Home haemodialysis: a right and a duty
Hemodiálisis domiciliaria: un derecho y un deber
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Ramón Pons-Prades, Esther Tamarit-Antequera, Juan J. Sánchez-Canel, Vicente Cerrillo-García, Elena Renau-Ortells, Laura Salvetti, M. Ángeles Fenollosa-Segarra" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Alejandro" "apellidos" => "Pérez-Alba" "email" => array:1 [ 0 => "aperezalba@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "J. Ramón" "apellidos" => "Pons-Prades" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 2 => array:3 [ "nombre" => "Esther" "apellidos" => "Tamarit-Antequera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "nombre" => "Juan J." "apellidos" => "Sánchez-Canel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "nombre" => "Vicente" "apellidos" => "Cerrillo-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 5 => array:3 [ "nombre" => "Elena" "apellidos" => "Renau-Ortells" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 6 => array:3 [ "nombre" => "Laura" "apellidos" => "Salvetti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 7 => array:3 [ "nombre" => "M. Ángeles" "apellidos" => "Fenollosa-Segarra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => " Servicio de Nefrología, Hospital General de Castellón, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => " Servicio de Nefrología, Hospital General de Castellón " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hemodiálisis domiciliaria: un derecho y un deber" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12476_16025_60227_en_f112476.jpg" "Alto" => 1223 "Ancho" => 1381 "Tamanyo" => 469666 ] ] "descripcion" => array:1 [ "en" => "Percentage of the quality indicators obtained." ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor,</span></p><p class="elsevierStylePara">There is a growing interest in home haemodialysis (HHD) both in Spain’s neighbouring countries and in the United States. This interest has arisen out of the limitations of the conventional three-weekly therapy sessions, shown in studies such as HEME<span class="elsevierStyleSup">1</span>, in order to increase the survival of stage 5 chronic kidney disease patients. There is an increasing number of publications that back home therapies in terms of quality of life<span class="elsevierStyleSup">2</span>, blood pressure management, reduction of left ventricular hypertrophy, calcium-phosphorus control, anaemia, nutritional state and lower morbidity and mortality<span class="elsevierStyleSup">4,5</span>, when compared to classic treatment plans; there are also studies supporting this treatment for its reduction of costs<span class="elsevierStyleSup">6</span>.</p><p class="elsevierStylePara">For this reason, we think it opportune to present our experience in implementing a short daily HHD programme. Between March 2008 and November 2013, we included 10 patients (3 in 2008, 0 in 2009, 1 in 2010, 1 in 2011, 4 in 2012 and 1 in 2013); 50% were females, with an average age of 61 (range: 38-81), distance to the centre 42 km (range: 0-122 km) and remained in the technique for 32 ± 17 months. As regards the origin of the patients: five came from outpatient consultations, three were on peritoneal dialysis and two from a peripheral centre. In terms of the programme exits, there were two deaths and two transplants. No patient required a change of renal replacement therapy and there were no losses in the training period.</p><p class="elsevierStylePara">In terms of morbidity, we had two hospitalisations in 2008, one in 2009, two in 2010, none in 2011, one in 2012 and six in 2013 (we should point out that half of the hospitalisations were scheduled). The reasons for admission were: three cardiovascular, two infectious (associated with vascular access, in 2008 and 2010), one neoplasia, one digestive, two due to vascular access of non-infectious cause (insertion of tunnelled catheter and closure of fistula aneurysm) and three due to other causes (scheduled nephrectomy, herniorrhaphy and clinical deterioration).</p><p class="elsevierStylePara">The prescribed haemodialysis plan and the results obtained are presented in Table 1 and Figure 1.</p><p class="elsevierStylePara">Regarding drugs, we used:</p><p class="elsevierStylePara">-         Antihypertensives: 43% did not require any antihypertensive drug, 53% required one drug, and only 4%, two or more.</p><p class="elsevierStylePara">-         Phosphate binders: the use of a binder was not required in 47% of the monthly checks; only one type of binder was needed in 35% of cases, predominantly calcium over non-calcium based binders; while a combination of various types of binders was required in the remaining cases. Although the average calcium carbonate dose used initially was high, 3829.8mg/day, there was subsequently a progressive substitution for calcium acetate, averaging 815.16mg/day. The other binders used were: aluminium hydroxide 77.66mg/day (one-off use and not used at present), 2478.83mg/day of sevelamer and 909.66mg/day of lanthanum carbonate.</p><p class="elsevierStylePara">-         Calcimimetic or vitamin D analogues: their use was not required for controlling parathyroid hormone values in 15% of cases; only paricalcitol was used in 40% of cases, cinacalcet in 21%, and a combination in the remaining cases (24%). The average cinacalcet dose used was 28.9mg/day, and 3.84µg/week of paricalcitol.</p><p class="elsevierStylePara">-         EPO: average dose was 69.34±71, 85UI/kg/week.</p><p class="elsevierStylePara">It must be highlighted that we did not observe any microbiological or chemical contamination in the checks carried out. In terms of technical complications, it must be noted that when dialysis treatment could not be carried out on the planned day, the patient took an un-planned break or went to hospital, on three occasions; we believe this fact to be anecdotic considering that more than 6000 sessions were undertaken in the study’s period.</p><p class="elsevierStylePara">The results obtained in clinical-analytical and morbidity and mortality terms surpass, or are at least comparable to, the standard quality of care objectives, with no incidences observed in relation to the patients’ safety. In addition, the technique has enabled a considerable improvement in patients’ quality of life. For these reasons, we consider that the patient has a right to the option of HHD, and therefore it is our duty to offer it. We believe that to do so, we must broaden patient selection criteria, not being led by preconceived ideas and strengthening the physical substrate in order to implement these programmes.</p><p class="elsevierStylePara"><a href="grande/12476_16025_60227_en_f112476.jpg" class="elsevierStyleCrossRefs"><img src="12476_16025_60227_en_f112476.jpg" alt="Percentage of the quality indicators obtained."></img></a></p><p class="elsevierStylePara">Figure 1. Percentage of the quality indicators obtained.</p><p class="elsevierStylePara"><a href="grande/12476_16025_60231_en_t112476.jpg" class="elsevierStyleCrossRefs"><img src="12476_16025_60231_en_t112476.jpg" alt="Description of the results"></img></a></p><p class="elsevierStylePara">Table 1. Description of the results</p>" "pdfFichero" => "P1-E572-S4665-A12476-EN.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12476_16025_60227_en_f112476.jpg" "Alto" => 1223 "Ancho" => 1381 "Tamanyo" => 469666 ] ] "descripcion" => array:1 [ "en" => "Percentage of the quality indicators obtained." ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12476_16025_60231_en_t112476.jpg" "Alto" => 827 "Ancho" => 2138 "Tamanyo" => 698896 ] ] "descripcion" => array:1 [ "en" => "Description of the results" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Eknoyan G, Beck GJ, Cheung AK, Daurgidas JT, Greene T, Kusek JW, et al. Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 2002;347(25):2010-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12490682" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Finkelstein FO, Schiller B, Daoui R, Gehr TW, Kraus MA, Lea J, et al. At-home short daily hemodialysis improves the long-term health-related quality of life. Kidney Int 2012;82(5):561-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22622497" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Daugirdas JT, Chertow GM, Larive B, Pierratos A, Greene T, Ayus JC, et al. Effects of frequent hemodialysis on measures of CKD mineral and bone disorder. J Am Soc Nephrol 2012;23(4):727-38. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22362907" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kjellstrand C, Buoncristiani U, Ting G, Traeger J, Piccoli GB, Sibai-Galland R, et al. Survival with short-daily hemodialysis: Association of time, site, and dose of dialysis. Hemodial Int 2010;14(4):464-70. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20854330" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Johansen KL, Zhang R, Huang Y, Chen SC, Blagg CR, Goldfarb-Rumyantzev AS, et al. Survival and hospitalization among patients using nocturnal and short daily compared to conventional hemodialysis: a USRDS study. Kidney Int 2009;76(9):984-90. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19692997" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Komenda P, Gavaghan M, Garfield S, Poret A, Sood M. An economic assessment model for in-center, conventional home, and more frequent home hemodialysis. Kidney Int 2012;81:307-13. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21993583" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "MATCH.D group. Method to assess treatment choices for home dialysis (MATCH-D). Available at: http://homedialysis.org/match-d." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003400000004/v0_201502091609/X2013251414054268/v0_201502091609/en/main.assets" "Apartado" => array:4 [ "identificador" => "35438" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief papers about basic research or clinical experiences" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003400000004/v0_201502091609/X2013251414054268/v0_201502091609/en/P1-E572-S4665-A12476-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251414054268?idApp=UINPBA000064" ]
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| 2021 December | 34 | 33 | 67 |
| 2021 November | 47 | 40 | 87 |
| 2021 October | 71 | 51 | 122 |
| 2021 September | 34 | 38 | 72 |
| 2021 August | 48 | 35 | 83 |
| 2021 July | 68 | 36 | 104 |
| 2021 June | 27 | 27 | 54 |
| 2021 May | 48 | 39 | 87 |
| 2021 April | 81 | 56 | 137 |
| 2021 March | 65 | 59 | 124 |
| 2021 February | 27 | 24 | 51 |
| 2021 January | 38 | 27 | 65 |
| 2020 December | 30 | 14 | 44 |
| 2020 November | 25 | 8 | 33 |
| 2020 October | 15 | 19 | 34 |
| 2020 September | 14 | 8 | 22 |
| 2020 August | 35 | 7 | 42 |
| 2020 July | 22 | 10 | 32 |
| 2020 June | 16 | 17 | 33 |
| 2020 May | 34 | 11 | 45 |
| 2020 April | 23 | 18 | 41 |
| 2020 March | 24 | 10 | 34 |
| 2020 February | 26 | 16 | 42 |
| 2020 January | 30 | 11 | 41 |
| 2019 December | 36 | 17 | 53 |
| 2019 November | 20 | 14 | 34 |
| 2019 October | 12 | 10 | 22 |
| 2019 September | 17 | 15 | 32 |
| 2019 August | 20 | 20 | 40 |
| 2019 July | 18 | 20 | 38 |
| 2019 June | 22 | 15 | 37 |
| 2019 May | 25 | 19 | 44 |
| 2019 April | 27 | 25 | 52 |
| 2019 March | 24 | 21 | 45 |
| 2019 February | 24 | 20 | 44 |
| 2019 January | 40 | 29 | 69 |
| 2018 December | 83 | 40 | 123 |
| 2018 November | 107 | 22 | 129 |
| 2018 October | 83 | 12 | 95 |
| 2018 September | 79 | 20 | 99 |
| 2018 August | 37 | 17 | 54 |
| 2018 July | 44 | 13 | 57 |
| 2018 June | 51 | 20 | 71 |
| 2018 May | 44 | 15 | 59 |
| 2018 April | 75 | 6 | 81 |
| 2018 March | 51 | 4 | 55 |
| 2018 February | 41 | 6 | 47 |
| 2018 January | 51 | 4 | 55 |
| 2017 December | 52 | 6 | 58 |
| 2017 November | 48 | 7 | 55 |
| 2017 October | 32 | 7 | 39 |
| 2017 September | 51 | 8 | 59 |
| 2017 August | 59 | 10 | 69 |
| 2017 July | 71 | 8 | 79 |
| 2017 June | 67 | 8 | 75 |
| 2017 May | 68 | 8 | 76 |
| 2017 April | 65 | 12 | 77 |
| 2017 March | 52 | 3 | 55 |
| 2017 February | 45 | 8 | 53 |
| 2017 January | 27 | 7 | 34 |
| 2016 December | 68 | 14 | 82 |
| 2016 November | 97 | 13 | 110 |
| 2016 October | 103 | 20 | 123 |
| 2016 September | 120 | 2 | 122 |
| 2016 August | 141 | 4 | 145 |
| 2016 July | 171 | 7 | 178 |
| 2016 June | 114 | 0 | 114 |
| 2016 May | 132 | 0 | 132 |
| 2016 April | 102 | 0 | 102 |
| 2016 March | 94 | 0 | 94 |
| 2016 February | 118 | 0 | 118 |
| 2016 January | 112 | 0 | 112 |
| 2015 December | 104 | 0 | 104 |
| 2015 November | 68 | 0 | 68 |
| 2015 October | 99 | 0 | 99 |
| 2015 September | 92 | 0 | 92 |
| 2015 August | 81 | 0 | 81 |
| 2015 July | 87 | 0 | 87 |
| 2015 June | 38 | 0 | 38 |
| 2015 May | 54 | 0 | 54 |
| 2015 April | 11 | 0 | 11 |
Show all
