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Through a quality improvement project, we developed an initiative that leveraged patient- and community-level data to address health disparities and social vulnerability among patients receiving outpatient dialysis, including both in-center and home modalities. Using the Area Deprivation Index, we identified patients living in areas with the highest levels of deprivation and developed targeted interventions to help address adverse social determinants of health to improve patient health outcomes. Our quality improvement project demonstrates the potential of data-driven approaches to identify and address health disparities in outpatient dialysis, and highlights the importance of addressing social determinants of health in improving patient outcomes. [ABSTRACT FROM AUTHOR]

Haemodialysis facilities have a large environmental impact due to high energy, water and consumable usage by haemodialysis equipment. As climate change and natural resource scarcity escalate, all the while the number of people requiring dialysis increases, there is an urgent need for dialysis facilities that meet care needs while minimising environmental impact. To address this, the Australian and New Zealand Society of Nephrology engaged an environmental sustainability consulting practise to develop a best practise guide for the environmentally sustainable design and operation of haemodialysis facilities. Four opportunity areas were considered, namely energy, water, waste and resource recovery, and additional sustainability. A total of 28 environmental improvement initiatives were identified. The majority (n = 23) were general measures that could be applied across all healthcare settings, while five were specific to haemodialysis facilities. Recommendations were made regarding specific measures that should be undertaken and/or standards that must be met to achieve the intent of each initiative. These were stratified to enable their application to both existing dialysis facilities and new builds. The lifecycle stage of a haemodialysis facility to which each initiative applied was highlighted, as was its potential impact. This guide provides a tailored and comprehensive resource for the kidney care community to enable the integration of best practise sustainability considerations into both existing and new facilities. If broadly implemented, it has the potential to markedly improve the environmental impact of haemodialysis provision. [ABSTRACT FROM AUTHOR]

Introduction: Many individuals start dialysis in an acute setting with suboptimal pre‐dialysis education. These individuals are often treated with central venous catheter insertion and initiation of in‐center hemodialysis and only a minority will transfer to a home‐based therapy. The dialysis start unit is a program performing in‐center hemodialysis in a separate space while providing support and education on chronic kidney disease and treatment options in the initial weeks of kidney replacement therapy. We aimed to assess the uptake of home dialysis therapies between 2013 and 2021 among patients who started acute inpatient hemodialysis at University Health Network, Toronto and underwent dialysis at the dialysis start unit. Methods: This is a retrospective observational cohort study based on prospectively collected data. Patients' demographics were obtained from electronic charts. In the dialysis start unit, all patients received dialysis modality education by a nurse educator, dedicated home dialysis nurses, and the allied health care team. Findings: During 2013–2021, 122 patients were dialyzed in the dialysis start unit and included in the study. Among those patients, 68 patients ultimately chose home dialysis (57 peritoneal dialysis and 11 home hemodialysis). Fifty‐four patients continued in‐center hemodialysis. Patients adopting home dialysis were less likely to have diabetes and hypertension as the etiology of kidney failure and more likely to have glomerulonephritis or vasculitis. Discussion: Dialysis modality education is implementable in advanced chronic kidney disease. Individualized education and care after unplanned start dialysis can potentially enhance home dialysis choice and utilization. [ABSTRACT FROM AUTHOR]

Background To estimate the projections of supply and demand for dialysis nurses (DNs) over 5 years in four European countries (France, Italy, Spain and the UK). Methods This study modelled the nursing labour workforce across each jurisdiction by estimating the current nursing labour force, number of nursing graduates and the attrition rate. Results France currently has the greatest demand for DNs (51 325 patients on dialysis), followed by Italy, the UK and Spain with 40 661, 30 301 and 28 007 patients on dialysis, respectively. The number of in-centre haemodialysis (HD) patients is expected to increase in the four countries, while the number of patients on home HD (HHD) or on peritoneal dialysis (PD) is expected to increase in the UK. Currently Italy has the greatest proportion of DNs (2.6%), followed by France (2.1%), Spain (1.7%) and the UK (1.5%). Estimation of the dialysis nursing staff growth rate over 5 years showed that the UK has the greatest estimated growth rate (6%), followed by Italy (2%), France (2%) and Spain (1%). Conclusions Dialysis demand will increase in the coming years, which may exacerbate the DN shortage. Additionally, competencies and training requirements of DNs should be precisely defined. Finally, implementing and facilitating PD and HHD strategies would be helpful for patients, healthcare professionals and healthcare systems and can even help ease the DN shortage. [ABSTRACT FROM AUTHOR]

Background Home dialysis therapies such as peritoneal dialysis (PD) and home hemodialysis (HHD) are beneficial for quality of life and patient empowerment. The short technique survival time partly explains their low prevalence. We aimed to assess the risk of transfer to facility-based hemodialysis in patients treated with autonomous PD, assisted PD and HHD. Methods This was a retrospective study using data from the REIN registry of patients starting home dialysis in France from 2002 to 2019. The risks of transfer to facility-based hemodialysis (HD) were compared between three modalities of home dialysis (HHD, nurse-assisted PD, autonomous PD) using survival models with a propensity score (PS)-matched and unmatched cohort of patients. Results The study included 17 909 patients: 628 in the HHD group, 10 214 in the autonomous PD group, and 7067 in the assisted PD group. During the follow-up period, there were 5347 transfers to facility-based HD. The observed number of transfers was 2458 (13.7%) at 1 year and 5069 (28.3) at 5 years after the start of home dialysis, including 3272 (32%) on autonomous PD, 1648 (23.3%) on assisted PD, and 149 (23.7) on HHD. Owing to clinical characteristics differences, only 38% of HHD patients could be matched to patients from the others group. In the PS-matched cohort, the adjusted Cox model showed no difference in the risk of transfer for assisted PD (cs-HR 1.04, 95% CI 0.75–1.44) or HHD (cs-HR 1.07, 95% CI 0.77–1.48) compared with autonomous PD. Conclusions Unlike results from other countries, where nurse assistance is not fully available for PD-associated care, there was no difference in technique survival between autonomous PD, nurse-assisted PD, and HHD in France. This discrepancy may be attributed to our inclusion of a broader spectrum of patients who derive significant benefits from assisted PD. [ABSTRACT FROM AUTHOR]

Introduction: Muscle cramps are a common and significant complication during haemodialysis, with a prevalence ranging from 35% to 86% among patients. These cramps can greatly impact the quality of life and overall well-being of those undergoing dialysis. Understanding the causes and exploring various treatment and prevention strategies is crucial for managing this condition effectively. Muscle cramps among haemodialysis patients, especially the elderly, can be effectively managed through various interventions. Intradialytic stretching exercises have shown significant promise in reducing cramp severity. Additional therapies like SCDs and acupressure further offer complementary benefits. By implementing these strategies, healthcare providers can enhance the quality of life for hemodialysis patients, ensuring better management of this common and troubling complication. Methodology: The study utilized a Quasi-Experimental Research Design, specifically a one-group pretest and posttest design. This design allows the researchers to measure changes in muscle cramp severity before and after the intervention (leg exercises) within the same group of participants. A Non-Probability Purposive Sampling Technique was employed. This method involves selecting subjects based on specific characteristics and relevance to the study, rather than random sampling. Patients undergoing haemodialysis from Selected government hospitals in Dehradun, Uttrakhand were included in the study Patients who were experiencing frequent muscle cramps during dialysis sessions In-Total 50 patients undergoing haemodialysis in the selected hospitals were included in the study. To assess the effectiveness of leg exercises on muscle cramps among haemodialysis patients, the following tools were used: Structured Questionnaire-Designed to gather demographic information and baseline data on the frequency and severity of muscle cramps. Cramp Severity Scale: A validated scale to quantify the severity of muscle cramps before and after the intervention. Data Collection Process Pre-Intervention Assessment: Demographic Data: Collected using the structured questionnaire. Baseline Cramp Severity; Measured using the cramp severity scale before the implementation of leg exercises .Intervention:-Leg Exercises: Patients performed specific leg exercises during their dialysis sessions over a period of one month. Exercises included ankle pumps, leg raises, quadriceps stretches, and hamstring stretches. Post-Intervention Assessment: Cramp Severity: Re-assessed using the same severity scale to measure the effectiveness of the intervention. Objective: To assess the effectiveness of leg exercises on muscle cramps among patients on haemodialysis in selected Government Hospitals. Conclusion: The study concluded that leg exercises are highly effective in reducing the frequency and severity of muscle cramps among haemodialysis patients. Implementing these exercises as part of the standard care protocol in dialysis units can greatly enhance patient comfort and overall well-being. [ABSTRACT FROM AUTHOR]

This article explores the significance of providing optimal care for Aboriginal and Torres Strait Islander peoples with kidney failure in the Northern Territory of Australia. It emphasizes the importance of addressing health disparities and cultural factors that influence health outcomes in order to improve the well-being of these communities. The article presents a case study of a Torres Strait Islander woman's health journey, highlighting the integration of traditional healing practices with biomedical approaches and the value of patient-centered care. Additionally, the article discusses the role of Storying, a method of knowledge collation and archiving in Aboriginal and Torres Strait Islander cultures, in amplifying marginalized voices and serving as an educational tool for healthcare providers and Indigenous individuals. The article underscores the significance of culturally sensitive care and patient autonomy in achieving positive health outcomes for Indigenous communities, and advocates for a model of care that prioritizes Indigenous self-determination, cultural safety, and acknowledges the social and cultural determinants of health. It also emphasizes the need for sustained support for Indigenous self-determination and the development of a diverse healthcare workforce to comprehensively address Indigenous health needs. [Extracted from the article]

Abstract Background In Japan, home hemodialysis (HHD) has several benefits, including a favorable prognosis, enhanced quality of life (QOL) of patients, and cost-effectiveness. However, the caregiver’s burden in assisting patients on HHD is significant, which influences their decision to continue HHD. This study focused on the relationship between medical and nursing interventions, caregiver resolve to continue HHD, and caregiver quality of life, aiming to create support strategies for caregivers. Methods A multicenter cross-sectional survey was conducted on caregivers of patients on HHD from 150 HHD facilities in Japan. The caregiver’s intent to continue HHD was assessed using a four-tier response scale that evaluated aspects such as caregiver–healthcare provider meetings, caregiver breaks, treatment discussions, difficulty in HHD initiation, and post-initiation medical support. Caregiver QOL was evaluated using the Short-form Health Survey, eight domains (SF-8). Statistical analysis involved χ-squared tests, independent t-tests, and propensity score matching. Results The study achieved a caregiver participation rate of 55.6%. Results indicated that caregivers who were inclined to continue HHD were significantly more likely to receive respite outpatient dialysis and had a better understanding of HHD mechanics as explained by healthcare professionals; however, propensity score matching revealed limited generalizability. There was no significant difference in the SF-8 scores before and after propensity score matching among the groups. Conclusions This study highlights that there are a small number of caregivers who have little motivation to continue HHD and emphasizes the crucial role of support from healthcare professionals. Comprehensive support, including respite dialysis and detailed HHD information, may affect HHD sustainability.

Introduction: Prior observational studies conducted in the hemodialysis population have suggested a reverse association between dialysis‐unit blood pressure (BP) and mortality. The present study aimed to investigate the prognostic association of home versus dialysis‐unit BP with all‐cause mortality in hemodialysis patients. Methods: At baseline, 146 patients receiving maintenance hemodialysis underwent assessment of their BP with the following methods: (i) 2‐week averaged routine predialysis and postdialysis BP measurements; (ii) home BP monitoring for 1 week that included duplicate morning and evening BP measurements with the use of validated devices. Results: Over a median follow‐up period of 38 months (interquartile range [IQR]: 22–54), 44 patients (31.1%) died. In Kaplan–Meier curves, predialysis and postdialysis systolic BP (SBP) was not associated with all‐cause mortality, while home SBP appeared to be of prognostic significance (log rank p = 0.029). After stratifying patients into quartiles, all‐cause mortality was lowest when home SBP was ranging from 128.1 to 136.8 mmHg (quartile 2). In univariate Cox regression analysis, using quartile 2 as a referent category, the risk of all‐cause mortality was 3.32‐fold higher in quartile 1, 1.53‐fold higher in quartile 3 and 3.25‐fold higher in quartile 4. The risk‐association remained unchanged after adjustment for several confounding factors (adjusted hazard ratio: 4.79, 1.79, 3.63 for quartiles 1, 3, and 4 of home systolic BP, respectively). Conclusion: Our findings suggest that among hemodialysis patients, 1‐week averaged home SBP is independently associated with all‐cause mortality. In sharp contrast, SBP recorded either before or after dialysis over 2 weeks is not prognostically informative. [ABSTRACT FROM AUTHOR]

In recent years, the incidence of end-stage kidney disease (ESKD) in China has been increasing annually. Dialysis patients often experience various complications, and they are also a high-risk population for psychological disorders such as anxiety and depression. The choice of dialysis method and the dialysis process are closely related to the daily lives of the patients and their families. All these patients require a patient-centric treatment strategy. Before entering end-stage renal disease (ESRD) and preparing for renal replacement therapy, it is crucial for patients and their families to understand the characteristics of each renal replacement therapy. Considering clinical treatment needs, as well as the patient's living environment, work and study requirements, social reintegration, psychological needs, and personalized preferences, a collaborative decision-making approach is essential to choose an appropriate renal replacement therapy. With the growing preference for shared decision-making, more patients wish to undergo home dialysis treatment. Currently, due to limitations in equipment technology, economic costs, and human resources, home hemodialysis is challenging to widely adopt. Peritoneal dialysis, as a primary form of home dialysis, faces issues such as improper patient operation, poor treatment compliance, delayed prescription adjustments, and intervention for complications due to problems related to training and follow-up management. This article focuses on elucidating the shared decision-making process for ESRD patients,the prescription settings and remote patient follow-up management of automated peritoneal dialysis,which may help to collectively improve the treatment quality and social reintegration of home peritoneal dialysis patients. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the factors associated with delay in arterio-venous fistula formation among the patients with chronic kidney disease on hemodialysis. Study Design: Comparative cross-sectional study. Place and Duration of Study: Combined Military Hospital, Lahore Pakistan, from Jan to Dec 2020. Methodology: Al patients above 18 years of age with chronic kidney disease on maintenance hemodialysis (end stage renal disease) were inducted in the study. Patients requiring hemodialysis for acute kidney injury were excluded from the study. Patients were interviewed face-to-face about their socio-demographic variables, cause of delay and mean delay time from diagnosis to Arterio-venous fistula formation. Results: Out of 292 patients, 228 patients (76%) had a delay in arterio-venous fistula and first dialysis through double lumen catheter. The mean age of these patients was 59.05 years with 78.1% males. The mean delay of these patients was 60.63+26.832 days. Patient unwilingness and lack of awareness of deteriorating renal disease were the commonest factors (35%) in patient related factors and delayed surgical appointment being commonest (49.1%) in health care associated factors. The longest delay time was 69.04±25.759 months which was associated with delayed surgical appointment (p<0.001). Monthly income, gender and age had significant impact on different factors included in this study. Conclusion: The study identified that differences in Arterio-venous fistula maturation with respect to age, gender and sociodemographic factors were significant. Timely formation of Arterio-venous fistula in patients with chronic kidney disease is the most favourable approach to establish vascular access for hemodialysis and improves outcome. [ABSTRACT FROM AUTHOR]

Objective: To determine the long-term survival of patients receiving home hemodialysis (HHD) through self-punctured arteriovenous access. Methods: We conducted an observational study of all patients receiving HHD at our facility between 2001 and 2020. The primary outcome was treatment survival, and it was defined as the duration from HHD initiation to the first event of death or technique failure. The secondary outcomes were the cumulative incidence of technique failure and mortality. Cox proportional hazard models were used to identify the predictive factors for treatment survival. Results: A total of 77 patients (mean age, 50.7 years; 84.4% male; 23.4% with diabetes) were included. The median dialysis duration was 18 hours per week, and all patients self-punctured their arteriovenous fistula. During a median follow-up of 116 months, 30 treatment failures (11 deaths and 19 technique failures) were observed. The treatment survival was 100% at 1 year, 83.5% at 5 years, 67.2% at 10 years, and 34.6% at 15 years. Age (adjusted hazard ratio [aHR], 1.07) and diabetes (aHR, 2.45) were significantly associated with treatment survival. Cardiovascular disease was the leading cause of death, and vascular access-related issues were the primary causes of technique failure, which occurred predominantly after 100 months from HHD initiation. Conclusion: This study showed a favorable long-term prognosis of patients receiving HHD. HHD can be a sustainable form of long-term kidney replacement therapy. However, access-related technique failures occur more frequently in patients receiving it over the long term. Therefore, careful management of vascular access is crucial to enhance technique survival. [ABSTRACT FROM AUTHOR]

The article is an obituary for Prof. Dr. med. Eberhard Ritz, a renowned nephrologist who passed away in Heidelberg, Germany in October 2023 at the age of 85. Ritz was known for his contributions to dialysis technology and the understanding of renal failure. He was a popular lecturer and a skilled moderator in scientific discussions. Ritz was born in Heidelberg in 1938 and pursued his medical studies in Germany, France, and the United States. He became a professor of internal medicine and made significant scientific contributions, particularly in the areas of calcium metabolism, diabetes, and the hormone aldosterone. Ritz was also recognized for his teaching abilities and his efforts to promote nephrology as a discipline. He organized seminars and conferences and served as a board member of various nephrological societies. Ritz's dedication to international scientific cooperation and his knowledge in science, medicine, history, and music were highly regarded. He is remembered as a pioneer and visionary in the field of nephrology. [Extracted from the article]

This article explores the difficulties faced by individuals in need of kidney replacement therapy (KRT) during times of war and armed conflict. It focuses on the impact of ongoing conflicts in Ukraine, Sudan, and Israel-Hamas on funding, patient numbers, dialysis modality, and the availability of supplies. The article emphasizes the vulnerability of individuals with kidney disease during these times and the importance of support and prioritization of their specific needs. It also highlights the need for coordination, preparedness, and advocacy from the kidney community, industry, and professional societies to mitigate the effects of armed conflicts on kidney care. [Extracted from the article]

'Elderly' is most commonly defined as an individual aged 65 years or older. However, this definition fails to account for the differences in genetics, lifestyle and overall health that contribute to significant heterogeneity among the elderly beyond chronological age. As the world population continues to age, the prevalence of chronic diseases, including chronic kidney disease (CKD), is increasing and CKD frequently progresses to kidney failure. Moreover, frailty represents a multidimensional clinical entity highly prevalent in this population, which needs to be adequately assessed to inform and support medical decisions. Selecting the optimal treatment pathway for the elderly and frail kidney failure population, be it haemodialysis, peritoneal dialysis or conservative kidney management, is complex because of the presence of comorbidities associated with low survival rates and impaired quality of life. Management of these patients should involve a multidisciplinary approach including doctors from various specialties, nurses, psychologists, dieticians and physiotherapists. Studies are mostly retrospective and observational, lacking adjustment for confounders or addressing selection and indication biases, making it difficult to use these data to guide treatment decisions. Throughout this review we discuss the difficulty of making a one-size-fits-all recommendation for the clinical needs of older patients with kidney failure. We advocate that a research agenda for optimization of the critical issues we present in this review be implemented. We recommend prospective studies that address these issues, and systematic reviews incorporating the complementary evidence of both observational and interventional studies. Furthermore, we strongly support a shared decision-making process matching evidence with patient preferences to ensure that individualized choices are made regarding dialysis vs conservative kidney management, dialysis modality and optimal vascular access. [ABSTRACT FROM AUTHOR]

A proportion of end-stage kidney disease (ESKD) patients require kidney replacement therapy to maintain clinical stability. Home dialysis therapies offer convenience, autonomy and potential quality of life improvements, all of which were heightened during the COVID-19 pandemic. While the superiority of specific modalities remains uncertain, patient choice and informed decision-making remain crucial. Missed opportunities for home therapies arise from systemic, programmatic and patient-level barriers. This paper introduces the integrated care model which prioritizes the safe and effective uptake of home therapies while also emphasizing patient-centered care, informed decision-making, and comprehensive support. The integrated care framework addresses challenges in patient identification, assessment, eligibility determination, education and modality transitions. Special considerations for urgent dialysis starts are discussed, acknowledging the unique barriers faced by this population. Continuous quality improvement is emphasized, with the understanding that local challenges may require tailored solutions. Overall, the integrated care model aims to create a seamless and beneficial transition to home dialysis therapies, promoting flexibility and improved quality of life for ESKD patients globally. [ABSTRACT FROM AUTHOR]

Use of peritoneal dialysis and home haemodialysis remains low in Europe, with the highest use in Scandinavian countries and the lowest in Eastern and Central Europe despite the advantages for people on dialysis and economic advantages for healthcare systems. This is partly due to the impact of the haemodialysis industry resulting in proliferation of haemodialysis units and nephrologist reimbursement related to use of haemodialysis. Equally important is the bias against home dialysis at both clinician and healthcare system levels. The underlying causes of this bias are discussed in relation to a mechanistic view of the human body, lack of compassion, failure to adjust dialysis provision for older age and frailty, proliferation of small dialysis centres, and complexity of decision-making and clinical care. For home dialysis to flourish, we need to foster a change in attitude to and vision of the aims of healthcare so that enabling meaningful activities of people requiring dialysis, as explored in the Standardized Outcomes in Nephrology initiative, rather than achieving biological numbers become the focus of care delivery. [ABSTRACT FROM AUTHOR]

Peritoneal dialysis (PD) is a form of kidney replacement therapy with the major advantage that it can be performed at home. This has a positive impact on patients' autonomy and quality of life. However, the dialysis population is ageing and physical and/or cognitive impairments are common. These limitations often form a barrier to PD and contribute to the low incidence and prevalence of PD in Europe. Assisted PD can be a solution to this problem. Assisted PD refers to a patient being assisted by a person or device in performing all or part of their dialysis-related tasks, thereby making PD more accessible to elderly but also younger frail patients. In this way, offering an assisted PD program can help lower the threshold for initiating PD. In this review, we provide an overview of the epidemiology of assisted PD in Europe, we discuss the different categories and clinical outcomes of assisted PD, and we present how assisted PD can be implemented in clinical practice as a possible strategy to increase and maintain home dialysis in Europe. [ABSTRACT FROM AUTHOR]

Implementing eHealth requires technological advancement, universal broadband and internet access, and devices to conduct telemedicine and remote patient monitoring in end-stage kidney disease patients receiving home dialysis. Although eHealth was beginning to make inroads in this patient population, the COVID-19 pandemic spurred telemedicine usage when many regulations were waived during the Public Health Emergency to limit the spread of infection by endorsing social distancing. At the same time, two-way communication automatic peritoneal dialysis cyclers were introduced to advance remote patient monitoring. Despite the numerous advantages and potential benefits afforded by both procedures, challenges and untapped resources remain to be addressed. Continuing research to assess the use of eHealth and technological innovation can make eHealth a powerful tool in home dialysis. We review the past, present and future of eHealth and remote patient monitoring in supporting home dialysis. [ABSTRACT FROM AUTHOR]

Peritoneal dialysis (PD) and home hemodialysis (HHD) are the two home dialysis modalities offered to patients. They promote patient autonomy, enhance independence, and are generally associated with better quality of life compared to facility hemodialysis. PD offers some advantages (enhanced flexibility, ability to travel, preservation of residual kidney function, and vascular access sites) but few patients remain on PD indefinitely due to peritonitis and other complications. By contrast, HHD incurs longer and more intensive training combined with increased upfront health costs compared to PD, but is easier to sustain in the long term. As a result, the integrated home dialysis model was proposed to combine the advantages of both home-based dialysis modalities. In this paradigm, patients are encouraged to initiate dialysis on PD and transfer to HHD after PD termination. Available evidence demonstrates the feasibility and safety of this approach and some observational studies have shown that patients who undergo the PD-to-HHD transition have clinical outcomes comparable to patients who initiate dialysis directly on HHD. Nevertheless, the prevalence of PD-to-HHD transfers remains low, reflecting the multiple barriers that prevent the full uptake of home-to-home transitions, notably a lack of awareness about the model, home-care "burnout," clinical inertia after a transfer to facility HD, suboptimal integration of PD and HHD centers, and insufficient funding for home dialysis programs. In this review, we will examine the conceptual advantages and disadvantages of integrated home dialysis, present the evidence that underlies it, identify challenges that prevent its success and finally, propose solutions to increase its adoption. [ABSTRACT FROM AUTHOR]

Background: In Thailand, there is a rapidly increasing population of older persons living with hemodialysis (OPLWH) for whom quality of life and clinical outcomes are their main focus. This study aims to assess the feasibility of an integrated home telehealth model on quality of life and laboratory parameters of OPLWH. Methods: In this study, the second phase of a mixed methods exploratory sequential design was conducted using a repeated measures experimental design. Participants met the inclusion criteria, which included being an OPLWH at a single hemodialysis center of one hospital in Chiang Mai province, Thailand, during the experimental period between 1 April and 30 September 2018, and willing to participate in the study. The 54 participants were purposively selected and randomly assigned to receive either an intervention (n = 24) consisting of health education and health monitoring using a telehealth device (an iPad) and a web application, or usual care (n = 30). The instruments included a demographic data form, which was analyzed using the chi-square test. The health-related quality of life questionnaire (the 9-item Thai Health Status Assessment questionnaire) and blood chemistry (BUN, Cr, Hb, Hct, Alb, K, Kt/V, and nPCR) were compared and measured at baseline, and at 3 and 6 months after enrolment using independent t-test and one-way repeated measures ANOVA. Results: The comparison of quality of life between the two groups at the two points of repeated measurement (after 3 months) showed a statistically significant difference in mental health scores at P < 0.05. Six months after the intervention, mean scores for health outcomes and patients' quality of life improved; however, this change did not reach statistical significance. Conclusions: An integrated home telehealth model implemented by a hemodialysis nurse is a feasible holistic care approach for OPLWH. However, the absence of statistical significance may partly be associated with the clinical characteristics of frailty and risk factors such as increased age, hypertension, diabetes, heart disease, longer dialysis time, and inadequacy of Kt/V. Large-scale multi-centre trials are warranted to fully examine the acceptability of the model. The duration and long-term effects of the telehealth model are also recommended for further investigation. Patient or public contribution: The development of a home telehealth model was a collaborative process between patients, caregivers, healthcare professionals from the hemodialysis unit, and the research team. [ABSTRACT FROM AUTHOR]

Background: The increase in the global population of hemodialysis patients is linked to aging demographics and the prevalence of conditions such as arterial hypertension and diabetes mellitus. While previous research in hemodialysis has mainly focused on mortality predictions, there is a gap in studies targeting short-term hospitalization predictions using detailed, monthly blood test data. Methods: This study employs advanced data preprocessing and machine learning techniques to predict hospitalizations within a 30-day period among hemodialysis patients. Initial steps include employing K-Nearest Neighbor (KNN) imputation to address missing data and using the Synthesized Minority Oversampling Technique (SMOTE) to ensure data balance. The study then applies a Support Vector Machine (SVM) algorithm for the predictive analysis, with an additional enhancement through ensemble learning techniques, in order to improve prediction accuracy. Results: The application of SVM in predicting hospitalizations within a 30-day period among hemodialysis patients resulted in an impressive accuracy rate of 93%. This accuracy rate further improved to 96% upon incorporating ensemble learning methods, demonstrating the efficacy of the chosen machine learning approach in this context. Conclusions: This study highlights the potential of utilizing machine learning to predict hospital readmissions within a 30-day period among hemodialysis patients based on monthly blood test data. It represents a significant leap towards precision medicine and personalized healthcare for this patient group, suggesting a paradigm shift in patient care through the proactive identification of hospitalization risks. [ABSTRACT FROM AUTHOR]

Background: End-stage renal disease (ESRD) necessitates maintenance hemodialysis, posing significant healthcare challenges, including high hospitalization and mortality rates. This study aimed to analyze the outcomes of hospitalization in ESRD patients undergoing maintenance hemodialysis in a tertiary care center. Methods: A prospective observational study was conducted on 130 patients, focusing on demographics, clinical characteristics, comorbidities, hospitalization causes, and outcomes. Results: The majority of patients were males (66.9%), with the most prevalent age group being 41-50 years (32.3%). Hypertension (87.7%) and diabetes mellitus (28.5%) were the most common comorbidities. Cardiac abnormalities significantly influenced hospitalization rates (p<0.0001), and acute pulmonary edema was the leading cause of hospitalization (31.4%). The overall mortality rate was 6.2%, with acute pulmonary edema, acute hemorrhagic stroke, and uremic encephalopathy being the primary causes of death. Patients under three times weekly maintenance hemodialysis showed higher hospitalization rates compared to those receiving twice-weekly sessions (p=0.004). Conclusion: The study highlights the critical role of comorbid conditions management and the need for individualized care strategies to mitigate hospitalization and improve outcomes in ESRD patients on maintenance hemodialysis. [ABSTRACT FROM AUTHOR]

This article discusses the challenges and ethical considerations surrounding the initiation and continuation of chronic hemodialysis (HD) in non-cooperative patients. Non-cooperative patients are defined as those who lack the capacity to make informed decisions about dialysis and have behavioral or psychiatric comorbidities that make invasive interventions difficult. The article explores the risks and benefits of dialysis, the use of sedatives and restraints, the impact on healthcare workers, and the feasibility of outpatient dialysis. It emphasizes the importance of involving surrogate decision makers, weighing the benefits and risks, and continually reevaluating the decision to initiate or continue dialysis. The authors argue that nephrologists have a moral obligation to approach dialysis for non-cooperative patients with a comprehensive and intentional decision-making framework. [Extracted from the article]

Ying Zhu Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, USACorrespondence: Ying Zhu, Department of Health Policy and Management, University of Maryland School of Public Health, 3310D School of Public Health (Bldg &num;255), 4200 Valley Drive, College Park, MD, 20742-2611, USA, Email yzhu0812@terpmail.umd.eduIntroduction: Home hemodialysis (HHD) offers patients with end-stage kidney disease (ESKD) greater flexibility and advantages of health outcomes over center hemodialysis (CHD). This study aims to investigate the differences between home and center hemodialysis with a focus on racial/ethnic minorities.Methods: The US Renal Disease System (USRDS) 2019 patient core data containing mortality and hospitalization which are cumulative since 2010 were merged with 2016– 2019 Medicare clinical claims. To assess demographic and medical factors adjusted utilization and mortality of HHD vs CHD within every racial/ethnic cohort, logistic regression was used, and negative binomial regression was conducted to analyze the number of hospitalizations.Results: Evaluating 548,453 (97.48%) CHD patients and 14,202 (2.52%) HHD patients with Whites 47%, Blacks 32%, Hispanics 15%, Asians 4%, and other minorities 2%, the outcomes from adjusted regressions showed that: 1) minorities were significantly less likely to use HHD than Whites (Blacks: OR, 0.568, 95% CI, 0.546– 0.592; Hispanics: OR, 0.510, 95% CI, 0.477– 0.544; Asians: OR, 0.689, 95% CI, 0.619– 0.766; Others: OR, 0.453, 95% CI, 0.390– 0.525; p < 0.001); 2) most minority patients were younger and had fewer comorbidities than Whites, and all minority groups displayed significantly lower mortality and hospitalization incidences than the White group with adjustment on multiple covariates; 3) in the overall and main racial/ethnic cohorts, HHD showed a significantly lower risk of death than CHD after confounding for major risk factors (overall cohort: OR, 0.686, 95% CI, 0.641– 0.734; White: OR, 0.670, 95% CI, 0.612– 0.734; Blacks: OR, 0.717, 95% CI, 0.644– 0.799; Hispanics: OR, 0.715, 95% CI, 0.575– 0.889; Others: OR, 0.473, 95% CI, 0.265– 0.844).Conclusion: There are substantial racial/ethnic variations in home hemodialysis use and health outcomes in the United States.Keywords: home hemodialysis, racial/ethnic differences, end-stage renal disease, health service use, risk of death

A large portion of new patients with end stage kidney disease initiates dialysis in the acute setting and continue with outpatient dialysis at in-center facilities. To increase home dialysis adoption, programs have successfully operationalized Urgent Start peritoneal dialysis to have patients avoid in-center dialysis and move straight to home. However, Urgent Start home hemodialysis (HHD) has not been a realistic option for providers or patients due to complex machines and long training times (greater than four weeks). The landscape of dialysis treatment is evolving, and innovative approaches are being explored to improve patient outcomes and optimize health care resources. This article delves into the concept of directly transitioning incident patients from hospital admission to HHD, bypassing traditional in-center dialysis training. This forward-thinking approach aims to empower patients, enhance their treatment experience, maximize efficiency, and streamline health care operations. A large hospital organization in the Northeast was able to successfully transition three patients from hospital "crash" starts on hemodialysis directly to HHD. [ABSTRACT FROM AUTHOR]

Aim: Vascular and peritoneal access are essential elements for sustainability of chronic dialysis programs. Data on availability, patterns of use, funding models, and workforce for vascular and peritoneal accesses for dialysis at a global scale is limited. Methods: An electronic survey of national leaders of nephrology societies, consumer representative organizations, and policymakers was conducted from July to September 2018. Questions focused on types of accesses used to initiate dialysis, funding for services, and availability of providers for access creation. Results: Data from 167 countries were available. In 31 countries (25% of surveyed countries), >75% of patients initiated haemodialysis (HD) with a temporary catheter. Seven countries (5% of surveyed countries) had >75% of patients initiating HD with arteriovenous fistulas or grafts. Seven countries (5% of surveyed countries) had >75% of their patients starting HD with tunnelled dialysis catheters. 57% of low‐income countries (LICs) had >75% of their patients initiating HD with a temporary catheter compared to 5% of high‐income countries (HICs). Shortages of surgeons to create vascular access were reported in 91% of LIC compared to 46% in HIC. Approximately 95% of participating countries in the LIC category reported shortages of surgeons for peritoneal dialysis (PD) access compared to 26% in HIC. Public funding was available for central venous catheters, fistula/graft creation, and PD catheter surgery in 57%, 54% and 54% of countries, respectively. Conclusion: There is a substantial variation in the availability, funding, workforce, and utilization of vascular and peritoneal access for dialysis across countries regions, with major gaps in low‐income countries. [ABSTRACT FROM AUTHOR]

Background: Peritoneal dialysis (PD) remains underutilised in Germany, prompting the initiation of the Sustainable Intensification of Peritoneal Dialysis in Schleswig–Holstein (SKIP-SH) project. The SKIP-SH cohort study aims to demonstrate the presumed benefits of PD, including enhanced quality of life and reduced healthcare personnel requirements, and to generate data to strengthen the use of PD. Methods: The prospective SKIP-SH cohort study recruits patients with advanced chronic kidney disease (CKD) and their caregivers. Comprehensive data, including demographic information, medical history, clinical course, laboratory data, and quality-of-life assessments, are collected. Additionally, biomaterials will be obtained. Primary study objectives are documenting the clinical course and complications, time on therapy for new dialysis patients, reasons influencing treatment modality choices, circumstances at the initiation of dialysis, and quality of life for patients with CKD and their caregivers. The collected biomaterials will serve as a basis for further translational research. Secondary objectives include identifying factors impacting disease-related quality of life, clinical complications, and therapy dropout, estimating ecological footprints, and evaluating healthcare costs and labour time for initiating and sustaining PD treatment. Discussion: PD is notably underutilised in Germany. The current therapy approach for advanced CKD often lacks emphasis on patient-focused care and quality-of-life considerations. Furthermore, adequate explorative research programs to improve our knowledge of mechanisms leading to disease progression and therapy failure in PD patients are scarce. The overarching goal of the SKIP-SH cohort study is to address the notably low PD prevalence in Germany whilst advocating for a shift towards patient-focused care, quality-of-life considerations, and robust translational research. Trial registration: This study was registered with the German trial registry (Deutsches Register klinischer Studien) on November 7, 2023, under trial number DRKS00032983. [ABSTRACT FROM AUTHOR]

Introduction: Rural areas face significant disparities in dialysis care compared to urban areas due to limited access to dialysis facilities, longer travel distances, and a shortage of healthcare professionals. The objective of this study was to conduct a national examination of rural-urban differences in quality of dialysis care offered across counties in the USA. Methods: Data were gathered from Medicare-certified dialysis facilities in 2020 from the Centers for Medicare and Medicaid Services website. To identify high-need counties, county-level estimated crude prevalence of diabetes in adults was obtained from the 2022 CDC PLACES data portal. Our analysis reviewed 3,141 counties in the USA. The primary outcome measured was whether the county had a dialysis facility. Among those counties that had a dialysis facility, additional outcomes were the average star rating, whether peritoneal dialysis was offered, and whether home dialysis was offered. Results: The type of services offered by dialysis facilities varied significantly, with peritoneal dialysis being the most commonly offered service (50.8%), followed by home hemodialysis (28.5%) and late-shift services (16.0%). These service availabilities are more prevalent in urban facilities than in rural facilities. The Centers for Medicare and Medicaid Services Five Star Quality ratings were quite different between urban and rural facilities, with 40.4% of rural facilities having a ranking of five, compared to 27.1% in urban. Conclusion: The majority of rural counties lack a single dialysis facility. Counties with high rates of chronic kidney disease, diabetes, and blood pressure, deemed high need, were less likely to have a highly rated dialysis facility. The findings can be used to further inform targeted efforts to increase diabetes educational programming and design appropriate interventions to those residing in rural communities and high-need counties who may need it the most. [ABSTRACT FROM AUTHOR]

Advances in the treatment of kidney failure with chronic dialysis have stagnated over the past three decades, with over 50% of patients still managed by conventional in-hospital haemodialysis. In parallel, the demands of chronic dialysis medical care have changed and evolved due to a growing population that has higher frailty and multimorbidity. Thus, the gap between the needs of kidney failure patients and the healthcare capability to provide effective overall management has widened. To address this problem, healthcare policy has increasingly aligned towards a human-centred approach. The paradigm shift of human-centred approach places patients at the forefront of decision-making processes, ensuring that specific needs are understood and prioritised. Integration of human-centred approaches with patient care has been shown to improve satisfaction and quality of life. The aim of this narrative is to evaluate the current clinical challenges for managing kidney failure for dialysis providers; summarise current experiences and unmet needs of chronic dialysis patients; and finally emphasise how human-centred care has advanced chronic dialysis care. Specific incremental advances include implementation of renal supportive care; home-assisted dialysis; hybrid dialysis; refinements to dialysis methods; whereas emerging advances include portable and wearable dialysis devices and the potential for the integration of artificial intelligence in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Health conservation enables elderly hemodialysis patients to maintain a positive state of well-being while undergoing treatment and maintenance of disease. This study was to identify the type of perceptions on health conservation of elderly hemodialysis patients and compare the characteristics of perceptions. Methods: This study used an exploratory study design applying Q methodology, which is designed to research subjectivity. The study determined a population of subjective statements, the concourse, based on the preceding literature and interviews with twenty-five elderly patients over 65 years of age with hemodialysis. We chose a total of 50 statements considered to be representative of the concourse for the Q-sample. The study selected 50 elderly patients over 65 years of age with hemodialysis as the P-set. The participants provided their internal viewpoints by sorting the Q-sample items into a grid. The researchers performed an analysis using PC-QUANL program. Data were collected from June to November, 2019. Results: Type I, 'support system-based effort' focused on one's own effort, positive and proactive attitude, family support, medical instructions, information, and medications. Type II, 'skeptical life maintaining' expressed a pessimistic future without hope, strongly negative perception on preserving health, and thus minimal effort and motivation to continue life. Type III, 'treatment process interest' is based on an interest in the hemodialysis process; for them, it is important to follow medical staff's instructions, take regular medications precisely, pay attention to the results of regular monthly blood tests, and control their health. Type IV, 'positive effort' accepts hemodialysis positively, lives with hemodialysis, and carries out all daily life activities. Conclusion: In nursing practice, nurses need to pay attention to the perceptions on health conservation of elderly hemodialysis patients. This study can be implied as the evidence of nursing practice based on the perception on health conservation of elderly hemodialysis patients. [ABSTRACT FROM AUTHOR]

Objectives: There is a lack of prognostic information to guide the prediction of short-term all-cause mortality in patients with end-stage renal disease (ESRD). The aim was to review the risk factors that influenced the risk of short-term all-cause mortality in patients with ESRD. Methods: MEDLINE, Embase, PubMed, CINAHL, the Cochrane Library and Web of Science databases were searched for articles published between 2000 and 2020. Articles describing risk factors predicting short-term mortality (≤ 3 years) in patients with ESRD were included. Four reviewers independently performed title, abstract, full text screening and data extraction. Assessment of risk of bias was assessed using the Quality In Prognosis Studies (QUIPS) tool checklist. Results: 20,840 articles were identified and 113 papers were included for this review. Of the 113 papers, 6.2% included only peritoneal dialysis (PD) patients, 67.3% included only hemodialysis (HD) patients, 20.4% included both PD and HD patients, with the remaining papers featuring patients on conservative management or awaiting renal transplant. Risk factors were categorised into 13 domains: 1)demographics/ lifestyle, 2) comorbidities 3)intradialytic blood pressure, 4)biomarkers, 5)cardiovascular measurements, 6)frailty status, 7)medications, 8)treatment related indicators, 9)renal related parameters, 10)health status, 11)cause of ESRD, 12)access to healthcare care/ information and, 13)proxy measures for poor health. C-reactive protein(CRP), age, and functional status were observed to have higher percentage of instances of being significantly associated with all-cause mortality. Conclusion: Commonly examined risk factors observed from this review may be used to build a general prognostic model for patients with ESRD, with specific treatment related risk factors added on to enhance the accuracy of the models. [ABSTRACT FROM AUTHOR]

This article discusses a study that examined the long-term effects of a lung ultrasound-guided treatment strategy in dialysis patients with chronic kidney disease (CKD). The study found that the treatment strategy did not significantly reduce the risk of death, heart failure, or myocardial infarction in the overall study population. However, when analyzing the data by sex, the study found that the treatment strategy was associated with a reduced risk of the composite endpoint in men but not in women. The study suggests that further research is needed to understand why the treatment strategy may be less effective in women. [Extracted from the article]

Background Chronic kidney disease–associated pruritus (CKD-aP) is an underrated symptom in patients with impaired kidney function. The present study assessed the prevalence, impact on quality of life (QoL) and risk factors for CKD-aP in a contemporary national cohort of patients on haemodialysis. In addition, we evaluated attending physicians' awareness and approach to therapy. Methods Validated patient's and physician's questionnaires on pruritus severity and QoL were used in combination with information obtained by the Austrian Dialysis and Transplant Registry. Results The prevalence of mild, moderate and severe pruritus in 962 observed patients was 34.4%, 11.4% and 4.3%. Physicians' estimated prevalence values were 25.0 (95% CI 16.8–33.2), 14.4 (11.3–17.6) and 6.3% (4.9–8.3), respectively. The estimated national prevalence estimate extrapolated from the observed patients was 45.0% (95% CI 39.5–51.2) for any, 13.9% (95% CI 10.6–17.2) for moderate and 4.2% (95% CI 2.1–6.2) for severe CKD-aP. CKD-aP severity was significantly associated with impaired QoL. Risk factors for moderate–severe pruritus were higher C-reactive protein [odds ratio (OR) 1.61 (95% CI 1.07–2.43)] and parathyroid hormone (PTH) values [OR 1.50 (95% CI 1.00–2.27)]. Therapy for CKD-aP included changes in the dialysis regimen, topical treatments, antihistamines, gabapentin and pregabalin and phototherapy in a majority of centres. Conclusions While the overall prevalence of CKD-aP in our study is similar to that in previously published literature, the prevalence of moderate–severe pruritus is lower. CKD-aP was associated with reduced QoL and elevated markers of inflammation and PTH. The high awareness of CKD-aP in Austrian nephrologists may explain the lower prevalence of more severe pruritus. [ABSTRACT FROM AUTHOR]

Introduction: Peritoneal dialysis (PD), as a home treatment, ensures better patient autonomy and lower intrusiveness compared to hemodialysis. However, choosing PD comes with an increased burden of responsibility that the patient may not always be able to bear, due to advanced age and deteriorating health condition. Various approaches have been explored to address this issue and mitigate its primary complications. In this study, we aim to present the ongoing PD training at-home program implemented by the Vicenza PD Center, and evaluate its impact on patients' prognoses. Material and Methods: We enrolled 210 patients who underwent PD at Vicenza Hospital between 1 January 2019 and 1 January 2022 for a minimum of 90 days. Each patient was observed retrospectively for one year. We categorized the patients into three groups based on their level of autonomy regarding their PD management: completely independent patients; patients able to perform some parts of the PD method on their own, while the remaining aspects were carried out by a caregiver; and patients who required complete assistance from a caregiver, like in the assisted PD program (asPD). Results: A total of 70% of the PD population were autonomous regarding their PD therapy, 14% had an intermediate degree of autonomy, and 16% were entirely dependent on caregivers. The PD nurses performed a median of four home visits per patient per year, with a tendency to make more visits to patients with a lower degree of autonomy. All the groups achieved similar clinical outcomes. At the end of the year of observation, only 6% of the patients witnessed a decline in their autonomy level, whereas 7% demonstrated an enhancement in their level of autonomy, and 87% remained stable. Conclusions: A home care assistance program ensures clinical support to a household with the purpose of improving the empowerment of the PD population and reducing the prevalence of assisted PD. Ongoing PD training at home helps patients to maintain a stable degree of autonomy and stay in their home setting, even though they present with relative attitudinal or social barriers. [ABSTRACT FROM AUTHOR]

Key Points: Question: How did dialysis facilities that serve patients with high social risk perform in the first year of the End-Stage Renal Disease Treatment Choices (ETC) model compared with those serving populations with lower social risk? Findings: In this observational study of 2191 dialysis facilities, those disproportionately serving marginalized populations as a safety-net facility received lower performance scores and were more likely to be financially penalized, driven primarily by lower use of home dialysis. Meaning: The ETC model disproportionately penalized dialysis facilities serving patients with higher social risk during the first year of implementation. Importance: The End-Stage Renal Disease Treatment Choices (ETC) model randomly selected 30% of US dialysis facilities to receive financial incentives based on their use of home dialysis, kidney transplant waitlisting, or transplant receipt. Facilities that disproportionately serve populations with high social risk have a lower use of home dialysis and kidney transplant raising concerns that these sites may fare poorly in the payment model. Objective: To examine first-year ETC model performance scores and financial penalties across dialysis facilities, stratified by their incident patients' social risk. Design, Setting, and Participants: A cross-sectional study of 2191 US dialysis facilities that participated in the ETC model from January 1 through December 31, 2021. Exposure: Composition of incident patient population, characterized by the proportion of patients who were non-Hispanic Black, Hispanic, living in a highly disadvantaged neighborhood, uninsured, or covered by Medicaid at dialysis initiation. A facility-level composite social risk score assessed whether each facility was in the highest quintile of having 0, 1, or at least 2 of these characteristics. Main Outcomes and Measures: Use of home dialysis, waitlisting, or transplant; model performance score; and financial penalization. Results: Using data from 125 984 incident patients (median age, 65 years [IQR, 54-74]; 41.8% female; 28.6% Black; 11.7% Hispanic), 1071 dialysis facilities (48.9%) had no social risk features, and 491 (22.4%) had 2 or more. In the first year of the ETC model, compared with those with no social risk features, dialysis facilities with 2 or more had lower mean performance scores (3.4 vs 3.6, P =.002) and lower use of home dialysis (14.1% vs 16.0%, P <.001). These facilities had higher receipt of financial penalties (18.5% vs 11.5%, P <.001), more frequently had the highest payment cut of 5% (2.4% vs 0.7%; P =.003), and were less likely to achieve the highest bonus of 4% (0% vs 2.7%; P <.001). Compared with all other facilities, those in the highest quintile of treating uninsured patients or those covered by Medicaid experienced more financial penalties (17.4% vs 12.9%, P =.01) as did those in the highest quintile in the proportion of patients who were Black (18.5% vs 12.6%, P =.001). Conclusions: In the first year of the Centers for Medicare & Medicaid Services' ETC model, dialysis facilities serving higher proportions of patients with social risk features had lower performance scores and experienced markedly higher receipt of financial penalties. This observational study assesses the first-year of the End-Stage Renal Disease Treatment Choices model performance and the financial penalties sustained by facilities that serve patients with high social risk vs facilities that serve populations with lower social risk. [ABSTRACT FROM AUTHOR]

Background: Caring for hemodialysis patients could be a heavy burden on family caregivers, causing them to become fatigued and decrease their quality of life. This study aimed to investigate whether Jacobson's relaxation can help alleviate the fatigue of family caregivers of hemodialysis patients. Methods: This randomized controlled trial was conducted in 2021. Sixty-six family caregivers of hemodialysis patients were recruited by convenience sampling from a referral hospital in Tehran, Iran, and assigned randomly by coin toss to two groups of experimental (n = 32) and control (n = 34). Caregivers in the experimental group performed Jacobson's relaxation three times a week, each time for 30–45 min, for 30 days. The score and severity of fatigue before, 2 weeks after, and 1 month after the intervention were measured with the Fatigue Severity Scale. Data analysis was performed in the statistics software SPSS using descriptive statistics (frequency, percentage, mean, and standard deviation) and analytic statistics (Independent Samples t-test, Mann–Whitney U test, Chi-Square test, Fisher's exact test, and RM-ANOVA test). The significance level was less than 0.05. Results: The fatigue scores of the experimental and control groups were not significantly different before the intervention (4.42 ± 0.42 vs. 4.38 ± 0.42, P = 0.696). However, the experimental group had significantly lower fatigue scores than the control group 2 weeks after the intervention (4.11 ± 0.63 vs. 4.39 ± 0.42, P = 0.036) and 1 month after the intervention (3.5 ± 0.71 vs. 4.4 ± 0.44, P = 0.001). The results also showed a significant drop in the fatigue score of the experimental group after the intervention (P < 0.0001), but no such change in the control group (P = 0.662). Conclusion: Jacobson's relaxation technique was effective in alleviating the fatigue of family caregivers of hemodialysis patients. Nurses are therefore recommended to promote the technique as a safe and easy method of fatigue management for family caregivers. [ABSTRACT FROM AUTHOR]

Introduction: Roxadustat is an oral hypoxia‐inducible factor prolyl hydroxylase inhibitor approved in several regions for the treatment of anemia of chronic kidney disease (CKD). DENALI, a phase 3b study, evaluated the efficacy, safety, and feasibility of roxadustat in patients with anemia of CKD receiving in‐center or home dialysis. Methods: Eligible patients received open‐label roxadustat, dosed three times weekly for 24 weeks, with an optional extension of ≤1 year. Initial dosing depended on erythropoiesis‐stimulating agent (ESA) dose at screening for patients receiving ESAs (≥6 weeks) and weight‐based for those not (total <6 weeks). Primary efficacy endpoints were proportion of patients with mean hemoglobin (Hb) ≥10.0 g/dL averaged over Weeks 16–24, and mean Hb change from baseline to the average during Weeks 16–24. Treatment‐emergent adverse events (TEAEs) and treatment‐emergent serious adverse events (TESAEs) were assessed. Findings: Of 281 patients screened, 203 were treated and 201 included in the full analysis set. Overall, 166 patients completed the 24‐week treatment period and 126 continued into the extension period. Mean baseline Hb was 10.4 g/dL and 82.6% received in‐center hemodialysis. Overall, 84.6% of patients achieved a mean Hb ≥ 10.0 g/dL averaged Weeks 16–24. Mean (standard deviation) Hb change from baseline averaged Weeks 16–24 was 0.5 (1.0) g/dL. Prespecified subgroup analyses were consistent with primary analyses. Dosing adherence was 94%. Overall, 3.0% of patients received a red blood cell transfusion at up to Week 24. TEAEs and TESAEs were reported by 71.4% and 25.6% of patients, respectively. The most frequently reported TESAEs were COVID‐19 (n = 5; 2.5%), and acute myocardial infarction, pneumonia, and sepsis (each n = 4; 2.0%). Discussion: Roxadustat effectively achieved and/or maintained mean Hb levels ≥10.0 g/dL in patients receiving dialysis. The feasibility of incorporating oral roxadustat into dialysis organizations was successfully demonstrated with high dosing adherence. No new safety signals were identified. [ABSTRACT FROM AUTHOR]

Background The French Renal Epidemiology and Information Network (REIN) is 20 years old. It is not just a national data registry, but rather an epidemiological and informational network serving patients with chronic kidney disease, nephrology teams and health services. Methods The past 10-year trends of the incidence and prevalence of renal replacement therapy by dialysis or kidney transplantation and waitlist activity are presented. To detect potential significant changes in trends from 2012 and 2021, a Joinpoint regression model was used. Results The overall incidence of treated end-stage kidney disease (ESKD) was 169 per million population (pmp) in 2021. It was stable despite an increase in the incidence of diabetes. We found a decreasing trend in the proportion of patients starting dialysis in an emergency but an increase in those starting haemodialysis (HD) with a temporary catheter. Peritoneal dialysis decreased by 1.7% each year, whereas home HD, although involving only 1% of dialysis patients, increased by 10% each year. For patients not treated at home, the median time to drive from the patient's home to the dialysis unit was 17 min. The proportion of patients on the transplantation waitlist at the start of dialysis increased from 7% to 12%. Among the 111 263 new ESKD patients from 2012 to 2021, 8% received a first transplant at 1 year and 20% at 5 years. Among kidney transplant recipients, the mean time on the waitlist increased from 13.8 to 22.6 months. Living donor transplants increased in frequency, representing 15% of kidney transplants. Conclusions Data from the REIN registry allow for the evaluation of needs and provide a planning tool for French authorities. The progressive implementation of automatic data retrieval from dialysis informatics charts might alleviate the burden of data collection. Furthermore, the research activity the REIN engenders, resulting in renewed confidence by health authorities in the dynamism of French nephrology, allows for an optimistic outlook for the REIN. [ABSTRACT FROM AUTHOR]

This article discusses a potential safety issue with the connection of Baxter Physioneal, Extraneal, Nutrineal (PEN) and Dianeal solution bags to Fresenius peritoneal dialysis catheter extensions. The authors describe a case where a patient accidentally connected the two systems, resulting in leakage and potential contamination. They recommend that hospitals switch patients back to their previous company's delivery system before discharge to minimize the risk of misconnection and peritonitis. Both Baxter and Fresenius Medical Care were informed of the issue prior to the publication of this article. [Extracted from the article]

Introduction: More frequent and/or longer hemodialysis (HD) has been associated with improvements in numerous clinical outcomes in patients on dialysis. Home HD (HHD), which allows more frequent and/or longer dialysis with lower cost and flexibility in treatment planning, is not widely used worldwide. Although, retrospective studies have indicated better survival with HHD, this issue remains controversial. In this multicenter study, we compared thrice-weekly extended HHD with in-center conventional HD (ICHD) in a large patient population with a long-term follow-up. Methods: We matched 349 patients starting HHD between 2010 and 2014 with 1047 concurrent patients on ICHD by using propensity scores. Patients were followed-up with from their respective baseline until September 30, 2018. The primary outcome was overall survival. Secondary outcomes were technique survival; hospitalization; and changes in clinical, laboratory, and medication parameters. Results: The mean duration of dialysis session was 418 ± 54 minutes in HHD and 242 ± 10 minutes in patients on ICHD. All-cause mortality rate was 3.76 and 6.27 per 100 patient-years in the HHD and the ICHD groups, respectively. In the intention-to-treat analysis, HHD was associated with a 40% lower risk for all-cause mortality than ICHD (hazard ratio [HR] = 0.60; 95% confidence interval [CI] 0.45 to 0.80; P < 0.001). In HHD, the 5-year technical survival was 86.5%. HHD treatment provided better phosphate and blood pressure (BP) control, improvements in nutrition and inflammation, and reduction in hospitalization days and medication requirement. Conclusion: These results indicate that extended HHD is associated with higher survival and better outcomes compared to ICHD.

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Background: Fluid overload is a common complication of the care of End-stage Renal Disease patients that may lead to prolonged hospitalization and mortality. This warrants an effective and systemic approach to early recognition and management to improve patient outcomes.Aim: This study aims to evaluate the effect of a modified fluid assessment tool to improve accurate clinical assessments, detection, and management of blood pressure control and fluid alteration among hemodialysis patients.Methods: In this retrospective study, data were collected from forty-three dialysis patients who were seen and followed up from a dialysis unit of an acute care hospital during 8 weeks of standard care. A modified assessment tool was used to systematically highlight the appropriateness of the patient set dry weight using intradialytic weight gain (IWDG) and patient blood pressure. Paired sample t-test and repeated measure ANOVA within-group analysis were applied to compare the mean difference score for IDWG and the mean arterial pressure within the study group, respectively.Result: A total of 43 patients were enrolled (mean age, 59.07) (ranges 27– 88 years) (SD – 14.30); 51.16% female; 79% Emirati Nationals, with Chronic Kidney Disease. A repeated measure ANOVA analysis showed a significant difference in the mean arterial pressure within the study group based on time, over six measurements (p = 0.001). However, the difference between the pre- and post-intra-dialytic weight gain mean scores yields insignificant results (p = 0.346).Conclusion: The implementation of a modified assessment tool improved blood pressure control, increased staff and physician involvement in assessing patient dry weight facilitated through fluid status evaluation, methodical assessment of dry weight, and precise fluid removal calculation, enhancing overall blood pressure and fluid management in HD patients. [ABSTRACT FROM AUTHOR]

Background: The global COVID-19 pandemic transformed healthcare services in ways that have impacted individual physical and psychological health. The substantial health challenges routinely faced by dialysis-dependent patients with advanced kidney disease have increased considerably during the ongoing COVID-19 pandemic but remain inadequately investigated. We therefore decided to analyze and compare the perspectives of dialysis patients on their own needs and challenges during the COVID-19 pandemic with those of their professional healthcare providers through interviews with both groups. Methods: Qualitative study of seven in-center hemodialysis patients, seven peritoneal dialysis patients, seven dialysis nurses, and seven physicians at the Medical University of Vienna between March 2020 and February 2021, involving content analysis of semi-structured interviews supported by a natural language processing technique. Results: Among the main themes emerging from interviews with patients were: (1) concerns about being a 'high-risk patient'; (2) little fear of COVID-19 as a patient on hemodialysis; (3) questions about home dialysis as a better choice than in-center dialysis. Among the main themes brought up by physicians and nurses were: (1) anxiety, sadness, and loneliness of peritoneal dialysis patients; (2) negative impact of changes in clinical routine on patients' well-being; (3) telehealth as a new modality of care. Conclusion: Preventive measures against COVID-19 (e.g., use of facemasks, distancing, isolation), the introduction of telemedicine, and an increase in home dialysis have led to communication barriers and reduced face-to-face and direct physical contact between healthcare providers and patients. Physicians did not perceive the full extent of patients' psychological burdens. Selection/modification of dialysis modality should include analysis of the patient's support network and proactive discussion between dialysis patients and their healthcare providers about implications of the ongoing COVID-19 epidemic. Modification of clinical routine care to increase frequency of psychological evaluation should be considered in anticipation of future surges of COVID-19 or currently unforeseen pandemics. [ABSTRACT FROM AUTHOR]

Uremia not only involves the accumulation of small molecules of uremic solutes in plasma but also ecological dysregulation of the gut microbiota. At present, hemodialysis is the preferred method for clinical management of uremic patients to avoid complications such as intestinal diseases caused by intestinal flora disturbances. Herein, we have attempted to clarify the clinical value of probiotics in progressive nutritional support nursing for uremic hemodialysis patients. One hundred and thirty-six uremic patients undergoing hemodialysis in our hospital between October 2021 and October 2022 were divided into experimental and control groups. The control group underwent conventional nursing care, whereas the experimental group underwent progressive nutritional support nursing (intervention group). After intervention, the visual analogue scale scores of the EuroQoL-5 Dimension Questionnaire in the experimental group were elevated relative to those in the controls (P < 0.05). The health-related quality of life questions that included creatinine clearance rate, urea nitrogen clearance rate, body mass index, and albumin were higher in the experimental group than controls, whereas the white blood cell count in the experimental group was lower than controls (P < 0.05). Furthermore, the total complication rate in the experimental group was lower than the control group (P < 0.05). In summary, applying progressive nutritional support nursing to uremic patients can improve clinical indicators and reduce the incidence of complications. [ABSTRACT FROM AUTHOR]

This study was conducted to understand the influencing factors for home peritoneal dialysis patients choosing APD and to provide a scientific basis for improving the completion rate of APD treatment and the follow-up of peritoneal dialysis patients.Methods: The study was a cross-sectional questionnaire-based study. A total of 588 patients on peritoneal dialysis were randomly selected from 6 regions in Fujian Province in southern China using a stratified cluster sampling method.Results: The mean age of the patients were 56.5 ± 14.73 years. In the univariate analysis, knowledge, user experience and family support were the factors that affected patients' choice of APD (all P < 0.05) and were positively correlated with the treatment utilization rate. In the multivariate analysis, 3 factors (treatment with APD, knowledge of APD, and family support) remained significantly associated not choosing APD. The selection rate for APD was 2.594 times higher among patients who had received APD than among patients who had never received APD. The selection rate for patients with "a lot of knowledge" about APD was 10.75 times that of patients with "no knowledge".Conclusion: Patients' knowledge of APD, experience in application and family support were the main factors affecting the choice of APD as a treatment mode (P < 0.05) and were positively correlated with the treatment utilization rate. Further studies are needed to improve the APD treatment completion rates by modulation the above-mentioned factors.Relevance to Clinical Practice: This study provides scientific evidence for improving APD treatment completion rates and improving patient quality of life. [ABSTRACT FROM AUTHOR]