Operationalizing Telehealth for Home Dialysis

In January, 2019, Medicare rules for telehealth changed to permit the home as an originating site for home dialysis patients. ESCOs can take advantage of waivers to obtain payment for a monthly comprehensive telehealth visit with a home patient after the first 3 months of therapy—with no geographic restrictions. Technical, regulatory, and operational challenges are discussed in this article.

Read the abstract » | (added 2019-04-11)

Tags: Maintenance Dialysis Therapy, Telehealth Services, Legislation, Regulatory Requirements, Remote Monitoring

Perspectives on Payment for More Frequent Home HD

This article explains the role of the Medicare regional contractors in implementing—or thwarting—payment for more than three home HD payments per week, and offers options for changing Medicare’s payment system to ensure that this option is supported.

Read the abstract » | (added 2019-04-11)

Tags: Medicare Regional Contractors, Medicare Payment System, HD Payments

HOW do AGE’s Cause Peritoneal Fibrosis?

For years, researchers have known that the advanced glycation endpoints (AGEs) that form when sugar-based PD fluid is made harm the membrane. But, we didn’t know why. Human cell modeling finds that AGEs cause outer layer peritoneal cells (epithelial) to become connective tissue cells (mesenchymal).

Read the abstract » | (added 2019-03-12)

Tags: AGEs, Mesothelial, Epithelial, STAT3

Home HD - Significantly Better Survival and Transplant Rate

A Swedish matched cohort study compared the long-term survival of 152 home HD patients with those doing PD (n=456) or standard in-center HD (n=608). Median survival for home HD was significantly better (18.5 years) than PD (15.0) and in-center HD (11.9). Home HD patients were also significantly more likely to have received a transplant.

Read the abstract » | (added 2019-03-12)

Tags: Survival, Home Hemodialysis, Institutional Hemodialysis, Peritoneal Dialysis

Clues to Home HD Retention

Why do people drop out of home HD? A new interview study of 15 current and 10 former patients sheds some light. The study identified five themes, each with a positive and a negative aspect: degree of independence, support, technical aspects, home environment, and attitudes and expectations.

Read the abstract » | (added 2019-03-12)

Tags: HHD, Modality, Discontinuation

Longer HD Treatments Do Not Make Up for the 2-day “Killer Gap”

For 20 years, the kidney community has known that death on HD is significantly higher on the day after the 2-day “killer gap.” An analysis of 250+ minutes vs. <200 minutes HD treatments found that even 4.5 hour long treatments thrice weekly did not make the gap less lethal.

Read the abstract » | (added 2019-03-12)

Tags: Treatment time, Interdialytic Interval, Hospitalization, Mortality

To Screen or Not to Screen PD Patients for Bacteria: That is the Question

Does the ISPD guideline for routine use of mupirocin ointment at PD exit sites risk creating mupirocin-resistant organisms? No, finds a surveillance study of 1,175 swabs from 240 patients.

Read the abstract » | (added 2019-02-14)

Tags: Mupirocin, PD, Catheter, Peritonitis, Pseudomonas, Hygiene

Urgent-start PD Catheter Placement - Surgical vs. Percutaneous

PD catheter placement does NOT have to be limited to just minimally-invasive percutaneous procedures, suggests a literature review. But, minimizing intraperitoneal pressure for the first 2 weeks IS important.

Read the abstract » | (added 2019-02-14)

Tags: PD, Catheter, Urgent start, Complications

Lower Dementia Risk with PD than Standard In-Center HD: Metaanalysis

An analysis of 15 studies concludes that PD is associated with a lower risk of cognitive decline and dementia than HD--but calls for well-conducted prospective studies.

Read the abstract » | (added 2019-02-14)

Tags: Dementia, PD, In center HD, Cognitive Functions

Fewer Hip Fractures with PD than Standard In-Center HD: Metaanalysis

Analysis of five cohort studies totalling more than 1.2 million ESRD patients found that those doing HD had a 61% higher risk of hip fracture than those doing PD.

Read the abstract » | (added 2019-02-14)

Tags: Hip Fractures, PD, In center HD