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This issue of the Home Dialyzors United newsletter includes some articles and links that deal with vascular access. As home hemodialysis usage increases, maintaining a viable vascular access is crucial.
Focus on Our Friends
Patient-reported outcomes in hemodialysis vascular access: A call to action - Karen Woo, Robert Fuld, Amanda Grandinetti, Jeffrey Lawson, Terry Litchfield, Mark Ohan, John Devin Peipert, Matthew B Rivara, Glenda Roberts, Prabir Roy-Chaudhury, Margo Underwood, Robert J Nordyke,
HDU's Advisory Board member, Glenda Roberts, is co-author of this study. Here is a summary from the introduction:
While access-related dysfunction is a clear driver of clinical outcomes and costs, the full impact of vascular access dysfunction on patient experience and quality of life is not fully characterized in the literature. One way to more comprehensively characterize the patient experience from the patient perspective is through patient reported outcomes (PROs). However, the limited implementation of PROs in clinical trials, patient registries, quality measurement, and other research settings has significantly constrained the patient voice in evaluation of vascular access outcomes and vascular access decision-making.
To address these issues, the Kidney Health Initiative, a public-private partnership between the American Society of Nephrology and the U.S. Food and Drug Administration, assembled an interdisciplinary workgroup to enhance uptake of access-related PROs with the aims of: (1) reviewing the domains of HRQOL that are affected by vascular access, collect information on existing instruments that measure access-specific HRQOL in hemodialysis, and identify gaps in existing measures; (2) identifying and critically assessing barriers to widespread use of access-specific PRO measures; and (3) defining initiatives to overcome barriers and make recommendations for strategies to improve the use and utility of access-specific PRO measures. A consensus group process identified potential barriers to use of PRO measures in six categories
The Renal Fellow Network continues to have many blogs as these new nephrologists learn about the complexities of dialysis and the issues that face home dialyzors on a daily basis. Here is the link to Dr. Achi's first experiences with catheters. His post simply and succinctly describes the differences in dialysis catheters.
Sai Santhoshini Achi, MD Internal Medicine Resident at Harlem Hospital Incoming Nephrology Fellow at University of Texas Health Science Center at Houston @SaiAchi1
"On the first day of my inpatient medicine rotation, I had three patients with dialysis catheters. I kept confusing the differences between tunneled and non-tunneled catheters and couldn't remember which type of catheter they had. I wanted to explore more about the catheters and share those pearls of knowledge with other junior trainees."
New Home Solo HD Section Debuts on Home Dialysis Central
Below is an excerpt from the most recent Home Dialysis Central press release. Although it does not deal directly with vascular access, maintaining a quality functioning access is a vital part of solo home dialysis.
Madison, Wisconsin- The non-profit Medical Education Institute (MEI) recently released an in-depth resource about solo home hemodialysis on Home Dialysis Central. Solo Home HD: Taking the Plunge offers supportive information for users of the only home HD machine currently FDA-approved for solo daytime use: NxStage. (The page will be updated to include additional machines when they are approved for solo home use.)
The new, illustrated section covers safety at home, arranging a treatment room and managing supplies, setting up the machine for treatment, self-cannulation and one-handed taping, managing during treatment, drawing blood samples, medications, and travel tips.
According to MEI Executive Director Dori Schatell, MS, "When we first started Home Dialysis Central, we believed that everyone who did home HD needed a partner. But our thinking evolved. A capable adult should not be denied the chance to choose an option that allows more control, flexibility, and better quality of life-and the FDA agrees. Solo home HD with NxStage during waking hours was approved in August 2017. We are delighted to offer some helpful information to support those who want to try this empowering treatment."
Vascular Access Quality Measures: Where Do We Go From Here?
From the Chronic Disease Research Group, here is a link to an interesting article by HDU's Advisory Board member, Eric Weinhandl, about the lack of change in dialysis access over the years. The post also contains a number of other articles by Eric and his colleagues that pertain to those with chronic kidney disease.
From the article: Dialysis facilities are evaluated according to numerous quality measures. Those measures feed into multiple programs, including Care Compare, Dialysis Facility Reports, and the End-Stage Renal Disease (ESRD) Quality Incentive Program. The hallmark measure in the federal landscape is the standardized fistula ratio (SFR). As with any standardized ratio, the measure assesses whether the number of patient-months with an arteriovenous fistula (AVF) is higher or lower than expected, given the mix of patients within a dialysis facility.
A Final Thought
HDU continues to work relentlessly to inform, inspire and advocate for n extraordinary quality of life for the home dialysis community. Toward that end, there are some exciting positive changes coming soon. Check us out on Facebook and Twitter and don't forget to go to the HDU website for the latest news.