On the Right Track: Implementing Interventions to Reduce Readmissions in Dialysis Patients

Plantinga, Laura C.; Jaar, Bernard G.

doi:10.1159/000477100

Cited by 1 publication

(2 citation statements)

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“…In this context, we have singled out the condition of FO that is a significant contributor of increased costs in HD delivery. The condition could be more manageable in dialysis units in an inexpensive manner with advanced technological tools that help reduce not only incidences of FO by better managing sodium and fluid but also hospitalization rates and hence costs [59].…”

Section: Discussionmentioning

confidence: 99%

“…This amounts to some USD 266 million (5.25 million USD per 1,000 patient years) total costs for hospitalization episodes related to FO for HD patients in a US Medicare setting as shown in Figure 2 (panel a). Based on a hospitalization rate of 38.7% according to the USRDS 2018 report and 42% rehospitalization for FO within 30 days reported by Plantinga et al [59], we calculated that 3.5 million USD per 1,000 patients and year are spent annually for FO-related hospitalization episodes in HD [59, 60] (Fig. 2, panel b).…”

Section: Impact Of Sodium-fluid Overload Imbalance On Patient Outcome...mentioning

confidence: 99%

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Personalized Management of Sodium and Volume Imbalance in Hemodialysis to Mitigate High Costs of Hospitalization

Hornig¹,

Canaud²,

Bowry³

2023

Blood Purif

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The primary objective of hemodialysis (HD) is lowering concentrations of organic uremic toxins that accumulate in blood in end-stage kidney disease (ESKD) and redress imbalances of inorganic compounds in particular sodium and water. Removal by ultrafiltration of excess fluid that has accumulated during the dialysis-free interval is a vital aspect of each HD session. Most HD patients are volume overloaded, with ∼25% of patients having severe (>2.5 L) fluid overload (FO). The potentially serious complications of FO contribute to the high cardiovascular morbidity and mortality observed in the HD population. Weekly cycles imposed by the schedule of HD treatments create a deleterious and unphysiological “tide phenomenon” marked by sodium-volume overload (loading) and depletion (unloading). Fluid overload-related hospitalizations are frequent and costly, with average cost estimates of $ 6,372 per episode, amounting to some $ 266 million total costs over a 2-year period in a US dialysis population. Various strategies (e.g., dry weight management or use of fluids with different sodium concentrations) have been attempted to rectify FO in HD patients but have met with limited success largely due to imprecise and cumbersome, or costly, approaches. In recent years, conductivity-based technologies have been refined to actively restore sodium and fluid imbalance and maintain the predialysis plasma sodium set point (plasma tonicity) of each patient. By automatically controlling the dialysate-plasma sodium gradient based on the specific patient needs throughout a session, an individualized sodium dialysate prescription can be delivered. Maintaining precise sodium mass balance helps better control of blood pressure, reduces FO, and thus tends to prevent hospitalization for congestive heart failure. We present the case for personalized salt and fluid management via a machine-integrated sodium management tool. Results from proof-of-principle clinical trials indicate that the tool enables individualized sodium-fluid volume control during each HD session. Its application in routine clinical practice has the potential to mitigate the substantial economic burden of hospitalizations attributed to volume overload complications in HD. Additionally, such a tool would contribute toward reduced symptomology and dialysis-induced multiorgan damage in HD patients and to improving their treatment perception and quality of life which matters most to patients.

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Section: Discussionmentioning

confidence: 99%

Section: Impact Of Sodium-fluid Overload Imbalance On Patient Outcome...mentioning

confidence: 99%

Personalized Management of Sodium and Volume Imbalance in Hemodialysis to Mitigate High Costs of Hospitalization

Hornig¹,

Canaud²,

Bowry³

2023

Blood Purif

View full text Add to dashboard Cite

show abstract

On the Right Track: Implementing Interventions to Reduce Readmissions in Dialysis Patients

Cited by 1 publication

References 5 publications

Personalized Management of Sodium and Volume Imbalance in Hemodialysis to Mitigate High Costs of Hospitalization

Personalized Management of Sodium and Volume Imbalance in Hemodialysis to Mitigate High Costs of Hospitalization

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