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Clinical, patient-related, and economic outcomes of home-based high-dose hemodialysis versus conventional in-center hemodialysis.

Mitsides N, Mitra S, Cornelis T - Int J Nephrol Renovasc Dis (2016)

Bottom Line: In the last 20 years, the focus of development in the field of hemodialysis (HD) has centered around adequate removal of urea and other associated toxins.However, the uptake of this modality is low, and the risk associated with the therapy is not fully understood.Recent studies have highlighted the evidence base and improved our understanding of this technique of dialysis.

View Article: PubMed Central - PubMed

Affiliation: Department of Renal Medicine, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Center, Manchester; National Institute for Healthcare Research Devices for Dignity Healthcare Co-operative, Sheffield, UK.

ABSTRACT
Despite technological advances in renal replacement therapy, the preservation of health and quality of life for individuals on dialysis still remains a challenge. The high morbidity and mortality in dialysis warrant further research and insight into the clinical domains of the technique and practice of this therapy. In the last 20 years, the focus of development in the field of hemodialysis (HD) has centered around adequate removal of urea and other associated toxins. High-dose HD offers an opportunity to improve mortality, morbidity, and quality of life of patients with end-stage kidney disease. However, the uptake of this modality is low, and the risk associated with the therapy is not fully understood. Recent studies have highlighted the evidence base and improved our understanding of this technique of dialysis. This article provides a review of high-dose and home HD, its clinical impact on patient outcome, and the controversies that exist.

No MeSH data available.


Related in: MedlinePlus

The Markov model.Note: The Markov model comprises a number of discrete health states through which patients can transition.Abbreviations: HD, hemodialysis; PD, peritoneal dialysis.
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f2-ijnrd-9-151: The Markov model.Note: The Markov model comprises a number of discrete health states through which patients can transition.Abbreviations: HD, hemodialysis; PD, peritoneal dialysis.

Mentions: We performed a preliminary economic analysis of HD modalities in the Netherlands (unpublished data 2016) based on a Markov model, which allows the capture of all possible treatment options for people with ESRD in so-called transition states, including PD, HD, and kidney transplantation (Figure 2).89 The objective was to compare the cost-effectiveness of high-dose HD (both in-center and at home) with conventional in-center HD. Key parameters of the analysis were QoL and the survival rates of the studied treatments. We found that treating patients at home with conventional HD costs significantly less than treating them in-center (−€21,205) with an additional health benefit (+0.242 quality-adjusted life-years). When delivering high-dose dialysis at home, the added health benefit is higher (+0.478 quality-adjusted life-years) for what we feel as an acceptable added cost (+€7,795). Therefore, we could conclude that in the Netherlands, high-dose home HD appears to be a cost-effective alternative to center-based HD.


Clinical, patient-related, and economic outcomes of home-based high-dose hemodialysis versus conventional in-center hemodialysis.

Mitsides N, Mitra S, Cornelis T - Int J Nephrol Renovasc Dis (2016)

The Markov model.Note: The Markov model comprises a number of discrete health states through which patients can transition.Abbreviations: HD, hemodialysis; PD, peritoneal dialysis.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940011&req=5

f2-ijnrd-9-151: The Markov model.Note: The Markov model comprises a number of discrete health states through which patients can transition.Abbreviations: HD, hemodialysis; PD, peritoneal dialysis.
Mentions: We performed a preliminary economic analysis of HD modalities in the Netherlands (unpublished data 2016) based on a Markov model, which allows the capture of all possible treatment options for people with ESRD in so-called transition states, including PD, HD, and kidney transplantation (Figure 2).89 The objective was to compare the cost-effectiveness of high-dose HD (both in-center and at home) with conventional in-center HD. Key parameters of the analysis were QoL and the survival rates of the studied treatments. We found that treating patients at home with conventional HD costs significantly less than treating them in-center (−€21,205) with an additional health benefit (+0.242 quality-adjusted life-years). When delivering high-dose dialysis at home, the added health benefit is higher (+0.478 quality-adjusted life-years) for what we feel as an acceptable added cost (+€7,795). Therefore, we could conclude that in the Netherlands, high-dose home HD appears to be a cost-effective alternative to center-based HD.

Bottom Line: In the last 20 years, the focus of development in the field of hemodialysis (HD) has centered around adequate removal of urea and other associated toxins.However, the uptake of this modality is low, and the risk associated with the therapy is not fully understood.Recent studies have highlighted the evidence base and improved our understanding of this technique of dialysis.

View Article: PubMed Central - PubMed

Affiliation: Department of Renal Medicine, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Center, Manchester; National Institute for Healthcare Research Devices for Dignity Healthcare Co-operative, Sheffield, UK.

ABSTRACT
Despite technological advances in renal replacement therapy, the preservation of health and quality of life for individuals on dialysis still remains a challenge. The high morbidity and mortality in dialysis warrant further research and insight into the clinical domains of the technique and practice of this therapy. In the last 20 years, the focus of development in the field of hemodialysis (HD) has centered around adequate removal of urea and other associated toxins. High-dose HD offers an opportunity to improve mortality, morbidity, and quality of life of patients with end-stage kidney disease. However, the uptake of this modality is low, and the risk associated with the therapy is not fully understood. Recent studies have highlighted the evidence base and improved our understanding of this technique of dialysis. This article provides a review of high-dose and home HD, its clinical impact on patient outcome, and the controversies that exist.

No MeSH data available.


Related in: MedlinePlus