Survival comparisons of intensive vs. conventional hemodialysis: Pitfalls and lessons

Miller, Amanda J.; Perl, Jeff; Tennankore, Karthik

doi:10.1111/hdi.12559

Cited by 12 publications

(4 citation statements)

References 41 publications

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“…Early kidney transplantation is the best renal remplacement therapy (RRT) option for many patients with end-stage renal disease (ESRD). However, most patients will need to spend time on dialysis prior to transplantation or when a transplant fails [ 1 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Design of therapeutic education workshops for home haemodialysis in a patient-centered chronic kidney diseases research: a qualitative study

Guerraoui¹,

Galland²,

Belkahla-Delabruyere³

et al. 2022

BMC Nephrol

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Rationale & Objective A quarter of patients do not receive any information on the modalities of renal remplacement therapy (RRT) before its initiation. In our facility, we provide therapeutic education workshops for all RRT except for home hemodialysis (HHD). The objectives of this study were to identify and describe the needs of CKD patients and caregivers for RRT with HHD and design therapeutic education workshops. Setting & participants Two sequential methods of qualitative data collection were conducted. Interviews with patients treated with HHD and doctors specialized in HHD were performed to define the interview guide followed by semi-structured interviews with the help of HHD patients from our center. Analytic approach Thematic analysis was conducted and were rooted in the principles of qualitative analysis for social scientists. Data were analyzed by two investigators. Transcribed interviews were entered into RQDA 3.6.1 software for data organization and coding purposes (Version 3.6.1). Results In total, five interviews were performed. We identified six themes related to the barriers, facilitators, and potential solutions to home dialysis therapy: (1) HHD allows autonomy and freedom with constraints, (2) safety of the care environment, (3) the caregiver and family environment, (4) patient’s experience and experiential knowledge, (5) self-care experience and impact on life, and (6) factors that impact the choice of treatment with HHD. We designed therapeutic education workshops in a group of patients and caregivers. Conclusions Our study confirmed previous results obtained in literature on the major barriers, facilitators, and potential solutions to HHD including the impact of HHD on the caregiver, the experiences of patients already treated with HHD, and the role of nurses and nephrologists in informing and educating patients. A program to develop patient-to-patient peer mentorship allowing patients to discuss their dialysis experience may be relevant.

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Section: Introductionmentioning

confidence: 99%

Design of therapeutic education workshops for home haemodialysis in a patient-centered chronic kidney diseases research: a qualitative study

Guerraoui¹,

Galland²,

Belkahla-Delabruyere³

et al. 2022

BMC Nephrol

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“…Chuasuwan et al’s [ 7 ] review points out that patients undergoing hemodialysis showed lower QOL than those undergoing PD. Studies indicate a potential survival advantage with intensive dialysis (an increase in dialysis frequency or duration), a goal that can be reached when dialysis takes place in the patient’s home [ 8 ]. Due to the high symptom burden and the complexity of their illness and treatment, patients undergoing hemodialysis are dependent on effective and real-time communication with the renal health care professionals for optimal QOL [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Interventions, Participative Role, Barriers, and Facilitators for Involvement in eHealth Communication for People Undergoing Hemodialysis: Protocol for a Scoping Review

Deinboll¹,

Moe²,

Ludvigsen³

2022

JMIR Res Protoc

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Background eHealth interventions have been shown to offer people living with chronic kidney disease the opportunity of embracing dialysis therapies with greater confidence, the potential to obtain better clinical outcomes and increased quality of life, and diverse and flexible designs and delivery options. eHealth interventions or solutions can offer one-way information without the possibility for dialogue, as with most mobile apps. eHealth interventions intending to enable two-way communication between patients undergoing hemodialysis and health professionals are the focus of this review. eHealth communication interventions that enable two-way communication between patients undergoing hemodialysis and health professionals is an emerging field, but issues relating to participation in eHealth communication for patients undergoing hemodialysis are scarcely described. The current conceptualization of this issue is too scattered to inform the development of future interventions. In this scoping review, we want to assemble and examine this scattered knowledge on participation in two-way eHealth communication for patients undergoing hemodialysis. Objective We want to understand the participative role of people living with chronic kidney disease undergoing hemodialysis in available communicative eHealth interventions and to understand which barriers and facilitators exist for patient involvement in eHealth communication with health professionals. Methods A scoping review methodology is guiding this study. Peer-reviewed primary studies, including quantitative, qualitative, and mixed methods study designs will be included. A systematic search for published studies, dissertations, and theses at the doctoral level in the English language will be conducted in five databases (MEDLINE, Embase, CINAHL, Scopus, and ProQuest Dissertations and Theses). The included literature will focus on adult (18 years or older) patients undergoing hemodialysis who are involved in eHealth communication with health professionals. Data on the type of eHealth communication interventions, the participative role, and barriers and facilitators for the involvement in eHealth communication for people undergoing hemodialysis will be extracted independently by two reviewers. The extracted data will be collected in a draft charting table prepared for the study. Any discrepancies between the reviewers will be solved through discussion or with a third reviewer. Results Results are anticipated by the spring of 2023 and will be presented in tabular format along with a narrative summary. The anticipated results will be presented in alignment with the objectives of the study, presenting findings on the participative role of patients undergoing hemodialysis in eHealth communication interventions. Conclusions We anticipate that this study will inform on eHealth communication interventions and the level of patient participation in eHealth communication for patients undergoing hemodialysis. The systematized overview will possibly identify research gaps and motivate further development of eHealth communication to ensure patient participation. The findings will be of interest to key stakeholders in clinical care, research, development, policy, and patient advocacy. International Registered Report Identifier (IRRID) PRR1-10.2196/38615

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“…It is well recognized that studies reporting survival outcomes with intensive HD—both randomized trials and observational designs—have yielded conflicting results due to various factors, including differences in study populations and other methodological issues. 13 For clinicians seeking to engage patients in shared decision-making around modality choice, these seemingly disparate findings are barriers to truly informed discussions of benefits and harms.…”

Section: Introductionmentioning

confidence: 99%

Mortality and Hospitalizations in Intensive Dialysis: A Systematic Review and Meta-Analysis

Mathew

McLeggon

Mehta

et al. 2018

Can J Kidney Health Dis

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Background:Survival and hospitalization are critically important outcomes considered when choosing between intensive hemodialysis (HD), conventional HD, and peritoneal dialysis (PD). However, the comparative effectiveness of these modalities is unclear.Objective:We had the following aims: (1) to compare the association of mortality and hospitalization in patients undergoing intensive HD, compared with conventional HD or PD and (2) to appraise the methodological quality of the supporting evidence.Data Sources:MEDLINE, Embase, ISI Web of Science, CENTRAL, and nephrology conference abstracts.Study Eligibility, Participants, and Interventions:We included cohort studies with comparator arm, and randomized controlled trials (RCTs) with >50% of adult patients (≥18 years) comparing any form of intensive HD (>4 sessions/wk or >5.5 h/session) with any form of chronic dialysis (PD, HD ≤4 sessions/wk or ≤5.5 h/session), that reported at least 1 predefined outcome (mortality or hospitalization).Methods:We used the GRADE approach to systematic reviews and quality appraisal. Two reviewers screened citations and full-text articles, and extracted study-level data independently, with discrepancies resolved by consensus. We pooled effect estimates of randomized and observational studies separately using generic inverse variance with random effects models, and used fixed-effects models when only 2 studies were available for pooling. Predefined subgroups for the intensive HD cohorts were classified by nocturnal versus short daily HD and home versus in-center HD.Results:Twenty-three studies with a total of 70 506 patients were included. Of the observational studies, compared with PD, intensive HD had a significantly lower mortality risk (hazard ratio [HR]: 0.67; 95% confidence interval [CI]: 0.53-0.84; I2 = 91%). Compared with conventional HD, home nocturnal (HR: 0.46; 95% CI: 0.38-0.55; I2 = 0%), in-center nocturnal (HR: 0.73; 95% CI: 0.60-0.90; I2 = 57%) and home short daily (HR: 0.54; 95% CI: 0.31-0.95; I2 = 82%) intensive regimens had lower mortality. Of the 2 RCTs assessing mortality, in-center short daily HD had lower mortality (HR: 0.54; 95% CI: 0.31-0.93), while home nocturnal HD had higher mortality (HR: 3.88; 95% CI: 1.27-11.79) in long-term observational follow-up. Hospitalization days per patient-year (mean difference: –1.98; 95% CI: –2.37 to −1.59; I2 = 6%) were lower in nocturnal compared with conventional HD. Quality of evidence was similarly low or very low in RCTs (due to imprecision) and observational studies (due to residual confounding and selection bias).Limitations:The overall quality of evidence was low or very low for critical outcomes. Outcomes such as quality of life, transplantation, and vascular access outcomes were not included in our review.Conclusions:Intensive HD regimens may be associated with reduced mortality and hospitalization compared with conventional HD or PD. As the quality of supporting evidence is low, patients who place a high value on survival must be adequately advised and counseled of ris...

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Survival comparisons of intensive vs. conventional hemodialysis: Pitfalls and lessons

Cited by 12 publications

References 41 publications

Design of therapeutic education workshops for home haemodialysis in a patient-centered chronic kidney diseases research: a qualitative study

Design of therapeutic education workshops for home haemodialysis in a patient-centered chronic kidney diseases research: a qualitative study

Interventions, Participative Role, Barriers, and Facilitators for Involvement in eHealth Communication for People Undergoing Hemodialysis: Protocol for a Scoping Review

Mortality and Hospitalizations in Intensive Dialysis: A Systematic Review and Meta-Analysis

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