Home dialysis (CAPD) effective for kidney patients after transplant fails
Published: Friday, January 14, 2011 - 10:07 in Health & Medicine
Patients who must return to dialysis after a kidney transplant failure survive just as well on home dialysis as hospital dialysis, but few choose that option, according to new research by Dr. Jeffrey Perl, a nephrologist at St. Michael's Hospital. Despite medical advances, transplanted kidneys don't last a lifetime and an increasing number of patients return to dialysis. These patients are at higher risk for complications and death than other dialysis patients because of such things as their exposure to immunosuppressive drugs and the length of time they were on dialysis,
According to a study in an upcoming issue of the Clinical Journal of the American Society Nephrology, only 18 per cent of these patients choose home dialysis. Yet the study showed no higher death rate among them and those who did dialysis in the hospital at two years, after two years and overall. The study tracked 2,110 Canadian adult patients over 14 years between 1991 and 2005.
Home dialysis, known as peritoneal dialysis, allows patients to manage their own therapy and live a relatively flexible lifestyle, including travel. Cleansing fluids are pumped into a patient's abdomen through a catheter tube. The fluid removes toxins and water from the blood using the peritoneum, the membrane lining the abdomen, as a filter. Waste products are drained several times a day. In hemodialysis, conducted in a hospital, blood is removed from the body, filtered and then returned.
Even though the number of people requiring dialysis is rising, home dialysis is declining in both Canada and the United States. Dr. Perl said one reason may be that patients whose transplants have failed may be reluctant to restart dialysis. The focus of their care may be trying to salvage the transplant, with less emphasis on education about and preparation for other options.
"It is important to empower patients who have kidney transplant failure to realize that despite the severe disappointment of returning to dialysis, they still have many options for dialysis therapy, which include opportunities for home-based therapies," Dr. Perl said.
Home-based dialysis is significantly less expensive than hospital dialysis
Patients who must return to dialysis after a kidney transplant failure survive just as well on home dialysis as hospital dialysis, but few choose that option, according to new research by Dr. Jeffrey Perl, a nephrologist at St. Michael's Hospital. Despite medical advances, transplanted kidneys don't last a lifetime and an increasing number of patients return to dialysis. These patients are at higher risk for complications and death than other dialysis patients because of such things as their exposure to immunosuppressive drugs and the length of time they were on dialysis,
According to a study in an upcoming issue of the Clinical Journal of the American Society Nephrology, only 18 per cent of these patients choose home dialysis. Yet the study showed no higher death rate among them and those who did dialysis in the hospital at two years, after two years and overall. The study tracked 2,110 Canadian adult patients over 14 years between 1991 and 2005.
Home dialysis, known as peritoneal dialysis, allows patients to manage their own therapy and live a relatively flexible lifestyle, including travel. Cleansing fluids are pumped into a patient's abdomen through a catheter tube. The fluid removes toxins and water from the blood using the peritoneum, the membrane lining the abdomen, as a filter. Waste products are drained several times a day. In hemodialysis, conducted in a hospital, blood is removed from the body, filtered and then returned.
Even though the number of people requiring dialysis is rising, home dialysis is declining in both Canada and the United States. Dr. Perl said one reason may be that patients whose transplants have failed may be reluctant to restart dialysis. The focus of their care may be trying to salvage the transplant, with less emphasis on education about and preparation for other options.
"It is important to empower patients who have kidney transplant failure to realize that despite the severe disappointment of returning to dialysis, they still have many options for dialysis therapy, which include opportunities for home-based therapies," Dr. Perl said.
Home-based dialysis is significantly less expensive than hospital dialysis
When a kidney transplant fails, home-based dialysis is an option
Published: Thursday, January 13, 2011 - 18:03 in Health & Medicine
Patients returning to dialysis after kidney transplant failure present unique challenges compared with other dialysis patients: they have been exposed to very powerful immunosuppressive medications and have been on dialysis for a longer period of time than other dialysis patients. This puts them at particularly high risk for various complications and death. According to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN), despite complications, these patients can choose to undergo dialysis in the comfort of their own homes. Patients who have had a kidney transplant are used to managing their own therapy, enjoying the ability to travel, and living a relatively flexible lifestyle and may therefore be well-suited to peritoneal dialysis (home-based) rather than hemodialysis (clinic-based), when they return to dialysis after transplant failure. Despite the many potential benefits of peritoneal dialysis over hemodialysis—including ease of performing the therapy at home, avoidance of hospital visits several times a week, and more flexibility to travel—only a very small proportion of patients returning to dialysis after transplant failure end up choosing to undergo peritoneal dialysis in both Canada and the United States.
Jeffrey Perl, MD (St. Michael's Hospital, University of Toronto, Canada) and his colleagues evaluated the impact that dialysis type (peritoneal vs. hemodialysis) has on the survival of patients returning to dialysis after transplant failure. The investigators studied 2,110 adult Canadian patients who initiated dialysis after their kidney transplant failed between January 1991 and December 2005. The researchers evaluated the impact of initial dialysis type on early (2-year), late (after 2 years), and overall deaths.
Hemodialysis and peritoneal dialysis patients died at similar rates in all analyses (early, late, and overall). "It is important to empower patients who have kidney transplant failure to realize that despite the severe disappointment of returning to dialysis, they still have many options for dialysis therapy, which include opportunities for home-based therapies," said Dr. Perl. "I hope this research helps guide patients and the health care professionals treating them to make informed decisions regarding dialysis modality decisions, namely that peritoneal dialysis is as effective a therapy as hemodialysis in patients returning to dialysis after kidney transplant failure."
Patients returning to dialysis after kidney transplant failure present unique challenges compared with other dialysis patients: they have been exposed to very powerful immunosuppressive medications and have been on dialysis for a longer period of time than other dialysis patients. This puts them at particularly high risk for various complications and death. According to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN), despite complications, these patients can choose to undergo dialysis in the comfort of their own homes. Patients who have had a kidney transplant are used to managing their own therapy, enjoying the ability to travel, and living a relatively flexible lifestyle and may therefore be well-suited to peritoneal dialysis (home-based) rather than hemodialysis (clinic-based), when they return to dialysis after transplant failure. Despite the many potential benefits of peritoneal dialysis over hemodialysis—including ease of performing the therapy at home, avoidance of hospital visits several times a week, and more flexibility to travel—only a very small proportion of patients returning to dialysis after transplant failure end up choosing to undergo peritoneal dialysis in both Canada and the United States.
Jeffrey Perl, MD (St. Michael's Hospital, University of Toronto, Canada) and his colleagues evaluated the impact that dialysis type (peritoneal vs. hemodialysis) has on the survival of patients returning to dialysis after transplant failure. The investigators studied 2,110 adult Canadian patients who initiated dialysis after their kidney transplant failed between January 1991 and December 2005. The researchers evaluated the impact of initial dialysis type on early (2-year), late (after 2 years), and overall deaths.
Hemodialysis and peritoneal dialysis patients died at similar rates in all analyses (early, late, and overall). "It is important to empower patients who have kidney transplant failure to realize that despite the severe disappointment of returning to dialysis, they still have many options for dialysis therapy, which include opportunities for home-based therapies," said Dr. Perl. "I hope this research helps guide patients and the health care professionals treating them to make informed decisions regarding dialysis modality decisions, namely that peritoneal dialysis is as effective a therapy as hemodialysis in patients returning to dialysis after kidney transplant failure."
Renal transplantation is best treatment option for improving quality of life in people with late-stage chronic kidney disease
Tuesday, September 11, 2012 - 18:00 in Health & Medicine
In people with late-stage chronic kidney disease, renal transplantation is the best treatment option to improve quality of life, but for those receiving dialysis, home-based automated peritoneal dialysis (in which fluids are infused into the abdominal cavity and can be done nightly at home) provides a better quality of life than continuous ambulatory peritoneal dialysis (a type of dialysis performed continuously throughout the day), according to a study by Australian researchers.
In people with late-stage chronic kidney disease, renal transplantation is the best treatment option to improve quality of life, but for those receiving dialysis, home-based automated peritoneal dialysis (in which fluids are infused into the abdominal cavity and can be done nightly at home) provides a better quality of life than continuous ambulatory peritoneal dialysis (a type of dialysis performed continuously throughout the day), according to a study by Australian researchers.