The effect of implementing a dialysis start unit on modality decision among patients with unplanned start kidney replacement therapy

IF 1.2 4区 医学 Q3 UROLOGY & NEPHROLOGY
Shira Goldman, Joanne M. Bargman, Charmaine E. Lok, Anna Gozdzik, Jeffrey Perl, Christopher T. Chan
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引用次数: 0

Abstract

Introduction

Many individuals start dialysis in an acute setting with suboptimal pre-dialysis education. These individuals are often treated with central venous catheter insertion and initiation of in-center hemodialysis and only a minority will transfer to a home-based therapy. The dialysis start unit is a program performing in-center hemodialysis in a separate space while providing support and education on chronic kidney disease and treatment options in the initial weeks of kidney replacement therapy. We aimed to assess the uptake of home dialysis therapies between 2013 and 2021 among patients who started acute inpatient hemodialysis at University Health Network, Toronto and underwent dialysis at the dialysis start unit.

Methods

This is a retrospective observational cohort study based on prospectively collected data. Patients' demographics were obtained from electronic charts. In the dialysis start unit, all patients received dialysis modality education by a nurse educator, dedicated home dialysis nurses, and the allied health care team.

Findings

During 2013–2021, 122 patients were dialyzed in the dialysis start unit and included in the study. Among those patients, 68 patients ultimately chose home dialysis (57 peritoneal dialysis and 11 home hemodialysis). Fifty-four patients continued in-center hemodialysis. Patients adopting home dialysis were less likely to have diabetes and hypertension as the etiology of kidney failure and more likely to have glomerulonephritis or vasculitis.

Discussion

Dialysis modality education is implementable in advanced chronic kidney disease. Individualized education and care after unplanned start dialysis can potentially enhance home dialysis choice and utilization.

实施透析起始单元对计划外开始肾脏替代治疗的患者决定透析方式的影响。
导言:许多人在急性透析环境中开始透析时,透析前的教育并不理想。这些患者通常需要插入中心静脉导管并开始中心内血液透析,只有少数患者会转入家庭透析治疗。透析启动单元是一个在独立空间内进行中心内血液透析的项目,同时在肾脏替代疗法的最初几周提供有关慢性肾脏病和治疗方案的支持和教育。我们的目的是评估2013年至2021年期间在多伦多大学健康网络开始急性住院血液透析并在透析起始单位接受透析治疗的患者中接受家庭透析疗法的情况:这是一项基于前瞻性收集数据的回顾性观察队列研究。患者的人口统计数据来自电子病历。在透析起始单位,所有患者都接受了由护士教育者、专职家庭透析护士和专职医疗团队提供的透析方式教育:2013-2021年间,共有122名患者在透析起始单位接受了透析,并被纳入研究范围。其中,68 名患者最终选择了家庭透析(57 名腹膜透析患者和 11 名家庭血液透析患者)。54名患者继续在中心进行血液透析。采用家庭透析的患者中,肾衰竭的病因是糖尿病和高血压的可能性较小,而肾小球肾炎或血管炎的可能性较大:讨论:透析方式教育可在晚期慢性肾脏病患者中实施。讨论:透析方式教育在晚期慢性肾脏病中是可以实施的,计划外开始透析后的个性化教育和护理有可能提高家庭透析的选择和利用率。
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来源期刊
Hemodialysis International
Hemodialysis International UROLOGY & NEPHROLOGY-
CiteScore
2.50
自引率
0.00%
发文量
58
审稿时长
6-12 weeks
期刊介绍: Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.
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