Risk of hospitalization, technique failure, and death with increased training duration in 3‐days‐a‐week home hemodialysis

2021 ◽  
Author(s):  
Catherine Morin ◽  
Isabelle Gionest ◽  
Louis‐Philippe Laurin ◽  
Rémi Goupil ◽  
Annie‐Claire Nadeau‐Fredette
Keyword(s):  
Home Hemodialysis ◽  
Technique Failure

Determinants of training and technique failure in home hemodialysis

2013 ◽  
Vol 17 (3) ◽  
Author(s):  
Michael E. Schachter ◽  
Karthik K. Tennankore ◽  
Christopher T. Chan
Keyword(s):  
Home Hemodialysis ◽  
Technique Failure

scholarly journals Quality Assurance Audit of Technique Failure and 90-Day Mortality after Program Discharge in a Canadian Home Hemodialysis Program

2017 ◽  
Vol 12 (8) ◽  
pp. 1259-1264 ◽  
Author(s):  
Nikhil Shah ◽  
Frances Reintjes ◽  
Mark Courtney ◽  
Scott W. Klarenbach ◽  
Feng Ye ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Home Hemodialysis ◽  
Technique Failure

Technique Failure in a Multicenter Canadian Home Hemodialysis Cohort

2019 ◽  
Vol 73 (2) ◽  
pp. 230-239 ◽  
Author(s):  
Robert P. Pauly ◽  
Rhonda J. Rosychuk ◽  
Iram Usman ◽  
Frances Reintjes ◽  
Maliha Muneer ◽  
...  
Keyword(s):  
Home Hemodialysis ◽  
Technique Failure

scholarly journals Understanding Home Hemodialysis Patient Attrition: A Cohort Study

2021 ◽  
Vol 8 ◽  
pp. 205435812110221
Author(s):  
Bailey Paterson ◽  
Danielle E. Fox ◽  
Chel Hee Lee ◽  
Victoria Riehl-Tonn ◽  
Elena Qirzaji ◽  
...  
Keyword(s):  
Cohort Study ◽  
Median Time ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Failure Time ◽  
Cumulative Probability ◽  
Home Hemodialysis ◽  
Number Of Patients ◽  
Small Patient Population ◽  
Technique Failure

Background: Home hemodialysis (HHD) offers a flexible, patient-centered modality for patients with kidney failure. Growth in HHD is achieved by increasing the number of patients starting HHD and reducing attrition with strategies to prevent the modifiable reasons for loss. Objective: Our primary objective was to describe a Canadian HHD population in terms of technique failure and time to exit from HHD in order to understand reasons for exit. Our secondary objectives include the following: (1) determining reasons for training failure, (2) reasons for early exit from HHD, and (3) timing of program exit. Design: A retrospective cohort study of incident adult HHD patients between January 1, 2013—June 30, 2020. Setting: Alberta Kidney Care South, AKC-S HHD program. Participants: Patients who started training for HHD in AKC-S. Methods: A retrospective, cohort study of incident adult HHD patients with primary outcome time on home hemodialysis, secondary outcomes include reason for train failure, time to and reasons for technique failure. Cox-proportional hazard model to determine associations between patient characteristics and technique failure. The cumulative probability of technique failure over time was reported using a competing risks model. Results: A total of 167 patients entered HHD. Training failure occurred in 20 (12%), at 3.1 [2.0, 5.5] weeks; these patients were older ( P < .001) and had 2 or more comorbidities ( P < .001). Reasons for HHD exit after training included transplant (35; 21%), death (8; 4.8%), and technique failure (24; 14.4%). Overall, the median time to HHD exit, was 23 months [11, 41] and the median time of technique failure was 17 months [8.9, 36]. Reasons for technique failure included: psychosocial reasons (37%) at a median time 8.9 months [7.7, 13], safety (12.5%) at 19 months [19, 36], and medical (37.5%) at 26 months [11, 50]. Limitations: Small patient population with quality of data limited by the electronic-based medical record and non-standardized definitions of reasons for exit. Conclusions: Training failure is a particularly important source of patient loss. Reasons for exit differ according to duration on HHD. Early interventions aimed at reducing train failure and increasing psychosocial supports may help program growth.

scholarly journals Predictors of Transfer to Home Hemodialysis after Peritoneal Dialysis Completion

2016 ◽  
Vol 36 (5) ◽  
pp. 547-554 ◽  
Author(s):  
Annie-Claire Nadeau-Fredette ◽  
Carmel Hawley ◽  
Elaine Pascoe ◽  
Christopher T. Chan ◽  
Martine Leblanc ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Competing Risks ◽  
Odds Ratio ◽  
Torres Strait Islander ◽  
Patient Characteristics ◽  
Home Hemodialysis ◽  
Competing Risks Analysis ◽  
Male Sex ◽  
Torres Strait ◽  
Technique Failure

BackgroundThe aim of the present study was to evaluate the predictors of transfer to home hemodialysis (HHD) after peritoneal dialysis (PD) completion.MethodsAll Australian and New Zealand patients treated with PD on day 90 after initiation of renal replacement therapy between 2000 and 2012 were included. Completion of PD was defined by death, transplantation, or hemodialysis (HD) for 180 days or more. Patients were categorized as “transferred to HHD” if they initiated HHD fewer than 180 days after PD had ended. Multivariable logistic regression was used to evaluate predictors of transfer to HHD in a restricted cohort experiencing PD technique failure; a competing-risks analysis was used in the unrestricted cohort.ResultsOf 10 710 incident PD patients, 3752 died, 1549 underwent transplantation, and 2915 transferred to HD, among whom 156 (5.4%) started HHD. The positive predictors of transfer to HHD in the restricted cohort were male sex [odds ratio (OR): 2.81], obesity (OR: 2.20), and PD therapy duration (OR: 1.10 per year). Negative predictors included age (OR: 0.95 per year), infectious cause of technique failure (OR: 0.48), underweight (OR: 0.50), kidney disease resulting from hypertension (OR: 0.38) or diabetes (OR: 0.32), race being Maori (OR: 0.65) or Aboriginal and Torres Strait Islander (OR: 0.30). Comparable results were obtained with a competing-risks model.ConclusionsTransfer to HHD after completion of PD is rare and predicted by patient characteristics at baseline and at the time of PD end. Transition to HHD should be considered more often in patients using PD, especially when they fulfill the identified characteristics.

scholarly journals Use of Home Hemodialysis after Peritoneal Dialysis Technique Failure

2013 ◽  
Vol 33 (1) ◽  
pp. 96-99 ◽  
Author(s):  
Davide P. Cinà ◽  
Niki Dacouris ◽  
Mina Kashani ◽  
Beth Unana ◽  
Ramona Cook ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Home Hemodialysis ◽  
Technique Failure ◽  
Dialysis Technique

scholarly journals A comparison of technique survival in Canadian peritoneal dialysis and home hemodialysis patients

2019 ◽  
Vol 34 (11) ◽  
pp. 1941-1949 ◽  
Author(s):  
Emilie Trinh ◽  
James A Hanley ◽  
Annie-Claire Nadeau-Fredette ◽  
Jeffrey Perl ◽  
Christopher T Chan
Keyword(s):  
Peritoneal Dialysis ◽  
Risk Model ◽  
Patient Characteristics ◽  
First Year ◽  
Home Hemodialysis ◽  
Home Dialysis ◽  
Technique Survival ◽  
And Gender ◽  
Technique Failure

AbstractBackgroundHigh discontinuation rates remain a challenge for home hemodialysis (HHD) and peritoneal dialysis (PD). We compared technique failure risks among Canadian patients receiving HHD and PD.MethodsUsing the Canadian Organ Replacement Register, we studied adult patients who initiated HHD or PD within 1 year of beginning dialysis between 2000 and 2012, with follow-up until 31 December 2013. Technique failure was defined as a transfer to any alternative modality for a period of ≥60 days. Technique survival between HHD and PD was compared using a Fine and Gray competing risk model. We also examined the time dependence of technique survival, the association of patient characteristics with technique failure and causes of technique failure.ResultsBetween 2000 and 2012, 15 314 patients were treated with a home dialysis modality within 1 year of dialysis initiation: 14 461 on PD and 853 on HHD. Crude technique failure rates were highest during the first year of therapy for both home modalities. During the entire period of follow-up, technique failure was lower with HHD compared with PD (adjusted hazard ratio = 0.79; 95% confidence interval 0.69–0.90). However, the relative technique failure risk was not proportional over time and the beneficial association with HHD was only apparent after the first year of dialysis. Comparisons also varied among subgroups and the superior technique survival associated with HHD relative to PD was less pronounced in more recent years and among older patients. Predictors of technique failure also differed between modalities. While obesity, smoking and small facility size were associated with higher technique failure in both PD and HHD, the association with age and gender differed. Furthermore, the majority of discontinuation occurred for medical reasons in PD (38%), while the majority of HHD patients experienced technique failure due to social reasons or inadequate resources (50%).ConclusionsIn this Canadian study of home dialysis patients, HHD was associated with better technique survival compared with PD. However, patterns of technique failure differed significantly among these modalities. Strategies to improve patient retention across all home dialysis modalities are needed.

scholarly journals Causes for Withdrawal in an Urban Peritoneal Dialysis Program

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Biruh Workeneh ◽  
Danielle Guffey ◽  
Charles G. Minard ◽  
William E. Mitch
Keyword(s):  
Peritoneal Dialysis ◽  
Urban Areas ◽  
The United States ◽  
Infectious Complications ◽  
Patient Choice ◽  
Home Hemodialysis ◽  
Dialysis Therapy ◽  
Technique Survival ◽  
Ultrafiltration Failure ◽  
Technique Failure

Background. Peritoneal dialysis (PD) is an underutilized dialysis modality in the United States, especially in urban areas with diverse patient populations. Technique retention is a major concern of dialysis providers and might influence their approach to patients ready to begin dialysis therapy.Methods. Records from January 2009 to March 2014 were abstracted for demographic information, technique duration, and the reasons for withdrawal.Results. The median technique survival of the 128 incident patients during the study window was 781 days (2.1 years). The principle reasons for PD withdrawal were repeated peritonitis (30%); catheter dysfunction (18%); ultrafiltration failure (16%); patient choice or lack of support (16%); or hernia, leak, or other surgical complications (6%); and a total of 6 patients died during this period. Of the patients who did not expire and were not transplanted, most transferred to in-center hemodialysis and 8% transitioned to home-hemodialysis.Conclusions. Our findings suggest measures to ensure proper catheter placement and limiting infectious complications should be primary areas of focus in order to promote technique retention. Lastly, more focused education about home-hemodialysis as an option may allow those on PD who are beginning to demonstrate signs of technique failure to stay on home therapy.

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