ABSTRACT
INTRODUCTION: This study explored employment trends among working-age patients undergoing hemodialysis using 5-year surveys from 1996 to 2021. Policy changes affecting individuals with disabilities, the economic environment, and employment status among the general population in Japan were considered. Differences in trends by gender and health status were examined. METHODS: Employment status was categorized into employment and nonemployment; and regular, nonregular, and self. Analytical data with similar characteristics were generated over the six surveys using the propensity score method. RESULTS: The employment rate, especially among women, increased from 1996 to 2021. However, the employment rate ratio to the general population was approximately 80% for men and 50% for women, even in 2021. The employment rate increased with an expansion in nonregular employment. Women's employment trends could be explained by changes in real gross domestic product and employment quotas for individuals with disabilities. CONCLUSION: Employment trends differ by gender and by regular versus nonregular employment.
Subject(s)
Employment , Renal Dialysis , Humans , Male , Female , Renal Dialysis/economics , Renal Dialysis/statistics & numerical data , Renal Dialysis/trends , Employment/statistics & numerical data , Employment/trends , Japan , Middle Aged , Adult , Sex Factors , Surveys and Questionnaires , Disabled Persons/statistics & numerical data , Health StatusABSTRACT
OBJECTIVE: Although forearm arteriovenous fistulas (AVFs) are the preferred initial vascular access for hemodialysis based on national guidelines, there are no population-level studies evaluating trends in creation of forearm vs upper arm AVFs and arteriovenous grafts (AVGs). The purpose of this study was to report temporal trends in first-time permanent hemodialysis access type, and to assess the effect of national initiatives on rates of AVF placement. METHODS: Retrospective cross-sectional study (2012-2022) utilizing the Vascular Quality Initiative database. All patients older than 18 years with creation of first-time upper extremity surgical hemodialysis access were included. Anatomic location of the AVF or AVG (forearm vs upper arm) was defined based on inflow artery, outflow vein, and presumed cannulation zone. Primary analysis examined temporal trends in rates of forearm vs upper arm AVFs and AVGs using time series analyses (modified Mann-Kendall test). Subgroup analyses examined rates of access configuration stratified by age, sex, race, dialysis, and socioeconomic status. Interrupted time series analysis was performed to assess the effect of the 2015 Fistula First Catheter Last initiative on rates of AVFs. RESULTS: Of the 52,170 accesses, 57.9% were upper arm AVFs, 25.2% were forearm AVFs, 15.4% were upper arm AVGs, and 1.5% were forearm AVGs. From 2012 to 2022, there was no significant change in overall rates of forearm or upper arm AVFs. There was a numerical increase in upper arm AVGs (13.9 to 18.2 per 100; P = .09), whereas forearm AVGs significantly declined (1.8 to 0.7 per 100; P = .02). In subgroup analyses, we observed a decrease in forearm AVFs among men (33.1 to 28.7 per 100; P = .04) and disadvantaged (Area Deprivation Index percentile ≥50) patients (29.0 to 20.7 per 100; P = .04), whereas female (17.2 to 23.1 per 100; P = .03), Black (15.6 to 24.5 per 100; P < .01), elderly (age ≥80 years) (18.7 to 32.5 per 100; P < .01), and disadvantaged (13.6 to 20.5 per 100; P < .01) patients had a significant increase in upper arm AVGs. The Fistula First Catheter Last initiative had no effect on the rate of AVF placement (83.2 to 83.7 per 100; P=.37). CONCLUSIONS: Despite national initiatives to promote autogenous vascular access, the rates of first-time AVFs have remained relatively constant, with forearm AVFs only representing one-quarter of all permanent surgical accesses. Furthermore, elderly, Black, female, and disadvantaged patients saw an increase in upper arm AVGs. Further efforts to elucidate factors associated with forearm AVF placement, as well as potential physician, center, and regional variation is warranted.
Subject(s)
Arteriovenous Shunt, Surgical , Databases, Factual , Forearm , Renal Dialysis , Humans , Arteriovenous Shunt, Surgical/trends , Arteriovenous Shunt, Surgical/statistics & numerical data , Renal Dialysis/trends , Female , Male , Retrospective Studies , Cross-Sectional Studies , Middle Aged , Aged , Time Factors , Forearm/blood supply , United States , Treatment Outcome , Blood Vessel Prosthesis Implantation/trends , Blood Vessel Prosthesis Implantation/adverse effects , Risk Factors , Adult , Upper Extremity/blood supply , Practice Patterns, Physicians'/trends , Interrupted Time Series AnalysisABSTRACT
La hemodiálisis (HD) con líquido de diálisis (LD) con bicarbonato requiere la presencia de un ácido para prevenir la precipitación del carbonato de calcio y magnesio. El más usado es el ácido acético, y con él se han descrito diversas complicaciones. En un trabajo previo describimos los cambios agudos, durante una sesión, en los pacientes en HD con un LD con citrato en lugar de acetato, y en este referimos los resultados a medio plazo: 16 semanas.Es un estudio prospectivo, multicéntrico, cruzado y aleatorizado, donde 56 pacientes en HD con bicarbonato 3 veces a la semana se dializaron 16 semanas con 3mmol/l acetato y 16 semanas con 1mmol/l de citrato. Se incluyeron pacientes mayores de 18 años con una estancia en HD previa superior a 3 meses y con fístula arteriovenosa normofuncionante. Se recogieron mensualmente datos epidemiológicos, de diálisis, bioimpedancia, bioquímica pre y postHD, así como los episodios de hipotensión.Después de 16 semanas de tratamiento con citrato el calcio iónico y el magnesio preHD eran significativamente inferiores y la hormona paratiroidea (PTH) más alta que en el periodo con acetato. No se observaron diferencias en la eficacia de la diálisis. Los episodios de hipotensión fueron significativamente más frecuentes con acetato que con citrato: 311 (14,1%) vs. 238 (10,8%) sesiones. El índice de masa magra se incrementó en 0,96±2,33kg/m2 cuando los pacientes pasaron de LD con acetato a citrato.La HD con citrato modifica varios parámetros del metabolismo óseo-mineral, no solo de forma aguda como se había descrito, sino también a medio plazo. La sustitución del acetato por el citrato mejora la estabilidad hemodinámica, produciendo menos hipotensiones y puede mejorar el estado nutricional. (AU)
Hemodialysis (HD) with bicarbonate dialysis fluid (DF) requires the presence of an acid to prevent the precipitation of calcium and magnesium carbonate. The most used acid is acetic acid, with it several complications have been described. In a previous work, we described the acute changes during an HD session with a DF with citrate instead of acetate. Now, we report the results in the medium term, 16 weeks. It is a prospective, multicenter, crossover and randomized study, where 56 HD patients with bicarbonate three times a week were dialysed for 16 weeks with 3mmol/L acetate and 16 weeks with 1mmol/L citrate. Patients older than 18 years with a previous stay on HD of more than 3 months and with a normal functioning arteriovenous fistula were included. Epidemiological data, dialysis, bioimpedance, biochemistry before and after HD, as well as hypotensive episodes, were collected monthly. After 16 weeks of citrate treatment, pre-HD ionic calcium and magnesium were significantly lower and paratiroid hormone (PTH) higher than in the acetate period. No differences were observed in the effectiveness of dialysis. Hypotensive episodes were significantly more frequent with acetate than with citrate: 311 (14.1%) vs 238 (10.8%) sessions. The lean mass index increased by 0.96±2.33kg/m2 when patients switched from DF with acetate to citrate.HD with citrate modifies several parameters of bone mineral metabolism, not only acutely as previously described, but also in the long-term. The substitution of acetate for citrate improves hemodynamic stability, producing less hypotension and can improve nutritional status. (AU)
Subject(s)
Humans , Renal Dialysis/methods , Renal Dialysis/trends , Citric Acid/therapeutic use , Magnesium/therapeutic use , Calcium/therapeutic use , Acetates/therapeutic use , Prospective Studies , Stochastic Processes , Cross-Over StudiesABSTRACT
OBJECTIVES: This study investigated the psychological status of patients and staff, and the implementation of preventative measures in hemodialysis centers in Guangdong province, China, during the 2019 novel coronavirus disease (COVID-19) pandemic. METHODS: An electronic questionnaire survey was carried out anonymously between March 28 and April 3, 2020. All of the 516 hemodialysis centers registered in Guangdong province were invited to participate in the survey. The questionnaires were designed to investigate the psychological status of hemodialysis patients and general staff members (doctors, nurses, technicians, and other staff), and to address the implementation of preventative measures for administrators (directors or head nurses) of the hemodialysis centers. RESULTS: A total of 1782 patients, 3400 staff, and 420 administrators voluntarily participated in this survey. Patients living in rural areas reported a higher incidence of severe anxiety compared to those living in other areas (in rural areas, towns, and cities, the incidence rate was 17.0%, 9.0%, and 8.9%, respectively, P < 0.001). Medical staff were less likely to worry about being infected than non-medical staff (13.1% vs 30.3%, respectively, P < 0.001). With respect to the implementation of preventative measures, hemodialysis centers in general hospitals outperformed stand-alone blood purification centers, while tertiary hospitals outperformed hospitals of other levels. However, restrictions regarding the admission of non-resident patients were lower in tertiary hospitals than in other hospitals. In this situation, only one patient imported from Hubei province was diagnosed with COVID-19. CONCLUSIONS: COVID-19 did not significantly affect the psychological status of most patients and medical staff members. Due to the implementation of comprehensive preventative measures, there were no cluster outbreaks of COVID-19 in hemodialysis centers. This provincial-level survey may provide referential guidance for other countries and regions that are experiencing a similar pandemic.
Subject(s)
Attitude of Health Personnel , COVID-19 , Infection Control/organization & administration , Kidney Failure, Chronic , Preventive Medicine , Renal Dialysis , COVID-19/epidemiology , COVID-19/prevention & control , China/epidemiology , Female , Humans , Incidence , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/psychology , Kidney Failure, Chronic/therapy , Male , Middle Aged , Organizational Innovation , Preventive Medicine/methods , Preventive Medicine/organization & administration , Psychology , Renal Dialysis/methods , Renal Dialysis/trends , SARS-CoV-2 , Surveys and QuestionnairesABSTRACT
Importance: Persons with kidney failure require treatment (ie, dialysis or transplantation) for survival. The burden of the COVID-19 pandemic and pandemic-related disruptions in care have disproportionately affected racial and ethnic minority and socially disadvantaged populations, raising the importance of understanding disparities in treatment initiation for kidney failure during the pandemic. Objective: To examine changes in the number and demographic characteristics of patients initiating treatment for incident kidney failure following the COVID-19 pandemic by race and ethnicity, county-level COVID-19 mortality rate, and neighborhood-level social disadvantage. Design, Setting, and Participants: This cross-sectional time-trend study used data from US patients who developed kidney failure between January 1, 2018, and June 30, 2020. Data were analyzed between January and July 2021. Exposures: COVID-19 pandemic. Main Outcomes and Measures: Number of patients initiating treatment for incident kidney failure and mean estimated glomerular filtration rate (eGFR) at treatment initiation. Results: The study population included 127â¯149 patients with incident kidney failure between January 1, 2018, and June 30, 2020 (mean [SD] age, 62.8 [15.3] years; 53â¯021 [41.7%] female, 32â¯932 [25.9%] non-Hispanic Black, and 19â¯835 [15.6%] Hispanic/Latino patients). Compared with the pre-COVID-19 period, in the first 4 months of the pandemic (ie, March 1 through June 30, 2020), there were significant decreases in the proportion of patients with incident kidney failure receiving preemptive transplantation (1805 [2.1%] pre-COVID-19 vs 551 [1.4%] during COVID-19; P < .001) and initiating hemodialysis treatment with an arteriovenous fistula (2430 [15.8%] pre-COVID-19 vs 914 [13.4%] during COVID-19; P < .001). The mean (SD) eGFR at initiation declined from 9.6 (5.0) mL/min/1.73 m2 to 9.5 (4.9) mL/min/1.73 m2 during the pandemic (P < .001). In stratified analyses by race/ethnicity, these declines were exclusively observed among non-Hispanic Black patients (mean [SD] eGFR: 8.4 [4.6] mL/min/1.73 m2 pre-COVID-19 vs 8.1 [4.5] mL/min/1.73 m2 during COVID-19; P < .001). There were significant declines in eGFR at initiation for patients residing in counties in the highest quintile of COVID-19 mortality rates (9.5 [5.0] mL/min/1.73 m2 pre-COVID-19 vs 9.2 [5.0] mL/min/1.73 m2 during COVID-19; P < .001), but not for patients residing in other counties. The number of patients initiating treatment for incident kidney failure was approximately 30% lower than projected in April 2020. Conclusions and Relevance: In this cross-sectional study of US adults, the COVID-19 pandemic was associated with a substantially lower number of patients initiating treatment for incident kidney failure and treatment initiation at lower levels of kidney function during the first 4 months, particularly for Black patients and people living in counties with high COVID-19 mortality rates.
Subject(s)
COVID-19 , Ethnicity , Health Services Accessibility/trends , Healthcare Disparities/trends , Minority Groups , Renal Insufficiency/therapy , Social Class , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/mortality , Cross-Sectional Studies , Female , Health Services Accessibility/economics , Healthcare Disparities/economics , Healthcare Disparities/ethnology , Humans , Kidney Transplantation/economics , Kidney Transplantation/trends , Male , Middle Aged , Pandemics , Poisson Distribution , Renal Dialysis/economics , Renal Dialysis/trends , Renal Insufficiency/economics , Renal Insufficiency/ethnology , Residence Characteristics , United States/epidemiology , Vulnerable Populations , Young AdultABSTRACT
INTRODUCTION: This study was conducted to better understand hemodialysis by reviewing the most-cited articles related to it. METHODS: We searched articles on the Web of Science and selected the 100 most frequently cited articles. Subsequently, we reviewed these articles and identified their characteristics. RESULTS: The 100 most frequently cited articles were published in 21 journals. The majority of these papers were published in the following journals: Kidney International (26 articles), New England Journal of Medicine (18 articles), Journal of the American Society of Nephrology (14 articles), and the American Journal of Kidney Disease (13 articles). The 100 most-cited articles were published in 25 countries. The United States of America was the country with the highest number of publications (65 articles). The University of Michigan was the institution with the highest number of articles (14 articles). FK Port was the author with the largest number of publications (13 articles). CONCLUSIONS: This is the first study in the field of nephrology that provides a list of the 100 most-cited articles on hemodialysis. Through this study, clinicians will be able to recognize major academic interests and research trends in hemodialysis.
Subject(s)
Renal Dialysis/trends , Bibliometrics , Humans , Renal Dialysis/methods , Renal Dialysis/standardsABSTRACT
Coronavirus disease (COVID-19) causes many deleterious effects throughout the body. Prior studies show that the incidence of acute kidney injury in COVID-19 patients could be as high as 25%. There are also autopsy reports showing evidence of viral tropism to the renal system. In this regard, COVID-19 can damage the kidneys and increase a patient's risk of requiring dialysis. Available evidence suggests that renal involvement in COVID-19 infection is not uncommon, and there has been an increased incidence of chronic kidney disease related to the pandemic. In this literature analysis, we address COVID-19 and its effects on the renal system, including the pathophysiologic mechanisms. We also address current studies on the causes of injury to the renal system, the cause of kidney failure, its effect on mortality, the impact on dialysis patients, and the impact on renal transplant patients. COVID-19 disease may have unique features in individuals on chronic dialysis and kidney transplant recipients, requiring increased vigilance in limiting viral transmission in perioperative, in-patient, and dialysis center settings.
Subject(s)
COVID-19/physiopathology , Kidney Diseases/physiopathology , Kidney/physiopathology , COVID-19/epidemiology , COVID-19/therapy , Humans , Kidney/virology , Kidney Diseases/epidemiology , Kidney Diseases/therapy , Kidney Diseases/virology , Renal Dialysis/methods , Renal Dialysis/trends , Treatment OutcomeABSTRACT
With both the elongation of hemodialysis (HD) duration resulting from the sophistication of HD technology and the increasing age at the time of HD initiation due to the aging society of Japan, the mean age of prevalent HD patients is increasing at an accelerating rate [...].
Subject(s)
Kidney Failure, Chronic/therapy , Life Expectancy/trends , Longevity , Quality of Life , Renal Dialysis/trends , Age Factors , Aged, 80 and over , Female , Humans , Japan , Kidney Failure, Chronic/complications , Male , Malnutrition/etiology , Malnutrition/therapy , Renal Dialysis/adverse effects , Time FactorsABSTRACT
The stroke incidence in hemodialysis (HD) patients is high, but the associated factors remain largely unknown. This study aimed to analyze stroke incidence in HD patients and changes in risk factors. Data of 291 patients were retrospectively analyzed. The cumulative stroke incidences were 21.6% at 10 years and 31.5% at 20. Diabetic nephropathy (DN) significantly increased overall stroke (hazard ratio (HR), 2.24; 95% confidence interval (CI), 1.21-4.12; p = 0.001) and ischemic stroke (HR, 2.16; 95% CI, 1.00-4.64; p = 0.049). Patients treated with online HDF were less likely to have overall stroke (HR, 0.13; 95% CI, 0.03-0.56; p = 0.006) and ischemic stroke (HR, 0.08; 95% CI, 0.01-0.60; p = 0.014). DN (HR, 1.56; 95% CI, 1.08-2.27; p = 0.019) and age >80 years at HD initiation (20-49 years old; HR 0.13, 95% CI, 0.05-0.35, p < 0.001 and age 50-79 years; HR 0.42, 95% CI, 0.26-0.66, p < 0.001 (reference: age >80 years)) were significantly associated with stroke and/or death events. Over time, stroke risk increased in HD patients, due to the increasing number of DN. Although dialysis technology has advanced over time, these advances could not overcome other risk factors for stroke. Further increase in stroke and mortality due to aging remains a concern.
Subject(s)
Diabetic Nephropathies/complications , Renal Dialysis/methods , Stroke/epidemiology , Adult , Age Factors , Aged , Aged, 80 and over , Diabetic Nephropathies/epidemiology , Female , Humans , Incidence , Male , Middle Aged , Renal Dialysis/trends , Retrospective Studies , Risk Factors , Stroke/etiology , Young AdultABSTRACT
RATIONALE & OBJECTIVE: Individuals faced with decisions regarding kidney replacement therapy options need information on how dialysis treatments might affect daily activities and quality of life, and what factors might influence the evolution over time of the impact of dialysis on daily activities and quality of life. STUDY DESIGN: Observational cohort study. SETTING & PARTICIPANTS: 7,771 hemodialysis (HD) and peritoneal dialysis (PD) participants from 6 countries participating in the Peritoneal and Dialysis Outcomes and Practice Patterns Studies (PDOPPS/DOPPS). PREDICTORS: Patient-reported functional status (based on daily living activities), country, demographic and clinical characteristics, and comorbidities. OUTCOME: Employment status and patient-reported outcomes (PROs) including Kidney Disease Quality of Life (KDQOL) instrument physical and mental component summary scores (PCS, MCS), kidney disease burden score, and depression symptoms (Center for Epidemiologic Studies Depression Scale [CES-D] score > 10). ANALYTICAL APPROACH: Linear regression (PCS, MCS, kidney disease burden score), logistic regression (depression symptoms), adjusted for predictors plus 12 additional comorbidities. RESULTS: In both dialysis modalities, patients in Japan had the highest PCS and employment (55% for HD and 68% for PD), whereas those in the United States had the highest MCS score, lowest kidney disease burden, and lowest employment (20% in HD and 42% in PD). After covariate adjustment, the association of age, sex, dialysis vintage, diabetes, and functional status with PROs was similar in both modalities, with women having lower PCS and kidney disease burden scores. Lower functional status (score <11) was strongly associated with lower PCS and MCS scores, a much greater burden of kidney disease, and greater likelihood of depression symptoms (CES-D, >10). The median change in KDQOL-based PROs was negligible over 1 year in participants who completed at least 2 annual questionnaires. LIMITATIONS: Selection bias due to incomplete survey responses. Generalizability was limited to the dialysis populations of the included countries. CONCLUSIONS: Variation exists in quality of life, burden of kidney disease, and depression across countries but did not appreciably change over time. Functional status remained one of the strongest predictors of all PROs. Routine assessment of functional status may provide valuable insights for patients and providers in anticipating outcomes and support needs for patients receiving either PD or HD.
Subject(s)
Cost of Illness , Employment/psychology , Peritoneal Dialysis/psychology , Quality of Life/psychology , Renal Dialysis/psychology , Renal Insufficiency, Chronic/psychology , Aged , Cohort Studies , Cross-Sectional Studies , Employment/trends , Female , Humans , Internationality , Longitudinal Studies , Male , Middle Aged , Peritoneal Dialysis/trends , Prospective Studies , Renal Dialysis/trends , Renal Insufficiency, Chronic/therapySubject(s)
Amyloidosis/pathology , Brain , Patient Acuity , Renal Dialysis/adverse effects , Aged , Amyloidosis/etiology , Autopsy , Female , Humans , Renal Dialysis/trends , Time FactorsABSTRACT
The COVID-19 pandemic has resulted in major disruption to the delivery of both routine and urgent healthcare needs in many institutions across the globe. Vascular access (VA) for haemodalysis (HD) is considered the patient's lifeline and its maintenance is essential for the continuation of a life saving treatment. Prior to the COVID-19 pandemic, the provision of VA for dialysis was already constrained. Throughout the pandemic, inevitably, many patients with chronic kidney disease (CKD) have not received timely intervention for VA care. This could have a detrimental impact on dialysis patient outcomes in the near future and needs to be addressed urgently. Many societies have issued prioritisation to allow rationing based on clinical risk, mainly according to estimated urgency and need for treatment. The recommendations recently proposed by the European and American Vascular Societies in the COVID-19 pandemic era regarding the triage of various vascular operations into urgent, emergent and elective are debatable. VA creation and interventions maintain the lifeline of complex HD patients, and the indication for surgery and other interventions warrants patient-specific clinical judgement and pathways. Keeping the use of central venous catheters at a minimum, with the goal of creating the right access, in the right patient, at the right time, and for the right reasons, is mandatory. These strategies may require local modifications. Risk assessments may need specific "renal pathways" to be developed rather than applying standard surgical risk stratification. In conclusion, in order to recover from the second wave of COVID-19 and prepare for further phases, the provision of the best dialysis access, including peritoneal dialysis, will require working closely with the multidisciplinary team involved in the assessment, creation, cannulation, surveillance, maintenance, and salvage of definitive access.
Subject(s)
Arteriovenous Shunt, Surgical/standards , COVID-19/epidemiology , Delivery of Health Care/standards , Kidney Failure, Chronic/therapy , Pandemics , Renal Dialysis/standards , Arteriovenous Shunt, Surgical/trends , Comorbidity , Humans , Kidney Failure, Chronic/epidemiology , Renal Dialysis/trends , Risk AssessmentABSTRACT
BACKGROUND: CKD is a risk factor for severe COVID-19. However, the clinical spectrum of COVID-19 in hemodialysis patients is still poorly characterized. OBJECTIVE: To analyze the clinical spectrum of COVID-19 on hemodialysis patients. METHOD: A retrospective observational study was conducted on 66 hemodialysis patients. Nasopharyngeal swab PCR and serology for SARS-CoV-2, blood analysis, chest radiography, treatment, and outcomes were assessed. RESULTS: COVID-19 was diagnosed in 50 patients: 38 (76%) were PCR-positive and 12 (24%) were PCR-negative but developed anti-SARS-CoV-2 antibodies. By contrast, 17% of PCR-positive patients failed to develop detectable antibodies against SARS-CoV-2. Among PCR-positive patients, 5/38 (13%) were asymptomatic, while among PCR-negative patients 7/12 (58%) were asymptomatic (p = 0.005) for a total of 12/50 (24%) asymptomatic patients. No other differences were found between PCR-positive and PCR-negative patients. No differences in potential predisposing factors were found between asymptomatic and symptomatic patients except for a lower use of ACE inhibitors among asymptomatic patients. Asymptomatic patients had laboratory evidence of milder disease such as higher lymphocyte counts and oxygen saturation and lower troponin I and interleukin-6 levels than symptomatic patients. Overall mortality was 7/50 (14%) and occurred only in symptomatic PCR-positive patients in whom mortality was 7/33 (21%). CONCLUSIONS: Asymptomatic SARS-CoV-2 infection is common in hemodialysis patients, especially among patients with initial negative PCR that later seroconvert. Thus COVID-19 mortality in hemodialysis patients may be lower than previously estimated based on PCR tests alone.
Subject(s)
Asymptomatic Diseases/epidemiology , COVID-19/diagnosis , COVID-19/epidemiology , Renal Dialysis/trends , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/epidemiology , Aged , Aged, 80 and over , COVID-19/blood , Female , Humans , Male , Middle Aged , Renal Insufficiency, Chronic/blood , Retrospective StudiesABSTRACT
AIM: Haemodialysis treatment prescription varies widely internationally. This study explored patient- and centre-level characteristics associated with weekly haemodialysis hours. METHODS: Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data were analysed. Characteristics associated with weekly duration were evaluated using mixed-effects linear regression models with patient- and centre-level covariates as fixed effects, and dialysis centre and state as random effects using the 2017 prevalent in-centre haemodialysis (ICHD) and home haemodialysis (HHD) cohorts. Evaluation of patterns of weekly duration over time analysed the 2000 to 2017 incident ICHD and HHD cohorts. RESULTS: Overall, 12 494 ICHD and 1493 HHD prevalent patients in 2017 were included. Median weekly treatment duration was 13.5 (interquartile range [IQR] 12-15) hours for ICHD and 16 (IQR 15-20) hours for HHD. Male sex, younger age, higher body mass index, arteriovenous fistula/graft use, Aboriginal and Torres Strait Islander ethnicity and longer dialysis vintage were associated with longer weekly duration for both ICHD and HHD. No centre characteristics were associated with duration. Variability in duration across centres was very limited in ICHD compared with HHD, with variation in HHD being associated with state. Duration did not vary significantly over time for ICHD, whereas longer weekly HHD treatments were reported between 2006 and 2012 compared with before and after this period. CONCLUSION: This study in the Australian and New Zealand haemodialysis population showed that weekly duration was primarily associated with patient characteristics. No centre effect was demonstrated. Practice patterns seemed to differ across states/countries, with more variability in HHD than ICHD.
Subject(s)
Ambulatory Care Facilities/trends , Nephrologists/trends , Practice Patterns, Physicians'/trends , Renal Dialysis/trends , Renal Insufficiency, Chronic/therapy , Adult , Aged , Australia , Female , Healthcare Disparities/trends , Hemodialysis, Home/trends , Humans , Incidence , Male , Middle Aged , Native Hawaiian or Other Pacific Islander , New Zealand/epidemiology , Prevalence , Registries , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/ethnology , Time FactorsABSTRACT
As increasing demand for hemodialysis (HD) treatment incurs significant financial burden to healthcare systems and ecological burden as well, novel therapeutic approaches as well as innovations and technological advances are being sought that could lead to the development of purification devices such as dialyzers with improved characteristics and wearable technology. Novel knowledge such as the development of more accurate kinetic models, the development of novel HD membranes with the use of nanotechnology, novel manufacturing processes, and the latest technology in the science of materials have enabled novel solutions already marketed or on the verge of becoming commercially available. This collaborative article reviews the latest advances in HD as they were presented by the authors in a recent symposium titled "Frontiers in Haemodialysis," held on 12th December 2019 at the Royal Society of Medicine in London.