Hospitalization in Daily Home Hemodialysis and Matched Thrice-Weekly In-Center Hemodialysis Patients

Weinhandl, Eric D.; Nieman, Kimberly; Gilbertson, David T.; Collins, Allan J.

doi:10.1053/j.ajkd.2014.06.015

Cited by 72 publications

(75 citation statements)

References 21 publications

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“…This discontinuation rate is similar to rates reported in other multicenter studies of HHD in the United States but prior studies had not focused on identifying predictors of HHD discontinuation. 4,9,12 We found that patients who discontinue are more likely to have diabetes or use tobacco, alcohol or recreational drugs and are less likely to be listed for kidney transplantation or live in a rural area.…”

Section: Discussionmentioning

confidence: 82%

“…In a study comparing hospitalization rates between 3,400 HHD patients using NxStage System One and in-center HD patients taken from USRDS, Weinhandl, et al noted 21.3 discontinuation events per 100 patient-years. 9 In another study, Weinhandl, et al reported 26.4% of 1,873 HHD patients discontinued because of change in dialysis modality over a mean follow-up time of 1.8 years. 4 In their most recent study, also with NxStage data from 2007–2010, Weinhandl and colleagues observed that 18% discontinued at 1 year of follow-up.…”

Section: Discussionmentioning

confidence: 97%

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Factors Associated With Discontinuation of Home Hemodialysis

Seshasai

Mitra

Chaknos

et al. 2016

American Journal of Kidney Diseases

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Background Home hemodialysis (HHD) is associated with improved clinical and quality of life outcomes compared with in-center hemodialysis but remains an underused modality in the United States. Discontinuation from HHD may be an important contributor to the low utilization of this modality. This study aimed to describe the rate and timing of HHD discontinuation, or technique failure, and identify contributing factors. Study Design Retrospective cohort study Setting & Participants Using data from a large dialysis provider, we identified a nationally representative cohort of patients who initiated HHD from 2007 – 2009 (N=2840). Factors Demographics, ESRD duration, kidney transplant listing status, co-morbid conditions, level of urbanization or rurality based on residence zip code, socioeconomic status based on residence zip code, and dialysis facility factors. Outcomes Discontinuation from HHD, defined as ≥60 days with no HHD treatments. Measurements Competing risk models were used to produce cumulative incidence plots and to identify socio-demographic and clinical variables associated with HHD discontinuation. Transplantation and death were treated as competing risks for HHD discontinuation. Results The 1-year incidence of discontinuation was 24.9% and the 1-year mortality estimate was 7.6%. Median ESRD duration prior to initiating HHD was 2.1 years. Diabetes and smoking/alcohol/drug use were associated with increased risk of HHD discontinuation (HRs of 1.34 [95% CI, 1.07–1.68] and 1.34 [95% CI, 1.01–1.78], respectively). Listing for kidney transplant and rural residence (rural-urban commuting area ≥ 7) were associated with decreased risk of HHD discontinuation (HRs of 0.73 [95% CI, 0.61–0.87] and 0.78 [95% CI, 0.59–1.02], respectively). Limitations Limited to variables available within the DaVita dialysis and US Renal Data System datasets. Conclusions A substantial proportion of patients discontinue HHD within the first 12 months of use of the modality. Patients with diabetes, substance use, non-listing for kidney transplant, and urban residence are at greater risk for discontinuation. Targeting high-risk patients for increased support from clinical teams is a potential strategy for reducing HHD discontinuation and increasing technique survival.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 97%

Factors Associated With Discontinuation of Home Hemodialysis

Seshasai

Mitra

Chaknos

et al. 2016

American Journal of Kidney Diseases

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“…Moreover, in a previous study using the United States Renal Data System database, daily home HD patients had a lower risk for hospitalization for cardiovascular events, including fluid overload, cerebrovascular disease, heart failure, cardiomyopathy, and hypertensive disease, compared with conventional in-center HD patients [23]. On the contrary, in the ANZDATA study, quasiintensive home HD reduced the mortality risk compared with conventional HD [15].…”

Section: Discussionmentioning

confidence: 87%

Increased Frequency of In-Center Hemodialysis as Rescue Therapy: Impact on Hospitalization for Acute Cardiovascular Events

et al. 2018

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Background: The intermittency of conventional hemodialysis (HD) leads to an increase in cardiovascular events. Objective: We aimed to evaluate the effect of in-center frequent HD (FHD, 4–6 times a week) as a rescue option for cardiovascular events. Method: Patients who failed to achieve fluid volume control with conventional HD (thrice a week) were administered FHD. A total of 52 patients were divided into 2 groups by left ventricular ejection fraction (LVEF): low ejection fraction (LEF [n = 26], LVEF < 55%) and normal ejection fraction (NEF [n = 26], LVEF ≥55%). Mortality and hospitalization rates were evaluated. Results: All-cause mortality tended to be higher in the LEF than in the NEF group (p = 0.09). The 1-year hospitalization rate for acute cardiovascular events decreased in both LEF (1.24–0.89; p = 0.049) and NEF (0.36–0.16; p = 0.01) groups. In Cox regression models, LVEF < 55% (hazard ratio 3.81; 95% CI 1.15–12.66; p = 0.03) was identified as the risk factor for hospitalization for acute cardiovascular events. Conclusion: In-center FHD may decrease acute cardiovascular events.

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“…Most recently, a large cohort study compared all-cause and cardiovascular-related hospitalization rates in CHD and daily HHD. There was no significant difference in all-cause hospitalization, but cardiovascular-related rates in HHD patients were lower, while infection-related cases were higher [22]. The FHN Daily and Nocturnal Trial concluded no clinically significant difference in hospitalizations between those receiving nocturnal HD and those receiving conventional HD [2].…”

Section: Dialysis Adequacymentioning

confidence: 99%

Home Hemodialysis Dose: Balancing Patient Needs and Preferences

et al. 2015

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Background: The aim in defining the dose of HHD is to provide sufficient dialysis required to possibly ‘normalize' all abnormalities associated with renal failure in order improve patient survival and quality of life. Much progress has been made in defining the dose required to accomplish this goal, but the evidence is still far from robust. The main limitations are incomplete understanding of uremic toxins, their relative importance in causing uremic symptoms, and our inability to comprehensively assess dry weight. Summary: This review provides guidance on realistic dosing of dialysis for the HHD patient based on the available evidence, where available, and alternative regimens that suit the individual's lifestyle and preferences. Key Messages: HHD can easily accommodate alternative, intensive HD prescriptions, including daily and nocturnal HD. HHD provides prescription flexibility to fulfill patient needs while taking their preferences into account.

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Hospitalization in Daily Home Hemodialysis and Matched Thrice-Weekly In-Center Hemodialysis Patients

Cited by 72 publications

References 21 publications

Factors Associated With Discontinuation of Home Hemodialysis

Factors Associated With Discontinuation of Home Hemodialysis

Increased Frequency of In-Center Hemodialysis as Rescue Therapy: Impact on Hospitalization for Acute Cardiovascular Events

Home Hemodialysis Dose: Balancing Patient Needs and Preferences

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