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Speaking of staying at home
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🏠" title="House building" aria-label="Emoji: House building">... let’s not forget that #AdvancingAmericanKidneyHealth (AAKH) aims to have 80% of people with kidney failure use a home dialysis modality or obtain a transplant by 2025. Do you know how close we are to that goal?
#NephMadness #EthicsRegion
Speaking of staying at home
#NephMadness #EthicsRegion
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As of December 2017, the USRDS reported 38% of people with kidney failure (or end stage renal disease/ESRD) in the United States were either on peritoneal dialysis (PD), home hemodialysis (HD), or had a functioning kidney transplant. What’s the breakdown of each modality?
As of December 2017, the USRDS reported 38% of people with kidney failure (or end stage renal disease/ESRD) in the United States were either on peritoneal dialysis (PD), home hemodialysis (HD), or had a functioning kidney transplant. What’s the breakdown of each modality?
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By and large, that 38% is made up of transplant - 30% of all ESRD patients have a functioning kidney transplant. Only 7% are on PD, and 1.3% are on home HD. The rest of our patients (~ 61%) receive in-center HD.
By and large, that 38% is made up of transplant - 30% of all ESRD patients have a functioning kidney transplant. Only 7% are on PD, and 1.3% are on home HD. The rest of our patients (~ 61%) receive in-center HD.
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In the spirit of #StayAtHomehttps://abs.twimg.com/hashflags... draggable="false" alt=""> (but also because #NephMadness), let’s focus on home dialysis modalities here. Check out this map from the USRDS on prevalence of home dialysis among people on dialysis between 2012-2016.
https://www.usrds.org/2019/download/USRDS_2019_ES_final.pdf">https://www.usrds.org/2019/down...
In the spirit of #StayAtHome
https://www.usrds.org/2019/download/USRDS_2019_ES_final.pdf">https://www.usrds.org/2019/down...
(but also because #NephMadness), let’s focus on home dialysis modalities here. Check out this map from the USRDS on prevalence of home dialysis among people on dialysis between 2012-2016. https://www.usrds.org/2019/down..." title="4/In the spirit of #StayAtHome https://abs.twimg.com/hashflags... draggable="false" alt=""> (but also because #NephMadness), let’s focus on home dialysis modalities here. Check out this map from the USRDS on prevalence of home dialysis among people on dialysis between 2012-2016. https://www.usrds.org/2019/down..." class="img-responsive" style="max-width:100%;"/>
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How does the United States compare to other countries regarding dialysis modality mixhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="🎨" title="Artist palette" aria-label="Emoji: Artist palette">?
Data from the EVEREST study demonstrate the % of incident patients on PD was 8% in the USA with a median of 12% across 36 other national registries. Source: https://www.ncbi.nlm.nih.gov/pubmed/23543592 ">https://www.ncbi.nlm.nih.gov/pubmed/23...
How does the United States compare to other countries regarding dialysis modality mix
Data from the EVEREST study demonstrate the % of incident patients on PD was 8% in the USA with a median of 12% across 36 other national registries. Source: https://www.ncbi.nlm.nih.gov/pubmed/23543592 ">https://www.ncbi.nlm.nih.gov/pubmed/23...
?Data from the EVEREST study demonstrate the % of incident patients on PD was 8% in the USA with a median of 12% across 36 other national registries. Source: https://www.ncbi.nlm.nih.gov/pubmed/23..." title="5/How does the United States compare to other countries regarding dialysis modality mix https://abs.twimg.com/emoji/v2/... draggable="false" alt="🎨" title="Artist palette" aria-label="Emoji: Artist palette">?Data from the EVEREST study demonstrate the % of incident patients on PD was 8% in the USA with a median of 12% across 36 other national registries. Source: https://www.ncbi.nlm.nih.gov/pubmed/23..." class="img-responsive" style="max-width:100%;"/>
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By the way, the countries with the highest rates of PD were not included in the prior study. They are Hong Kong, El Salvador and Mexico, which have 79%, 76% and 66% of dialysis patients on PD, respectively.https://abs.twimg.com/emoji/v2/... draggable="false" alt="😮" title="Face with open mouth" aria-label="Emoji: Face with open mouth">
Source: https://www.ncbi.nlm.nih.gov/pubmed/22302194 ">https://www.ncbi.nlm.nih.gov/pubmed/22...
By the way, the countries with the highest rates of PD were not included in the prior study. They are Hong Kong, El Salvador and Mexico, which have 79%, 76% and 66% of dialysis patients on PD, respectively.
Source: https://www.ncbi.nlm.nih.gov/pubmed/22302194 ">https://www.ncbi.nlm.nih.gov/pubmed/22...
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Hong Kong has the highest % of PD patients in the world due to a PD first policy. Latin America also has very high numbers of people on PD.
Source: https://www.ncbi.nlm.nih.gov/pubmed/23737482 ">https://www.ncbi.nlm.nih.gov/pubmed/23...
Hong Kong has the highest % of PD patients in the world due to a PD first policy. Latin America also has very high numbers of people on PD.
Source: https://www.ncbi.nlm.nih.gov/pubmed/23737482 ">https://www.ncbi.nlm.nih.gov/pubmed/23...
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From a population health perspective, PD becomes less common as
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Heavy check mark" aria-label="Emoji: Heavy check mark">% of GDP spent on healthcare increases
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Heavy check mark" aria-label="Emoji: Heavy check mark">% of HD centers run for-profit increases
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Heavy check mark" aria-label="Emoji: Heavy check mark">Cost of PD consumables relative to staffing increases
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Heavy check mark" aria-label="Emoji: Heavy check mark">% of patients with diabetes increases
Source: #37093503">https://academic.oup.com/ndt/article/29/8/1494/1938072 #37093503">https://academic.oup.com/ndt/artic...
From a population health perspective, PD becomes less common as
Source: #37093503">https://academic.oup.com/ndt/article/29/8/1494/1938072 #37093503">https://academic.oup.com/ndt/artic...
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But how about individual choice? What factors do patients perceive as most important when choosing a dialysis modality?
But how about individual choice? What factors do patients perceive as most important when choosing a dialysis modality?
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The EPOCH-RRT study surveyed 180 people and found that the 3 most important factors were
1) Maintaining independence (96%)
2) Issues related to quality and quantity of life (94%)
3) Schedule flexibility (92%)
Source: https://www.ncbi.nlm.nih.gov/pubmed/25582285 ">https://www.ncbi.nlm.nih.gov/pubmed/25...
The EPOCH-RRT study surveyed 180 people and found that the 3 most important factors were
1) Maintaining independence (96%)
2) Issues related to quality and quantity of life (94%)
3) Schedule flexibility (92%)
Source: https://www.ncbi.nlm.nih.gov/pubmed/25582285 ">https://www.ncbi.nlm.nih.gov/pubmed/25...
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From a patient perspective, we do know that people tend to be more satisfied with their care on PD
Source: https://www.ncbi.nlm.nih.gov/pubmed/14871912 ">https://www.ncbi.nlm.nih.gov/pubmed/14...
From a patient perspective, we do know that people tend to be more satisfied with their care on PD
Source: https://www.ncbi.nlm.nih.gov/pubmed/14871912 ">https://www.ncbi.nlm.nih.gov/pubmed/14...
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Not only are people more satisfied with their care, PD is also linked to...
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Heavy check mark" aria-label="Emoji: Heavy check mark">Better preservation and recovery of residual kidney function
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Heavy check mark" aria-label="Emoji: Heavy check mark">Fewer infectious complications
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Heavy check mark" aria-label="Emoji: Heavy check mark">Better preservation of dialysis access #policy">https://ajkdblog.org/2020/03/13/nephmadness-2020-ethics-region/ #policy">https://ajkdblog.org/2020/03/1...
Not only are people more satisfied with their care, PD is also linked to...
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Home HD is associated with:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Heavy check mark" aria-label="Emoji: Heavy check mark">Improvements in cardiac structure
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Heavy check mark" aria-label="Emoji: Heavy check mark">Nutritional parameters
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Heavy check mark" aria-label="Emoji: Heavy check mark">Potentially survival? #policy">https://ajkdblog.org/2020/03/13/nephmadness-2020-ethics-region/ #policy">https://ajkdblog.org/2020/03/1...
Home HD is associated with:
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In regards to quality of life, some aspects may be improved on PD (ability to work and travel, less pain and diet problems), while others are worse compared to HD (sleep, sexual function)... what works for most people may not work for everyone #BeneficenceVsAutonomy
In regards to quality of life, some aspects may be improved on PD (ability to work and travel, less pain and diet problems), while others are worse compared to HD (sleep, sexual function)... what works for most people may not work for everyone #BeneficenceVsAutonomy
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In addition, mortality risk seems to be no different between HD and PD when adjusted for selection bias (adjusted for demographics, comorbidities, hospitalization history)
Source: https://jasn.asnjournals.org/content/22/8/1398.long">https://jasn.asnjournals.org/content/2...
In addition, mortality risk seems to be no different between HD and PD when adjusted for selection bias (adjusted for demographics, comorbidities, hospitalization history)
Source: https://jasn.asnjournals.org/content/22/8/1398.long">https://jasn.asnjournals.org/content/2...
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From a national perspective, a major benefit of a transition to PD is economic - a comparison of cost between HD and PD across 46 countries found a HD/PD cost ratio of 1.29 in the USA.
Source: https://www.ncbi.nlm.nih.gov/pubmed/23737482 ">https://www.ncbi.nlm.nih.gov/pubmed/23...
From a national perspective, a major benefit of a transition to PD is economic - a comparison of cost between HD and PD across 46 countries found a HD/PD cost ratio of 1.29 in the USA.
Source: https://www.ncbi.nlm.nih.gov/pubmed/23737482 ">https://www.ncbi.nlm.nih.gov/pubmed/23...
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Policy such as AAKH can be a powerful driver of outcomes in dialysis, although as featured in #NephMadness, there is a tradeoff with autonomy. The needs of some patients differ. Specifically, people who tend to be placed on HD are:
Policy such as AAKH can be a powerful driver of outcomes in dialysis, although as featured in #NephMadness, there is a tradeoff with autonomy. The needs of some patients differ. Specifically, people who tend to be placed on HD are:
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That’s right - it is all of the above.
In summary:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Heavy check mark" aria-label="Emoji: Heavy check mark">AAKH aims to have 80% of people who have reached ESRD receive a transplant or be on home dialysis
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Heavy check mark" aria-label="Emoji: Heavy check mark">We are at 38%, of which nearly 80% is transplant and 18% is PD
That’s right - it is all of the above.
In summary:
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BONUS: What barriers do we face in implementing home dialysis modalities?
Per a report by Kidney International, there are many including issues related to accessibility, infrastructure, delivery models and need for patient education and support.
BONUS: What barriers do we face in implementing home dialysis modalities?
Per a report by Kidney International, there are many including issues related to accessibility, infrastructure, delivery models and need for patient education and support.
Source: https://www.kidney-international.org/article/S0085-2538%2819%2930138-3/fulltext">https://www.kidney-international.org/article/S...
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What do you think? Is this feasible? What tradeoffs are there?
And don’t forget, NephMadness is open until April 30!
You can vote for #EthicsRegionhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="⚖️" title="Scales" aria-label="Emoji: Scales"> here:
https://www.tourneytopia.com/AJKD/NephMadness/SubmitPicks/Picks.aspx">https://www.tourneytopia.com/AJKD/Neph...
What do you think? Is this feasible? What tradeoffs are there?
And don’t forget, NephMadness is open until April 30!
You can vote for #EthicsRegion
https://www.tourneytopia.com/AJKD/NephMadness/SubmitPicks/Picks.aspx">https://www.tourneytopia.com/AJKD/Neph...
