A top area to watch in 2020 is the new emphasis on home dialysis. On July 10, 2019, President Donald Trump signed an executive order launching Advancing American Kidney Health. Based on this executive order, the US Department of Health and Human Services (HHS) released three major goals to improve kidney health. The first goal is that 80% of incident kidney failure patients in 2025 receive a home modality of dialysis or a transplant. To facilitate this goal, mandatory and voluntary reimbursement models are being released. The mandatory model, ESRD Treatment Choices, will incentivize the provision of dialysis in the
The Kidney Disease Outcomes Quality Initiative recommends discussing kidney replacement therapy options when patients reach chronic kidney disease (CKD) stage 4 or have an estimated GFR <30 mL/min per 1.73 m2 (1). Preparing patients and vetting the options for renal replacement therapy remain pivotal to providing excellent CKD care, which ultimately leads to better patient outcomes. During these conversations, it is crucial that patients fully examine the quality of life, morbidity, and mortality associated with each therapy. For years, researchers have dedicated their time to examining the effects of these modalities in hopes of better facilitating
In the day-to-day jargon of a nephrologist, the word “adequacy” is unique in its usage in this profession. Whereas the Merriam-Webster definition of “adequate” is “sufficient for a specific need or requirement,” nephrologists use this term to reflect the quality of the dialysis prescription.
Measuring the adequacy of hemodialysis (HD) and peritoneal dialysis (PD) has long been a topic of intense interest and debate. Currently, we measure adequacy using the fractional urea clearance equation known as Kt/V, whereby K is the clearance of urea, t is time during dialysis, and V is volume of distribution of urea.
Peritoneal dialysis (PD) is associated with improved quality of life, is cost effective, and has outcomes comparable with those of hemodialysis (HD). Despite this, there is a big discrepancy in the percentage of US patients using PD: 10.1% versus HD at 89.9% (1). One reason for this difference is likely the number of myths surrounding appropriate PD candidates. These myths are often based on tradition or authority as opposed to evidence. Ready acceptance of such beliefs without re-examining them can lead to improper care. A myth we noted in a previous article in this series is the negligible
Once the decision to pursue peritoneal dialysis (PD) is made, two primary modalities are available from which patients can choose: continuous ambulatory PD (CAPD) and ambulatory PD (APD). CAPD involves manually performed exchanges using gravity to fill and drain the peritoneal cavity, and APD involves exchanges that are performed using a cycler over several hours, typically during the night. The selection of a PD modality is dependent on an individual's lifestyle because there is no difference in patient and technique survival (1).
Subtypes of APD include continuous cycling PD (CCPD), nightly intermittent PD (NIPD), and tidal PD (TPD)
Nidhi Aggarwal, Harshitha Kota, Natasha N. Dave, and Ankur Shah
Most nephrologists consider peritoneal dialysis (PD) to be the best therapy for planned initiation of dialysis and frequent home-based hemodialysis (HD) as the best long-term therapy not only for patients with end stage kidney disease (ESKD) but also for themselves (1). A major barrier to increasing home dialysis therapies is the limited training in most US nephrology fellowship programs. Based on multiple national surveys, graduating trainees do not feel well trained and competent in either form of home dialysis (2, 3). Another survey of nephrology fellowship program directors identified lack of sufficient patients on