract

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Relative risk of home hemodialysis attrition in patients using a telehealth platform

Weinhandl¹,

Collins

2017

Hemodialysis International

View full text Add to dashboard Cite

show abstract

“…Removal of phosphorus is primarily time-dependent, so increased HD hours per week may be effective when phosphate binders are ineffective. However, frequent HD is more likely prescribed in the home setting, where efficacy is currently limited by substantial risk of technique failure and burden on care partners [38,39]. Second, cardioprotective medications should be critically evaluated.…”

Section: Resultsmentioning

confidence: 99%

Contemporary Trends in Clinical Outcomes among Dialysis Patients with Medicare Coverage

Weinhandl

Ray²,

Kubisiak³

et al. 2019

Am J Nephrol

View full text Add to dashboard Cite

Background: The dialysis patient population in the United States continues to grow. Trends in rates of death and hospitalization among dialysis patients have important consequences for outpatient dialysis capacity and Medicare spending. Objectives: To estimate contemporary trends in rates of death and hospitalization among dialysis patients in the United States, overall and within subgroups. Methods: We used Medicare Limited Data Sets (100% sample) in 2014–2017 to estimate trends in rates of death and hospitalization among dialysis patients with Medicare Parts A and B enrollment. We used seasonal autoregressive integrated moving average models to identify secular trends in the incidence of outcomes. Results: There were 631,075 unique patients; 222,924 deaths; and 1,876,779 hospital admissions. Weekly risks of both death and hospitalization exhibited strong seasonality. However, overall weekly risks of death were 34.9, 35.4, 35.2, and 35.7 deaths per 10,000 patients in 2014–2017, respectively (p = 0.47, from a likelihood ratio test of secular trend). The overall weekly risk of hospitalization was 3.08, 3.05, 3.11, and 3.11% in 2014, 2015, 2016, and 2017, respectively (p = 0.30). There were significant secular trends in risk of death in subgroups defined by black race and residency in South Atlantic states (p < 0.05). There were also secular trends in risk of hospitalization in subgroups defined by age 20–44 years, concurrent enrollment in Medicaid, and residency in South Central states. Conclusion: For the first time since the beginning of this century, rates of both death and hospitalization among dialysis patients with Medicare fee-for-service coverage have stagnated. The reasons for this change are unknown and require detailed assessment. Persistent lack of change in clinical outcomes may alter the future expectations about dialysis patient population growth.

show abstract

“…Reasons cited for low utilization of HHD include fear by patients of self‐cannulation and complications occurring in the home, lack of physician comfort and experience prescribing the modality, inadequate CKD and modality education for patients, burden to family members, and a high rate of discontinuation . To increase utilization of HHD in the United States, it is necessary to prioritize not only facilitating HHD initiation, but also reducing the high discontinuation rate which has been reported to be 18% to 25% within 1‐year . Although a number of factors have been associated with higher likelihood of HHD discontinuation, including demographic and patient characteristics and comorbidity burden, many practitioners of HHD believe psychosocial issues and burden of therapy are prominent drivers of HHD discontinuation .…”

Section: Introductionmentioning

confidence: 99%

The home hemodialysis patient experience: A qualitative assessment of modality use and discontinuation

Seshasai¹,

Wong²,

Glickman³

et al. 2019

Hemodialysis International

Self Cite

View full text Add to dashboard Cite

Introduction: Home hemodialysis (HHD) is an under‐utilized renal replacement modality in the United States in part because of high rates of discontinuation and transfer to in‐center hemodialysis. Understanding, from the perspective of patients, facilitators, and barriers to sustained use of HHD is important for increasing successful use of this modality. Methods: We conducted 25 semistructured interviews with 15 current and 10 former adult patients treated with home hemodialysis (23 short daily HHD and 2 nocturnal HHD). Interview transcripts were audiotaped, transcribed verbatim, and thematically analyzed. Findings: Five themes related to continuation or discontinuation of HHD emerged: (1) degree of independence (increased flexibility, burden of therapy), (2) availability of support (emotional and physical support and caregiver burden), (3) technical aspects (familiarity with machine), (4) home environment (ability to organize supplies, space in home), and (5) attitude and expectations (positive or negative outlook about performing HHD). For each theme, positive aspects facilitated continuation of HHD and negative aspects contributed to discontinuation of HHD. Discussion: HHD can be burdensome to patients and family members, and some discontinuations may be preventable. Helping patients with scheduling and organization, improving communication about expectations and trouble‐shooting, supporting patients as well as family members, adapting the dialysis prescription to the patient's lifestyle when possible, and providing respite when needed may make HHD more sustainable for patients.

show abstract

Factors Associated With Discontinuation of Home Hemodialysis

Cited by 41 publications

References 37 publications

Relative risk of home hemodialysis attrition in patients using a telehealth platform

Relative risk of home hemodialysis attrition in patients using a telehealth platform

Contemporary Trends in Clinical Outcomes among Dialysis Patients with Medicare Coverage

The home hemodialysis patient experience: A qualitative assessment of modality use and discontinuation

Contact Info

Product

Resources

About