Early results and medico-economic evaluation of a short daily home hemodialysis program in a Private hemodialysis center
Short daily home hemodialysis programm
Keywords:NxStage, button-hole, weekly Kt/v, daily hemodialysis, home hemodialysis
Abstract: Between 2015 and 2017 there was a 40% increase in daily hemodialysis, according to the REIN database. This increase concerns 1% of patients and the private sector remains under-represented. Our retrospective study aims to describe the clinical features, the organizational and medico-economic specificities of this technique in a private hemodialysis center.
Methods: We included 12 dialyzed patients trained on Nx Stage® machine from February 2020 to April 2021. Data were retrospectively obtained through review of our electronic medical records (EUCLID®).
Results: Of the 12 patients trained, 11 dialyzed from home, with an average follow-up of 9 months (1-14). The average age was 45 with a sex ratio of 4/8 (M/W), and a median Charlson score of 3 (2-4). The average residual urinary output was 700 mL/24h, and 50% of patients were anuric. 100% of patients had an arteriovenous fistula and were cannulated using the buttonhole technique. 9 patients are on a transplant list. One patient needed anticoagulants. The mean training time was 35 days (28-35). 83% of patients were dialyzed 6 days a week with an average duration of 210 minutes (130-150) per session. The average volume of dialysate was 24.85 liters. One patient developed an allergy to the PUREMA® membrane. Pre-dialytic hemoglobin, serum creatinine, urea, phosphoremia and B2-microglobuline are stable at 9 months with improvement in metabolic acidosis.
Conclusion: DHHD allowed a better socio-professional integration. One patient received a transplant and 3 patients resumed professional activity.
Wilkie M Home dialysis an international perspective NDT Plus 2011; 4[Suppl 3]: iii4–iii6
Van Walraven C. Manuel D.G. Knoll G. Survival trends in ESRD patients compared with the general population in the United States. Am J Kidney Dis. 2014; 63: 491-499
Eknoyan G, Beck GJ, Cheung AK, Daugirdas JT, Greene T, Kusek JW, Allon M, Bailey, Teehan Toto R, Hemodialysis (HEMO) Study Group: Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 2002; 347: 2010–2019
Weinhandl ED, Liu J, Gilbertson DT, et al. Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients Am Soc Nephrol, 2012;23:895-904
Nesrallah GE, Lindsay RM, Cuerden MS, et al. Intensive hemodialysis associates with improved survival compared with conventional hemodialysis, J Am Soc Nephrol. 2012; 23: 696-705
Chan CT, Floras JS, Miller JA, et al. Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis. Kidney Int, 2002; 61: 2235-2239
Susantitaphong P, Koulouridis I, Balk EM et al. Effect of frequent or extended hemodialysis on cardiovascular parameters: a meta-analysis. Am JKidney Dis 2012; 59: 689–699
Jaber BL, Lee Y, Collins AJ et al. Effect of daily hemodialysis on depressive symptoms and post dialysis recovery time: interim report from the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study. Am J Kidney Dis 2010; 56: 531–539
Stel VS, de Jong RW, Kramer A, Andrusev AM, et al. Supplemented ERA-EDTA Registry data evaluated the frequency of dialysis, kidney transplantation, and comprehensive conservative management for patients with kidney failure in Europe. Kidney Int. 2021 Jan 7: S0085-2538(20)31529-5.
Argilés A, Kerr PG. Home based therapies: can wishes would be realized? Nephrol Dial Transplant. 2020 Nov 1;35(11):1836-1839.
Van Eps CL, Jeffries JK, Johnson DWet al. Quality of life and alternate nightly nocturnal home hemodialysis. Hemodial Int 2010 ; 14 : 29–38
Vos PF, Zilch O, Jennekens-Schinkel A et al. Effect of short daily home haemodialysis on quality of life, cognitive functioning and the electroencephalogram. Nephrol Dial Transplant 2006; 21: 2529–2535
Hanly PJ, Pierratos A. Improvement of sleep apnea in patients with chronic renal failure who undergo nocturnal hemodialysis. N Engl J Med 2001; 344: 102–107
Johansen KL, Zhang R, Huang Y et al. Survival and hospitalization among patients using nocturnal and short daily compared to conventional hemodialysis: a USRDS study. Kidney Int 2009; 76: 984–990
Lockridge RS, Kjellstrand CM. Nightly home hemodialysis: outcome and factors associated with survival. Hemodial Int 2011; 15: 211–218
Cherukuri S, Bajo M, Colussi G, Corciulo R, Fessi H, Ficheux M, Slon M, Weinhandl M and Borman N. Home hemodialysis treatment and outcomes: retrospective analysis of the Knowledge to Improve Home Dialysis Network in Europe (KIHDNEy) cohort, BMC Nephrology (2018) 19:262
Weinhandl ED, Liu J, Gilbertson DT, Arneson TJ, Collins AJ. Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. J Am Soc Nephrol 2012; 23:895–904.
Komenda P, Copland M, Er L, Djurdjev O, Levin A. Outcomes of a provincial home haemodialysis programme-a two-year experience: establishing benchmarks for programme evaluation. Nephrol Dial Transplant 2008; 23:2647–52.
Nadeau A, Hawley C, Pascoe E, Chan C, Clayton P, Polinghorne K, et al. An incident cohort study comparing survival on home hemodialysis and peritoneal dialysis (ANZDATA Registry). Clin J Am Soc Nephrol 2015; 10:1397–407.
Rocco MV, Lockridge RS, Jr, Beck GJ et al. The effects of frequent nocturnal home hemodialysis: the frequent hemodialysis network nocturnal trial. Kidney Int 2011; 80: 1080–1091
Copland M, Murphy-Burke D, Levin A, Singh R, Taylor P, Er L. Implementing a home haemodialysis programme without adversely affecting a peritoneal dialysis programme. Nephrol Dial Transplant 2009; 24:2546–50.
Finkelstein FO, Schiller B, Daoui R, Gehr T, Kraus M, Lea J, et al. At-home short daily hemodialysis improves the long-term health-related quality of life. Kidney Int 2012; 82:561-9.
John K. Leypoldt, Michael A. Kraus, Bertrand L. Jaber, Eric D. Weinhandl and Allan J. Collins, Effect of dialysate potassium and lactate on serum potassium and bicarbonate concentrations during daily hemodialysis at low dialysate flow rates BMC Nephrology (2019) 20:252
Spanner E, Suri R, Heidenheim P, Lindsay R. The impact of quotidian hemodialysis on nutrition. Am J Kidney Dis 2003;42: S30–5.
Galland R, Traeger J, Arkouche W, Delawari E, Fouque D. Short daily hemodialysis and nutritional status. Am J Kidney Dis 2001;37: S95–8.
Trial Group FHN, Chertow G, Levin N, Beck G, Depner T, Eggers P. In-center hemodialysis six times per week versus three times per week. N Engl J Med 2010; 363:2287–300.
Copland M, Komenda P, Weinhandl ED, McCullough PA, Morfin JA. Intensive Hemodialysis, Mineral and Bone Disorder, and Phosphate Binder Use. Am J Kidney Dis. 2016 Nov;68(5S1): S24-S32.
Daniel B. Ornt, Brett Larive, Anjay Rastogi, Mohamad Rashid, John T. Daugirdas, Ann Hernandez, Manjula Kurella Tamura, Rita S. Suri, Nathan W. Levin, Alan S. Kliger, and the Frequent Hemodialysis Network Trial Group, Impact of frequent hemodialysis on anemia management: results from the Frequent Hemodialysis Network (FHN) Trials, Nephrol Dial Transplant. 2013 Jul; 28(7): 1888–1898.
Daugirdas JT, Chertow GM, Larive B, et al. Effects of frequent hemodialysis on measures of CKD mineral and bone disorder. J Am Soc Nephrol. 2012;23(4):727-738.
Kohn OF, Coe FL, Ing TS. Solute kinetics with short-daily home hemodialysis using slow dialysate flow rate. Hemodial Int 2010; 14:39–46.
Zatisky J, Rastogi A, Fischmann G, Yan J, Kleiman K, Chow G, et al. Short daily hemodialysis is associated with lower plasma FGF23 levels when compared with conventional hemodialysis. Nephrol Dial Transplant 2014; 29:437–41.
Kraus M, Burkart J, Hegeman R, Solomon R, Coplon N, Moran J. A comparison of center-based vs. home-based daily hemodialysis for patients with end-stage renal disease. Hemodial Int. 2007 ; 11 :468–477.
Guillet B, Simon N, Sampol J, Lorec-Penet A, Portugal H, Berlan Y, et al. Pharmacokinetics of the low molecular weight heparin-enoxaparin during 48 h after bolus administration of an anticoagulant in hemodialysis. Nephrol Dial Transplant 2003; 18:2348–53.
Finazzi G, Remuzzi G. Heparin-induced thrombocytopenia: background and implications for haemodialysis. Nephrol Dial Transplant 1996; 11:2120–2.
Leypoldt JK, Agar BU, Bernardo AA, Culleton BF. Prescriptions of dialysate potassium concentration during short daily or long nocturnal (high dose) hemodialysis. Hemodial Int. 2016; 20:218–25.
King RS, Glickman JD. Electrolyte management in frequent home hemodialysis. Semin Dial. 2010 ; 23 :571–4.
Sargent JA, Marano M, Marano S, et al. Acid-base homeostasis during hemodialysis: new insights into the mystery of bicarbonate disappearance during treatment. Semin Dial 2018; 31(5): 468–478.
Leypoldt JK, Pietribiasi M, Ebinger A, Kraus MA, Collins A, Waniewski J. Acid-base kinetics during hemodialysis using bicarbonate and lactate as dialysate buffer bases based on the H+ mobilization model. Int J Artif Organs. 2020 Oct;43(10):645-652.
Lynn KL, Buttimore AL, Wells JE, Inkster JA, Roake JA, Morton JB. Long-term survival of arteriovenous fistulas in home hemodialysis patients. Kidney Int. 2004 May;65(5):1890-6.
Rose FARATRO,1 Janine JEFFRIES,2 Gihad E. NESRALLAH,3 Jennifer M. MACRAE, The care and keeping of vascular access for home hemodialysis patients, Hemodialysis International 2015; 19: S80–S92
Piccoli G, Bermond P, Mezza E, Burdese M, Fop F, Mangiarotti G, et al. Vascular access survival and morbidity on daily dialysis: a comparative analysis of home and limited care haemodialysis. Nephrol Dial Transplant 2004;19: 2084–94.
Achinger P, Ikizler T, Bian A, Shintani A, Ayus J. Long term effects of daily hemodialysis on vascular access outcomes: a prospective controlled study. Hemodial Int 2013; 17:208–15.
Muir C, Kotwal S, Hawley C, Polkinghorne K, Gallagher M, Snelling P, et al. Buttonhole cannulation and clinical outcomes in a home hemodialysis cohort and systematic review. Clin J Am Soc Nephrol 2014; 9:110–9
Parisotto M, Schoder V, Miriunis C, Grassmann A, Scatizzil L, Kaufmann P, et al. Cannulation technique influences arteriovenous fistula and graft survival. Kidney Int 2014; 86:790–7.
Suri R, Larive B, Frequent hemodialysis network trial group. Risk of vascular access complications with frequent hemodialysis. J Am Soc Nephrol 2013; 24:498–505.
Benabed A, Henri P, Lobbedez T , Goffin E , Baluta S, Benziane A, Rachi A, van der Pijl JW, Bechade C, Ficheux M, Low flux dialysate daily home hemodialysis: A result for the 62 first French and Belgian patients Nephrologie & Therapeutique 13 (2017) 18–25
Diaz-Buxo JA, Crawford-Bonadio TL, St Pierre D, Ingram KM. Establishing a successful home dialysis program. Blood Purif. 2006;24(1):22-7.
Ethier I, Cho Y, Hawley C, Pascoe EM, Roberts MA, Semple D, Nadeau-Fredette AC, Sypek MP, Viecelli A, Campbell S, van Eps C, Isbel NM, Johnson DW. Effect of patient- and center-level characteristics on uptake of home dialysis in Australia and New Zealand: a multicenter registry analysis. Nephrol Dial Transplant. 2020 Nov 1;35(11):1938-1949.
Bennett PN, Schatell D, Shah KD. Psychosocial aspects in home hemodialysis: a review. Hemodial Int. 2015 Apr;19 Suppl 1: S128-34.
Charytoniuc, Krystyna. “Buttonhole: Requirements and Experience”. Bulletin De La Dialyse à Domicile 2 (4), 2019 ; 207-13. https://doi.org/10.25796/bdd.v2i4.21653.
Verger Christian, and Emmanuel Fabre. “Transition Between Peritoneal Dialysis and Home Hemodialysis in Belgium and France in the RDPLF”. Bulletin De La Dialyse à Domicile 3 (3), 2020 ; 169-76. https://doi.org/10.25796/bdd.v3i3.58393.
Verger Christian, Ghislaine Veniez, Marie-Christine Padernoz, and Emmanuel Fabre. 2021. “Home Dialysis in French Speaking Countries en 2020 (RDPLF Database)”. Bulletin De La Dialyse à Domicile 4 (1), 2020 ; 55-70. https://doi.org/10.25796/bdd.v4i1.61543.
Denny T, Reengineering hemodialysis for the home environment, Biomed Instrum Technol, 2010; Suppl Home Healthcare:73-8.
Haute Autorité de Santé. Evaluation médico-économique des stratégies de prise en charge de l’insuffisance rénale chronique terminale en France. Octobre 2014
How to Cite
Copyright (c) 2021 Hadia HEBIBI, Magali CIROLDI, LAURE CORNILLAC, Samah SAIBI, Fatia EL BOUNDRI, Charles CHAZOT, David ATTAF
This work is licensed under a Creative Commons Attribution 4.0 International License.