Underutilization of Home Hemodialysis

家庭血液透析的利用不足

• 批准号: 8646471
• 负责人: Rebecca Kurnik Seshasai
• 金额: $ 7.27万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8646471
• 关键词: Age; Biometry; Blood Pressure; Blood Vessels; Canada; Caregivers; Caring; Catheters; Certification; Characteristics; Clinical; Comorbidity; Data; Data Analyses; Data Collection; Data Set; Dependence; Diabetes Mellitus; Dialysis patients; Dialysis procedure; End stage renal failure; Failure; Family; Family member; Fright; Future; Hemodialysis; Home Hemodialysis; Home environment; Hospitalization; Hour; Human Resources; Individual; Information Systems; Intervention; Intervention Trial; Interview; Kidney; Kidney Transplantation; Maintenance; Master' s Degree; Measures; Medicare; Metabolism; Methods; Minerals; Modality; Nephrology; Nurses; Outcome; Patients; Pennsylvania; Peritoneal Dialysis; Physicians; Prospective Studies; Provider; Qualitative Methods; Quality of life; Reporting; Research; Risk; Severities; Structure; Surveys; Techniques; Time; Training; United States; Universities; Venous; Work; career; clinical epidemiology; cost; design; experience; functional status; insight; low socioeconomic status; mortality; prevent; programs; public health relevance; success; uptake

DESCRIPTION (provided by applicant): More than 400,000 individuals in the United States are treated with maintenance dialysis for end-stage renal disease. Most of these patients receive hemodialysis at a dialysis center with treatments administered by nurses and technicians and minimal involvement by the patient. A small proportion of patients perform dialysis in the home using either peritoneal dialysis (8%), or home hemodialysis (HHD) (<1%). In contrast to in-center hemodialysis which usually consists of thrice weekly treatments 3-4 hours in duration, HHD is typically performed 5-6 times per week or with 6-8 hour nocturnal sessions three times per week. There is accumulating suggestive evidence that, in comparison with conventional in-center hemodialysis, HHD has benefits on blood pressure, mineral metabolism, hospitalization rates, quality of life, and survival. The use of HHD by such a small proportion of patients despite these potential benefits has been attributed to limited access to this modality because of the relatively small number of centers offering HHD, lack of physician experience with the modality, and limited dialysis provider organization infra-structure to support HHD. A less appreciated contributor to the low utilization of HHD is discontinuation of HHD by patients who have initiated treatment with the modality. HHD discontinuation, which has been reported to occur at rates of 20-25% during the first year of treatment, has a substantial deleterious impact given the large upfront costs, personnel time and patient/family commitment required for HHD training and initiation. Little is known about the reasons patients discontinue HHD or effective approaches to reduce HHD discontinuation. The objective of the proposed study is to identify patient and dialysis facility factors associated with HHD discontinuation witha specific focus on potentially modifiable contributors and indicators of risk that could trigger increased support to prevent discontinuation. A unique dataset created by merging data from the United States Renal Data System (USRDS) and a dialysis provider organization with a large HHD program will be used to characterize the rate and timing of HHD discontinuation, identify patient and facility factors associated with HHD discontinuation, and determine the impact of hospitalizations on HHD discontinuation. In addition, semi-structured interviews will be conducted with patients, family members and dialysis facility staff from the University of Pennsylvania HHD Program to explore factors contributing to HHD discontinuation that cannot be measured through secondary data analysis alone. This work is expected to 1) identify targets for interventions to reduce HHD discontinuation, an important but poorly understood barrier to utilization of this dialysis modality, and 2) provide the applicant with experience in biostatistic, clinical epidemiology and primary data collection that, together with the formal coursework in her master's degree program, will prepare her for a research career in nephrology.

描述（由申请人提供）：美国有超过40万人接受终末期肾病维持性透析治疗。这些患者中的大多数在透析中心接受血液透析，由护士和技术人员进行治疗，患者的参与最小。一小部分患者在家中使用腹膜透析（8%）或家庭血液透析（HHD）（<1%）进行透析。与通常包括每周三次治疗3-4小时的中心血液透析相比，HHD通常每周进行5-6次或每周三次6-8小时的夜间治疗。越来越多的证据表明，与传统的中心血液透析相比，HHD在血压、矿物质代谢、住院率、生活质量和生存率方面具有益处。尽管有这些潜在的益处，但使用HHD的患者比例如此之小，这是由于提供HHD的中心数量相对较少，医生缺乏该模式的经验，以及有限的透析提供者组织基础设施支持，因此使用该模式的机会有限 HHD。HHD利用率低的一个不太受重视的因素是已开始使用该模式治疗的患者停止HHD。据报道，HHD停药的发生率在治疗的第一年为20-25%，考虑到HHD培训和启动所需的大量前期成本、人员时间和患者/家庭承诺，HHD停药具有实质性的有害影响。关于患者停止HHD的原因或减少HHD停药的有效方法知之甚少。 拟定研究的目的是确定与HHD停药相关的患者和透析机构因素，特别关注可能引发增加支持以防止停药的潜在可改变因素和风险指标。通过合并来自美国肾脏数据系统（USRDS）和具有大型HHD项目的透析提供者组织的数据创建的独特数据集将用于表征HHD停药的速率和时间，识别与HHD停药相关的患者和机构因素，并确定住院对HHD停药的影响。此外，将对宾夕法尼亚大学HHD项目的患者、家庭成员和透析机构工作人员进行半结构化访谈，以探索无法单独通过次要数据分析测量的导致HHD停药的因素。这项工作预计将1）确定干预措施的目标，以减少HHD停药，这是使用这种透析方式的一个重要但知之甚少的障碍，以及2）为申请人提供生物统计学，临床流行病学和主要数据收集方面的经验，连同她的硕士学位课程中的正式课程，将为她在肾脏病学的研究生涯做好准备。

项目成果

Factors Associated With Discontinuation of Home Hemodialysis.

与停止家庭血液透析相关的因素。

• DOI: 10.1053/j.ajkd.2015.11.003
• 发表时间: 2016
• 期刊: American journal of kidney diseases : the official journal of the National Kidney Foundation
• 作者: Seshasai,RebeccaKurnik;Mitra,Nandita;Chaknos,CMichael;Li,Jiaqi;Wirtalla,Christopher;Negoianu,Dan;Glickman,JoelD;Dember,LauraM
• 通讯作者: Dember,LauraM