Outcomes of Extended-Hours Hemodialysis Performed Predominantly at Home

Jun, Min; Jardine, Meg; Gray, Nicholas A; Masterson, Rosemary; Kerr, Peter G.; Agar, John; Hawley, Carmel M.; Eps, Carolyn van; Cass, Alan; Gallagher, Martin; Perkovic, Vlado

doi:10.1053/j.ajkd.2012.08.032

Cited by 56 publications

(68 citation statements)

References 14 publications

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“…By contrast, the high primary patency rates (12-month rates for RL and BH were 90.9% and 93.8%, respectively) in our study may have obscured a true benefit from BH cannulation. Our high primary patency rates were no doubt because of, at least in part, conduct in home dialysis patients, a population known for their relatively good outcomes (28,30), and exclusion of radiologic interventions from our composite end point. The last and perhaps most compelling explanation is that both findings are caused by chance given the relatively small size of both studies.…”

Section: Discussionmentioning

confidence: 97%

“…Comparable rates for BHrelated infection in the literature (converted into rates per 1000 AVF-days) are 0.34 reported in a Belgian study (18), 0.43 reported among Australian HHD patients (14), and 50 per 1000 sessions of local infections reported in a Canadian conventional hemodialysis cohort (19). Although lower than the bloodstream infection rate of 1.27/1000 days associated with catheters in a American conventional hemodialysis cohort (26), any increase in AVF-related events is important because of its impact on clinical outcomes and survival (27,28). This finding is particularly concerning in an HHD population given that these patients generally have better prognostic baseline characteristics and outcomes (28), leading to the expectation of lower rates of adverse events.…”

Section: Discussionmentioning

confidence: 97%

“…Although lower than the bloodstream infection rate of 1.27/1000 days associated with catheters in a American conventional hemodialysis cohort (26), any increase in AVF-related events is important because of its impact on clinical outcomes and survival (27,28). This finding is particularly concerning in an HHD population given that these patients generally have better prognostic baseline characteristics and outcomes (28), leading to the expectation of lower rates of adverse events. Additionally, AVF events can lead to discontinuation of HHD (27,28).…”

Section: Discussionmentioning

confidence: 99%

“…This finding is particularly concerning in an HHD population given that these patients generally have better prognostic baseline characteristics and outcomes (28), leading to the expectation of lower rates of adverse events. Additionally, AVF events can lead to discontinuation of HHD (27,28).…”

Section: Discussionmentioning

confidence: 99%

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Buttonhole Cannulation and Clinical Outcomes in a Home Hemodialysis Cohort and Systematic Review

Muir

Kotwal

Hawley

et al. 2014

Clinical Journal of the American Society of Nephrology

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105

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SummaryBackground and objectives The relative merits of buttonhole (or blunt needle) versus rope ladder (or sharp needle) cannulation for hemodialysis vascular access are unclear.Design, setting, participants, & measurements Clinical outcomes by cannulation method were reviewed in 90 consecutive home hemodialysis patients. Initially, patients were trained in rope ladder cannulation. From 2004 on, all incident patients were started on buttonhole cannulation, and prevalent patients were converted to this cannulation method. Coprimary outcomes were arteriovenous fistula-attributable systemic infections and a composite of arteriovenous fistula loss or requirement for surgical intervention. Secondary outcomes were total arteriovenous fistula-related infections and staff time requirements. Additionally, a systematic review evaluating infections by cannulation method was performed.Results Seventeen systemic arteriovenous fistula-attributable infections were documented in 90 patients who were followed for 3765 arteriovenous fistula-months. Compared with rope ladder, buttonhole was not associated with a significantly higher rate of systemic arteriovenous fistula-attributable infections (incidence rate ratio, 2.71; 95% confidence interval, 0.66 to 11.09; P=0.17). However, use of buttonhole was associated with a significantly higher rate of total arteriovenous fistula infections (incidence rate ratio, 3.85; 95% confidence interval, 1.66 to 12.77; P=0.03). Initial and ongoing staff time requirements were significantly higher with buttonhole cannulation. Arteriovenous fistula loss or requirement for surgical intervention was not different between cannulation methods. A systematic review found increased arteriovenous fistula-related infections with buttonhole compared with rope ladder in four randomized trials (relative risk, 3.34; 95% confidence interval, 0.91 to 12.20), seven observational studies comparing before with after changes (relative risk, 3.15; 95% confidence interval, 1.90 to 5.21), and three observational studies comparing units with different cannulation methods (relative risk, 3.27; 95% confidence interval, 1.44 to 7.43).Conclusion Buttonhole cannulation was associated with higher rates of infectious events, increased staff support requirements, and no reduction in surgical arteriovenous fistula interventions compared with rope ladder in home hemodialysis patients. A systematic review of the published literature found that buttonhole is associated with higher risk of arteriovenous fistula-related infections.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Buttonhole Cannulation and Clinical Outcomes in a Home Hemodialysis Cohort and Systematic Review

Muir

Kotwal

Hawley

et al. 2014

Clinical Journal of the American Society of Nephrology

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105

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“…On-treatment survival was defined by any death occurring with the initial home dialysis modality and up to 90 days after a switch from this modality (30). Patients were censored at the time of technique failure.…”

Section: Outcomes Assessmentmentioning

confidence: 99%

An Incident Cohort Study Comparing Survival on Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry)

Nadeau‐Fredette

Hawley

Pascoe

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Home dialysis is often recognized as a first-choice therapy for patients initiating dialysis. However, studies comparing clinical outcomes between peritoneal dialysis and home hemodialysis have been very limited. Design, setting, participants, & measurements This Australia and New Zealand Dialysis and TransplantationRegistry study assessed all Australian and New Zealand adult patients receiving home dialysis on day 90 after initiation of RRT between 2000 and 2012. The primary outcome was overall survival. The secondary outcomes were on-treatment survival, patient and technique survival, and death-censored technique survival. All results were adjusted with three prespecified models: multivariable Cox proportional hazards model (main model), propensity score quintile-stratified model, and propensity score-matched model. ResultsThe study included 10,710 patients on incident peritoneal dialysis and 706 patients on incident home hemodialysis. Treatment with home hemodialysis was associated with better patient survival than treatment with peritoneal dialysis (5-year survival: 85% versus 44%, respectively; log-rank P,0.001). Using multivariable Cox proportional hazards analysis, home hemodialysis was associated with superior patient survival (hazard ratio for overall death, 0.47; 95% confidence interval, 0.38 to 0.59) as well as better on-treatment survival (hazard ratio for on-treatment death, 0.34; 95% confidence interval, 0.26 to 0.45), composite patient and technique survival (hazard ratio for death or technique failure, 0.34; 95% confidence interval, 0.29 to 0.40), and death-censored technique survival (hazard ratio for technique failure, 0.34; 95% confidence interval, 0.28 to 0.41). Similar results were obtained with the propensity score models as well as sensitivity analyses using competing risks models and different definitions for technique failure and lag period after modality switch, during which events were attributed to the initial modality.Conclusions Home hemodialysis was associated with superior patient and technique survival compared with peritoneal dialysis.

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Frequent Hemodialysis

Trinh¹,

Chan²

2019

Chronic Kidney Disease, Dialysis, and Transplantation

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Outcomes of Extended-Hours Hemodialysis Performed Predominantly at Home

Cited by 56 publications

References 14 publications

Buttonhole Cannulation and Clinical Outcomes in a Home Hemodialysis Cohort and Systematic Review

Buttonhole Cannulation and Clinical Outcomes in a Home Hemodialysis Cohort and Systematic Review

An Incident Cohort Study Comparing Survival on Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry)

Frequent Hemodialysis

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