Home dialysis as a first option: a new paradigm

  • Dimitrios G. Oreopoulos
  • Elias Thodis
  • Ploumis Passadakis
  • Vassilis Vargemezis
Nephrology - Review

Abstract

Traditionally, the initial choice of dialysis for patients with end stage renal disease (ESRD) has been in-center hemodialysis (HD) or peritoneal dialysis (PD). Usually, the choice between these (PD vs. HD) has been based on the characteristics of the dialysis techniques. Obviously the choice of peritoneal dialysis implied dialysis at home, but its geographic location has been only a secondary consideration. Peritoneal dialysis has evolved as a dependable mode that gives good outcomes. This method has become more attractive with the option of overnight cyclers and the recent use of home helpers in some jurisdictions. At the same time the interest in home hemodialysis was rekindled by reports of good outcomes with short daily or nocturnal hemodialysis. Home dialysis (PD or HD) offers high quality of treatment, a high degree of patient independence, and is financially attractive. Therefore, we propose a change in our approach to the choice of the initial form of dialysis for patients with ESRD. Instead of choosing between HD and PD we should present the new patients the advantage of dialysis at home and instead of asking them to choose between peritoneal dialysis or hemodialysis, they should be offered the option to choose between dialysis at home (PD or HD) or in-hospital. This paper will review the advantages of the home-based dialysis methods and the arguments for this simple but vital change in the process of choosing the method of dialysis.

Keywords

Home dialysis Peritoneal dialysis Home hemodialysis End-stage renal disease 

References

  1. 1.
    Jassal SV, Krishna G et al (2002) Attitudes of British Isles nephrologists towards dialysis modality selection: a questionnaire study. Nephrol Dial Transplant 17(3):474–477. doi:10.1093/ndt/17.3.474 PubMedCrossRefGoogle Scholar
  2. 2.
    Krishnan M, Lok CE et al (2002) Epidemiology and demographic aspects of treated end-stage renal disease in the elderly. Semin Dial 15(2):79–83. doi:10.1046/j.1525-139X.2002.00028.x PubMedCrossRefGoogle Scholar
  3. 3.
    Verger C, Duman M et al (2007) Influence of autonomy and type of home assistance on the prevention of peritonitis in assisted automated peritoneal dialysis patients. An analysis of data from the French language peritoneal dialysis registry. Nephrol Dial Transplant 22(4):1218–1223. doi:10.1093/ndt/gfl760 PubMedCrossRefGoogle Scholar
  4. 4.
    Szabo E, Moody H et al (1997) Choice of treatment improves quality of life. A study on patients undergoing dialysis. Arch Intern Med 157(12):1352–1356. doi:10.1001/archinte.157.12.1352 PubMedCrossRefGoogle Scholar
  5. 5.
    Mehrotra R, Marsh D et al (2005) Patient education and access of ESRD patients to renal replacement therapies beyond in-center hemodialysis. Kidney Int 68(1):378–390PubMedGoogle Scholar
  6. 6.
    Little J, Irwin A et al (2001) Predicting a patient’s choice of dialysis modality: experience in a United Kingdom renal department. Am J Kidney Dis 37(5):981–986. doi:10.1016/S0272-6386(05)80014-9 PubMedCrossRefGoogle Scholar
  7. 7.
    Van Biesen W, Vanholder R et al (2000) The role of peritoneal dialysis as the first-line renal replacement modality. Perit Dial Int 20(4):375–383PubMedGoogle Scholar
  8. 8.
    Lameire N, Van Biesen W et al (2000) The role of peritoneal dialysis as first modality in an integrative approach to patients with end-stage renal disease. Perit Dial Int 20(Suppl 2):S134–S141PubMedGoogle Scholar
  9. 9.
    Blake PG (2001) Integrated end-stage renal disease care: the role of peritoneal dialysis. Nephrol Dial Transplant 16(Suppl 5):61–66. doi:10.1093/ndt/16.1.61 PubMedGoogle Scholar
  10. 10.
    The United Kingdom Renal Registry (2002) 5th Annual reportGoogle Scholar
  11. 11.
    Nissenson AR, Prichard SS et al (1997) ESRD modality selection into the 21st century: the importance of non medical factors. ASAIO J 43(3):143–150. doi:10.1097/00002480-199743030-00005 PubMedCrossRefGoogle Scholar
  12. 12.
    Jung B, Blake PG et al (1999) Attitudes of Canadian nephrologists toward dialysis modality selection. Perit Dial Int 19(3):263–268PubMedGoogle Scholar
  13. 13.
    Ledebo I, Ronco C (2008) The best dialysis therapy? Results from an international survey among nephrology professionals. NDT Plus 1(6):403–408. doi:10.1093/ndtplus/sfn148 PubMedCrossRefGoogle Scholar
  14. 14.
    Termorshuizen F, Korevaar JC et al (2003) Hemodialysis and peritoneal dialysis: comparison of adjusted mortality rates according to the duration of dialysis: analysis of The Netherlands cooperative study on the adequacy of dialysis 2. J Am Soc Nephrol 14(11):2851–2860. doi:10.1097/01.ASN.0000091585.45723.9E PubMedCrossRefGoogle Scholar
  15. 15.
    Fenton SS, Schaubel DE et al (1997) Hemodialysis versus peritoneal dialysis: a comparison of adjusted mortality rates. Am J Kidney Dis 30(3):334–342. doi:10.1016/S0272-6386(97)90276-6 PubMedCrossRefGoogle Scholar
  16. 16.
    Bloembergen WE, Port FK et al (1995) A comparison of mortality between patients treated with hemodialysis and peritoneal dialysis. J Am Soc Nephrol 6(2):177–183PubMedGoogle Scholar
  17. 17.
    CORR Report (2002, 2003) Treatment of end stage organ failure in Canada, 2002 and 2003. p 9Google Scholar
  18. 18.
    Gokal R, Figueras M et al (1999) Outcomes in peritoneal dialysis and haemodialysis—a comparative assessment of survival and quality of life. Nephrol Dial Transplant 14(Suppl 6):24–30PubMedCrossRefGoogle Scholar
  19. 19.
    Held PJ, Port FK et al (1994) Continuous ambulatory peritoneal dialysis and hemodialysis: comparison of patient mortality with adjustment for comorbid conditions. Kidney Int 45(4):1163–1169PubMedCrossRefGoogle Scholar
  20. 20.
    Fox JG, Fowler I et al (1993) Audit of a decade of continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant 8(3):240–243PubMedGoogle Scholar
  21. 21.
    Maiorca R, Cancarini GC et al (1996) Differing dialysis treatment strategies and outcome. Nephrol Dial Transplant 11(Suppl 2):134–139PubMedGoogle Scholar
  22. 22.
    Maitra S, Sekercioglu N et al (2007) Causes of death in older peritoneal dialysis patients—can we depend on registry reports? Int Urol Nephrol 39(1):345–350PubMedCrossRefGoogle Scholar
  23. 23.
    Coles GA, Williams JD (1998) What is the place of peritoneal dialysis in the integrated treatment of renal failure? Kidney Int 54(6):2234–2240PubMedCrossRefGoogle Scholar
  24. 24.
    Keshaviah P, Collins AJ et al (2002) Survival comparison between hemodialysis and peritoneal dialysis based on matched doses of delivered therapy. J Am Soc Nephrol 13(Suppl 1):S48–S52PubMedGoogle Scholar
  25. 25.
    US Renal Data System (USRDS) (2007) Annual data report: Atlas of end-stage renal disease in the United States patient survivalGoogle Scholar
  26. 26.
    Tanna MM, Vonesh EF et al (2000) Patient survival among incident peritoneal dialysis and hemodialysis patients in an urban setting. Am J Kidney Dis 36(6):1175–1182PubMedCrossRefGoogle Scholar
  27. 27.
    Davies SJ, Phillips L et al (1998) What really happens to people on long-term peritoneal dialysis? Kidney Int 54(6):2207–2217PubMedCrossRefGoogle Scholar
  28. 28.
    Lysaght MJ (1996) Preservation of residual renal function in maintenance dialysis patients. Perit Dial Int 16(2):126–127PubMedGoogle Scholar
  29. 29.
    Berlanga JR, Marron B et al (2002) Peritoneal dialysis retardation of progression of advanced renal failure. Perit Dial Int 22(2):239–242PubMedGoogle Scholar
  30. 30.
    Degoulet P, Legrain M et al (1982) Mortality risk factors in patients treated by chronic hemodialysis. Report of the diaphane collaborative study. Nephron 31(2):103–110PubMedCrossRefGoogle Scholar
  31. 31.
    Leavey SF, Strawderman RL et al (1998) Simple nutritional indicators as independent predictors of mortality in hemodialysis patients. Am J Kidney Dis 31(6):997–1006PubMedCrossRefGoogle Scholar
  32. 32.
    Aslam N, Bernardini J et al (2002) Large body mass index does not predict short-term survival in peritoneal dialysis patients. Perit Dial Int 22(2):191–196PubMedGoogle Scholar
  33. 33.
    Pliakogiannis T, Trpeski L et al (2007) Reverse epidemiology in peritoneal dialysis patients: the Canadian experience and review of the literature. Int Urol Nephrol 39(1):281–288PubMedCrossRefGoogle Scholar
  34. 34.
    (1996) Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. Canada–USA (CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol 7(2):198–207Google Scholar
  35. 35.
    Hakim RM, Lowrie E (1999) Obesity and mortality in ESRD: is it good to be fat? Kidney Int 55(4):1580–1581PubMedCrossRefGoogle Scholar
  36. 36.
    McCusker FX, Teehan BP et al (1996) How much peritoneal dialysis is required for the maintenance of a good nutritional state? Canada–USA (CANUSA) Peritoneal Dialysis Study Group. Kidney Int Suppl 56:S56–S61Google Scholar
  37. 37.
    Ramkumar N, Pappas LM et al (2005) Effect of body size and body composition on survival in peritoneal dialysis patients. Perit Dial Int 25(5):461–469PubMedGoogle Scholar
  38. 38.
    Fried L, Bernardini J et al (1996) Neither size nor weight predicts survival in peritoneal dialysis patients. Perit Dial Int 16(4):357–361PubMedGoogle Scholar
  39. 39.
    Just PM, de Charro FT et al (2008) Reimbursement and economic factors influencing dialysis modality choice around the world. Nephrol Dial Transplant 23(7):2365–2373PubMedCrossRefGoogle Scholar
  40. 40.
    Baboolal K, McEwan P et al (2008) The cost of renal dialysis in a UK setting—a multicentre study. Nephrol Dial Transplant 23(6):1982–1989PubMedCrossRefGoogle Scholar
  41. 41.
    De Vecchi AF, Dratwa M et al (1999) Healthcare systems and end-stage renal disease (ESRD) therapies—an international review: costs and reimbursement/funding of ESRD therapies. Nephrol Dial Transplant 14(Suppl 6):31–41PubMedCrossRefGoogle Scholar
  42. 42.
    Shih YC, Guo A et al (2005) Impact of initial dialysis modality and modality switches on Medicare expenditures of end-stage renal disease patients. Kidney Int 68(1):319–329PubMedCrossRefGoogle Scholar
  43. 43.
    Salonen T, Reina T et al (2007) Alternative strategies to evaluate the cost-effectiveness of peritoneal dialysis and hemodialysis. Int Urol Nephrol 39(1):289–298PubMedCrossRefGoogle Scholar
  44. 44.
    NBVN jaarverslang (2003) www.nbvn.be, 2008)
  45. 45.
    Bericht uber Dialysebehandlung und Nierentansplation in Deutschland 2005–2006. www.quasi-niere.de, 2008-09-01
  46. 46.
    Goeree R, Manalich J et al (1995) Cost analysis of dialysis treatments for end-stage renal disease (ESRD). Clin Invest Med 18(6):455–464PubMedGoogle Scholar
  47. 47.
    Wolcott DL, Nissenson AR (1988) Quality of life in chronic dialysis patients: a critical comparison of continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis. Am J Kidney Dis 11(5):402–412PubMedGoogle Scholar
  48. 48.
    Bremer BA, McCauley CR et al (1989) Quality of life in end-stage renal disease: a reexamination. Am J Kidney Dis 13(3):200–209PubMedGoogle Scholar
  49. 49.
    Simmons RG, Anderson CR et al (1990) Quality of life and rehabilitation differences among four end-stage renal disease therapy groups. Scand J Urol Nephrol Suppl 131:7–22PubMedGoogle Scholar
  50. 50.
    Auer J, Gokal R et al (1990) The Oxford–Manchester study of dialysis patients. Age, risk factors and treatment method in relation to quality of life. Scand J Urol Nephrol Suppl 131:31–37Google Scholar
  51. 51.
    Tucker CM, Ziller RC et al (1991) Quality of life of patients on in-center hemodialysis versus continuous ambulatory peritoneal dialysis. Perit Dial Int 11(4):341–346PubMedGoogle Scholar
  52. 52.
    Apostolou T (2007) Quality of life in the elderly patients on dialysis. Int Urol Nephrol 39(2):679–683PubMedCrossRefGoogle Scholar
  53. 53.
    Ronco C, La Greca G (1997) Integration of peritoneal dialysis in active uremia treatment. Perit Dial Int 17(Suppl 2):S155–S160PubMedGoogle Scholar
  54. 54.
    Julius M, Kneisley JD et al (1989) A comparison of employment rates of patients treated with continuous ambulatory peritoneal dialysis vs in-center hemodialysis (Michigan End-Stage Renal Disease Study). Arch Intern Med 149(4):839–842PubMedCrossRefGoogle Scholar
  55. 55.
    Merkus MP, Jager KJ et al (1997) Quality of life in patients on chronic dialysis: self-assessment 3 months after the start of treatment. The Necosad Study Group. Am J Kidney Dis 29(4):584–592PubMedCrossRefGoogle Scholar
  56. 56.
    Woods JD, Port FK et al (1996) Comparison of mortality with home hemodialysis and center hemodialysis: a national study. Kidney Int 49(5):1464–1470PubMedCrossRefGoogle Scholar
  57. 57.
    Wu AW, Fink NE et al (2004) Changes in quality of life during hemodialysis and peritoneal dialysis treatment: generic and disease specific measures. J Am Soc Nephrol 15(3):743–753PubMedCrossRefGoogle Scholar
  58. 58.
    Bleyer AJ, Burkart JM et al (1999) Dialysis modality and delayed graft function after cadaveric renal transplantation. J Am Soc Nephrol 10(1):154–159PubMedGoogle Scholar
  59. 59.
    Van Loo A, Heering P, Vanholder R, Grabensee B, Van Biesen W, Hesse U, Lameire N (1998) Reduced incidence of acute renal graft failure in patients treated with peritoneal dialysis compared to haemodialysis. Nephrol Dial Transplant 13:831 abstractGoogle Scholar
  60. 60.
    Cancarini GC, Sandrini S et al (2006) Transplantation outcome in patients on PD and HD. Contrib Nephrol 150:259–270PubMedCrossRefGoogle Scholar
  61. 61.
    Chalem Y, Ryckelynck JP et al (2005) Access to, and outcome of, renal transplantation according to treatment modality of end-stage renal disease in France. Kidney Int 67(6):2448–2453PubMedCrossRefGoogle Scholar
  62. 62.
    Helal I, Abderrahim E et al (2007) Impact of dialysis modality on posttransplantation results in kidney transplantation. Transplant Proc 39(8):2547–2549PubMedCrossRefGoogle Scholar
  63. 63.
    Suri RS, Nesrallah GE et al (2006) Daily hemodialysis: a systematic review. Clin J Am Soc Nephrol 1(1):33–42PubMedCrossRefGoogle Scholar
  64. 64.
    (2003) USRDS: The United States Renal Data System. Am J Kidney Dis 42(6 Suppl 5):1–230Google Scholar
  65. 65.
    Eknoyan G, Beck GJ et al (2002) Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 347(25):2010–2019PubMedCrossRefGoogle Scholar
  66. 66.
    Paniagua R, Amato D et al (2002) Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial. J Am Soc Nephrol 13(5):1307–1320PubMedGoogle Scholar
  67. 67.
    Kjellstrand CM, Evans RL et al. (1975) The “unphysiology” of dialysis: a major cause of dialysis side effects? Kidney Int Suppl(2):30–4Google Scholar
  68. 68.
    Grzegorzewska AE, Banachowicz W (2008) Evaluation of hemodialysis adequacy using online Kt/V and single-pool variable-volume urea Kt/V. Int Urol Nephrol 40(3):771–778PubMedCrossRefGoogle Scholar
  69. 69.
    Nesrallah G, Suri R et al (2003) Volume control and blood pressure management in patients undergoing quotidian hemodialysis. Am J Kidney Dis 42(1 Suppl):13–17PubMedCrossRefGoogle Scholar
  70. 70.
    Woods JD, Port FK et al (1999) Clinical and biochemical correlates of starting “daily” hemodialysis. Kidney Int 55(6):2467–2476PubMedCrossRefGoogle Scholar
  71. 71.
    Chan CT, Harvey PJ et al (2003) Short-term blood pressure, noradrenergic, and vascular effects of nocturnal home hemodialysis. Hypertension 42(5):925–931PubMedCrossRefGoogle Scholar
  72. 72.
    Foley RN, Parfrey PS et al (1995) The prognostic importance of left ventricular geometry in uremic cardiomyopathy. J Am Soc Nephrol 5(12):2024–2031PubMedGoogle Scholar
  73. 73.
    London GM, Pannier B et al (2001) Alterations of left ventricular hypertrophy in and survival of patients receiving hemodialysis: follow-up of an interventional study. J Am Soc Nephrol 12(12):2759–2767PubMedGoogle Scholar
  74. 74.
    Turkmen F, Emre A et al (2008) Relationship between aortic valve sclerosis and left ventricular hypertrophy in chronic haemodialysis patients. Int Urol Nephrol 40(2):497–502PubMedCrossRefGoogle Scholar
  75. 75.
    Chan C, Floras JS et al (2002) Improvement in ejection fraction by nocturnal haemodialysis in end-stage renal failure patients with coexisting heart failure. Nephrol Dial Transplant 17(8):1518–1521PubMedCrossRefGoogle Scholar
  76. 76.
    Lindsay RM, Alhejaili F et al (2003) Calcium and phosphate balance with quotidian hemodialysis. Am J Kidney Dis 42(1 Suppl):24–29PubMedCrossRefGoogle Scholar
  77. 77.
    Al-Hejaili F, Kortas C et al (2003) Nocturnal but not short hours quotidian hemodialysis requires an elevated dialysate calcium concentration. J Am Soc Nephrol 14(9):2322–2328PubMedCrossRefGoogle Scholar
  78. 78.
    Heidenheim AP, Muirhead N et al (2003) Patient quality of life on quotidian hemodialysis. Am J Kidney Dis 42(1 Suppl):36–41PubMedCrossRefGoogle Scholar
  79. 79.
    Ting GO, Kjellstrand C et al (2003) Long-term study of high-comorbidity ESRD patients converted from conventional to short daily hemodialysis. Am J Kidney Dis 42(5):1020–1035PubMedGoogle Scholar
  80. 80.
    Fong E, Bargman JM et al (2007) Cross-sectional comparison of quality of life and illness intrusiveness in patients who are treated with nocturnal home hemodialysis versus peritoneal dialysis. Clin J Am Soc Nephrol 2(6):1195–1200PubMedCrossRefGoogle Scholar
  81. 81.
    Woods JD, Port FK, Orzol S, Buoncristiani U, Young E, Wolfe RA et al (1999) Clinical and biochemical correlates of starting “daily”hemodialysis. Kidney Int 55:2467–2476PubMedCrossRefGoogle Scholar
  82. 82.
    Pierratos A (2004) Daily nocturnal home hemodialysis. Kidney Int 65(5):1975–1986PubMedCrossRefGoogle Scholar
  83. 83.
    Kjellstrand CM, Buoncristiani U et al (2008) Short daily haemodialysis: survival in 415 patients treated for 1006 patient-years. Nephrol Dial Transplant 23(10):3283–3289PubMedCrossRefGoogle Scholar
  84. 84.
    Blagg CR (2003) Quotidian dialysis: The London, Ontario experience. Am J Kidney Dis 42(1 Suppl):1–2PubMedCrossRefGoogle Scholar
  85. 85.
    Culleton BF, Walsh M et al (2007) Effect of frequent nocturnal hemodialysis vs conventional hemodialysis on left ventricular mass and quality of life: a randomized controlled trial. JAMA 298(11):1291–1299PubMedCrossRefGoogle Scholar
  86. 86.
    Mohr PE, Neumann PJ et al (2001) The case for daily dialysis: its impact on costs and quality of life. Am J Kidney Dis 37(4):777–789PubMedCrossRefGoogle Scholar
  87. 87.
    McFarlane PA, Bayoumi AM et al (2006) The impact of home nocturnal hemodialysis on end-stage renal disease therapies: a decision analysis. Kidney Int 69(5):798–805PubMedCrossRefGoogle Scholar
  88. 88.
    Lee H, Manns B, Taub K, Ghali WA, Dean S, Johnson D, Donaldson D (2002) Cost analysis of ongoing care of patients with end-stage renal disease: The impact of dialysis modality and dialysis access. Am J Kidney Dis 40(3):611–622PubMedCrossRefGoogle Scholar
  89. 89.
    Veger C et al (2007) Influence of autonomy and the type of home assistance on the prevention of peritonitis in assisted automated peritoneal dialysis patients: an analysis of data from the French Language Peritoneal Dialysis Registry. Nephrol Dial Transplant 22:1218–1223CrossRefGoogle Scholar
  90. 90.
    Quinn RR, Oliver MJ (2006) Is assisted peritoneal dialysis an alternative to in-center hemodialysis? Perit Dial Int 26(6):650–653PubMedGoogle Scholar
  91. 91.
    Inaguma D, Tatematsu M et al (2006) Effect of an educational program on the predialysis period for patients with chronic renal failure. Clin Exp Nephrol 10(4):274–278PubMedCrossRefGoogle Scholar
  92. 92.
    Taskapan H, Tam P et al (2008) Improvement in eGFR in patients with chronic kidney disease attending a nephrology clinic. Int Urol Nephrol 40(3):841–848PubMedCrossRefGoogle Scholar
  93. 93.
    Ifudu O, Dawood M et al (1996) Excess morbidity in patients starting uremia therapy without prior care by a nephrologist. Am J Kidney Dis 28(6):841–845PubMedCrossRefGoogle Scholar
  94. 94.
    Innes A, Rowe PA et al (1992) Early deaths on renal replacement therapy: the need for early nephrological referral. Nephrol Dial Transplant 7(6):467–471PubMedGoogle Scholar
  95. 95.
    Roderick P, Jones C et al (2002) Late referral for end-stage renal disease: a region-wide survey in the south west of England. Nephrol Dial Transplant 17(7):1252–1259PubMedCrossRefGoogle Scholar
  96. 96.
    Stevenson KB, Hannah EL et al (2002) Epidemiology of hemodialysis vascular access infections from longitudinal infection surveillance data: predicting the impact of NKF-DOQI clinical practice guidelines for vascular access. Am J Kidney Dis 39(3):549–555PubMedCrossRefGoogle Scholar
  97. 97.
    Blake PG (1999) Factors affecting international utilization of peritoneal dialysis: implications for increasing utilization in the United States. Semin Dial 12:365–369CrossRefGoogle Scholar
  98. 98.
    Schmidt RJ, Domico JR et al (1998) Early referral and its impact on emergent first dialyses, health care costs, and outcome. Am J Kidney Dis 32(2):278–283PubMedCrossRefGoogle Scholar
  99. 99.
    Tzamaloukas AH, Konstantinov KN et al (2008) Twenty-first Century ethics of medical research involving human subjects: achievements and challenges. Int Urol Nephrol 40(1):153–163PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2009

Authors and Affiliations

  • Dimitrios G. Oreopoulos
    • 1
  • Elias Thodis
    • 2
  • Ploumis Passadakis
    • 2
  • Vassilis Vargemezis
    • 2
  1. 1.Division of NephrologyUniversity Health Network, and University of TorontoTorontoCanada
  2. 2.Department of Nephrology, Medical SchoolDemocritus University of ThraceAlexandroupolisGreece

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