Home dialysis in the Netherlands: Removing the barriers!

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2 Home dialysis in the Netherlands: Removing the barriers! Brigit van Jaarsveld & Alferso Abrahams Dialysis Initiatives Nefrologen September 21, 2017

3 No. of patients with ESKD 16000

4 Total no. of dialysis patients 6453

5 1558 No. of PD patients

6 No. of PD patients

7 No. of PD patients % (!) decrease since

8 No. of home HD patients 248

9 No. of home dialysis patients

10 No. of home dialysis patients 33%

11 No. of home dialysis patients 33% 17%

12 No. of home dialysis patients 33% > 50% (!) decrease since %

13 % PD patients per center (2015) 50,0 45,0 40,0 35,0 % 30,0 25,0 20,0 15,0 10,0 5,0 0,

14 % PD technique failure per year ( ) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

15 Dutch nocturnal and home dialysis Study To Improve Clinical Outcomes

16 Overview DOMESTICO project

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19 incident PD patients

20 PD technique survival after technique failure

21 30 days PD technique failure

22 180 days PD technique failure

23 Reasons for technique failure

24 incident PD patients 51 centers in Australia

25 Hazard ratio of technique failure Unadjusted Patient-level adjusted Patient- and center-level adjusted

26 Center characteristics and deathcensored technique failure

27 incident PD patients 51 centers in Australia

28 Peritonitis incidence rate ratio Unadjusted Patient-level adjusted Patient- and center-level adjusted

29 Center characteristics and peritonitis rate and time to 1 st episode

30 MeroPerRest vs IP rifa-genta

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35 Cure rate of PM vs SO EM episodes 100 ** *** % all EM+ polymicrobial single organism UMCU VUmc

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37 Summary Statements Complication of long-term PD (> 5 yrs); low incidence Brown, ISPD/PDI 2017

38 Patients in Dutch EPS Registry Clinical characteristics N=53 Male 31 (58.5%) Age (year) 56.9 ± 14.8 PD duration (months) 65.3 ± 32.5 No. peritonitis episodes 4.5 ± 3.4 Time to death after diagnosis (months) 28.3 Betjes, PDI 2017

39 EPS incidence in NL % Betjes, PDI 2017

40 Summary Statements Complication of long-term PD (> 5 yrs); low incidence Potential preventive strategies Minimizing dialysate glucose exposure Preventing PD-related peritonitis Use of biocompatible solutions GI symptoms may develop after ceasation PD No specific predictors Brown, ISPD/PDI 2017

41 Individual decision Factors to take into account Age and prognosis PD duration Quality of PD Suitability for KTx Risk of HD Quality of life! Shared decision-making Brown, ISPD/PDI 2017

42 Overview DOMESTICO project

43 SF-36 Courtesy of F. Dekker

44 SF-12 some qq.

45 SF-12 is kortere versie van SF vragen Fysiek domein Psycho-sociaal domein "Geen losse dimensies Panel van Nierpatienten Vereniging: 4 minuten invullen Courtesy of F. Dekker

46 DSI

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48 EQ- 5D

49 Systematic review DOMESTICO ZonMw Bonenkamp ZonMw 2017 DOMESTICO

50 QOL in frequent HHD vs conventional HD Watanabe Hemodial Int 2014;18:S32-38

51 QOL in elderly PD vs conventional HD PD HD P value N=70 N=70 SF-12 PCS 36 ±12 34 ± SF-12 MCS 55 ±8 51 ± A higher score indicates a better quality of life Brown NDT 2010;25:

52 QOL in PD vs HD vs CKD Molsted Nephron Clin Pract 2007;106:c24-33

53 Systematic review DOMESTICO ZonMw Results of included studies Study No. of patients QOL scale CHD (mean ± SD) PD (mean ± SD) Home HD (mean ± SD) P-value Watanabe 34 CHD 46 HHD KDQOL- SF PCS 37.1 ±12.9 MCS 49.6 ±6.2 - PCS 48.7 ±9.2 MCS 51.2 ±8.9 < ,2 Brown 70 CHD 70 PD SF-12 PCS 34.3 ±9.7 MCS 51.3 ±12.9 PCS 36 ±12.1 MCS 55.0 ± Molsted 71 CHD 59 PD KDQOL- SF PCS 36.0 ±10.2 MCS 51.1 ±10.8 PCS 37.4 ±10.4 MCS 47.1 ±7.8 - NS Bonenkamp ZonMw 2017 DOMESTICO

54 RCT of extended-hours HD vs conventional HD on quality of life, n=200 Jardine JASN 2017;28:

55 RCT of extended-hours HD vs conventional HD on quality of life Jardine JASN 2017;28:

56 RCT of extended-hours HD vs conventional HD on quality of life Jardine JASN 2017;28:

57 DOMESTICO What: project in cooperation Dutch Kidney Patients (NVN) Nefrovisie Dutch Kidney Foundation (Nierstichting) Dutch Fed.of Nephrology! dialysis centers Dialysis Nurses (V&VN) Health Insurance Companies Dialysis Industry Goal: renewed attention for home dialysis!

58 Overview DOMESTICO project

59 Question 2 Does home dialysis lead to improved quality of life, measured by CKD-PROMs, comparable clinical outcomes and lower total costs, compared to in-centre HD?

60 DOMESTICO Prospective Goal: investigate the effects of home dialysis on quality of life, clinical outcomes and integral costs Design: prospective study with questionnaires Population 800 patients starting with home dialysis between Dec 2017 and Dec 2021 vs. 800 patients who start with in-center hemodialysis Outcome measures: PROMs, clinical outcomes, all costs (also taxi, assistance, work)

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64 Bedankt Doet u mee?