Andrea Pizutti, LCSW Gayle Hall, BSN, RN, CNN Regional Operations Director Area Director Davita NxStage Kidney Care

Transcription

1 Andrea Pizutti, LCSW Regional Operations Director Davita Gayle Hall, BSN, RN, CNN Area Director NxStage Kidney Care 1

2 Compare and contrast Home Dialysis Therapies Describe the End Stage Renal Disease patient life cycle Discuss administration of erythrocyte stimulating agents (ESAs) for home dialysis patients 2

3 Incident Prevalent ESRD Summary Annual Report, April

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5 FMQAI. (October 2013) Annual Report. Retrieved from 5

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8 Dialysis Hemodialysis In-Center (ICHD) Home (HHD) Peritoneal Dialysis Continuous Ambulatory Peritoneal Dialysis (CAPD) Continuous Cycling Peritoneal Dialysis (CCPD) (also known as Automated Peritoneal Dialysis [APD]) Transplantation No treatment 8

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10 New to Dialysis Home ICHD Transfer to ICHD Transfer to Home PD to HHD HHD to PD Transplant 10

11 In a survey of 78 dialysis center medical directors (nephrologists) 98% would choose home modality if they needed dialysis. 1 In a survey of 145 physicians and nurses working with a national US dialysis provider >90% would chose home therapy if they needed dialysis. 1. BioTrends Research Group.Special Report: Dialysis Modalities in the US Available at: Sept 6, Perceptions about renal replacement therapy among nephrology professionals. Schiller B, Neitzer A, Doss S. Nephrol News Issues Sep;24(10):36, 38, 11

12 Condition: Patients Rights The dialysis facility must inform patients (or their representatives) of their rights Standard: Patients rights. The patient has the right to (7) Be informed about all treatment modalities and settings, including but not limited to, transplantation, home dialysis modalities (home hemodialysis, intermittent peritoneal dialysis, continuous ambulatory peritoneal dialysis, continuous cycling peritoneal dialysis), and infacility hemodialysis. (a) CMS,

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14 Using a Traditional Dialysis Machine at Home 14

15 Significant Improvements 15

16 Dialysis is only a small part of the total annual cost for End Stage Renal Disease (ESRD) patients Dialysis only accounted for 20.5 % of the total cost of care Hospitalization and drugs comprised 50% of the total cost More frequent home HD has been shown to decrease both drug use and hospitalizations Home dialysis has been shown to reduce overall costs per patient per year. Average Annual Cost of Care $86, 592 per patient Drugs 12,999 Physician 14,567 Other 10,938 Hospital 30,292 Dialysis 17,796 U.S. Renal Data System, USRDS 2013 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD,

17 Extensive, growing body peer-reviewed literature proving benefits* Improved: survival, blood pressure/volume control, time to recovery and post-dialysis fatigue, mental and physical health, sleep quality and restless leg; Reduced: left ventricular hypertrophy (LVH) and depression; Higher rate of transplantation Frequent Hemodialysis Network (FHN) study of frequency first positive National Institutes of Health study in dialysis Fit with Congressional mandate for the ESRD program Maximum practical number treated in the home ; develop reimbursement mechanisms that foster home-based therapies** Need both PD and HHD to achieve PD not for everyone, PD not forever for anyone Medical professionals (physicians and nurses) overwhelmingly would choose for themselves 9 of 10 would choose a home modality; most would choose HHD*** *Note: There is no study showing superiority of PD to in-center HD **Social Security Act, Section 1881 (c)(6) ***Menghi, J et al., Insights into nephrologists training, clinical practice and dialysis choice. Hemodialysis International, 2011; Schiller B et al. Perceptions about renal replacement therapy among nephrology professionals. Nephrology News and Issues, September

18 Benefits of Frequent HHD Kjellstrand et al, FHN Frequent Hemodialysis Network

19 More frequent HHD recently demonstrated 27% lower risk of 30-day readmission after hospitalization for heart failure vs Incenter Hemodialysis patients Weinhandl and Collins, Abstract presented at National Kidney Foundation Spring Clinicals 19

20 Study Population 1873 DHHD patients (263 transplants) 9365 matched controls (1165 transplants); matching included transplant list status Transplant incidence higher with daily HHD (relative incidence:1.13; P=0.07) On waitlist at start of follow-up (relative incidence: 0.90; P=0.21) Not listed (relative incidence: 2.21; P<0.01) Weinhandl et al; Chronic Research Disease Group, Minneapolis, MN. 20

21 (Short Daily Hemodialysis) 21

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23 Advantages Much quicker recovery time after treatment Improved appetite Freedom to drink more Fewer symptoms of depression Better mental and physical health More energy and vitality Feeling of being in control More able to make work a part of their daily routine Improved sleep quality Improvements in Restless Leg Syndrome Considerations Requires a partner Vascular access Isolation Burnout 23

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28 Membrane Predicted Response Preferred Dialysis Ultrafiltration Dialysis High 14.1% High Average 41.5% Low Average 32.3% Low 12.1% Poor Adequate APD Avoid long dwells Adequate Adequate Std. Dose PD Good Adequate Inadequate Std. Dose PD Hi Dose PD Excellent Inadequate Hi Dose PD Hemodialysis

29 CAPD N = CCPD % of PD patients on each therapy. FMQAI Network 7 Annual Report,

30 Patient crashes into dialysis at the hospital Doctor examines patient and determines best dialysis modality for patient If PD is recommended (and patient agrees), patient is placed with a PD catheter by a vascular surgeon or IR Patient is discharged to facility same day or next day Patients visit facility on normal PD schedule as prescribed by nephrologist Patient is trained on PD just as other PD pts Patient is admitted to facility. If dialysis is needed, in-center low volume PD is initiated. Patients receive treatments for 2 weeks or until catheter fully heals 30

31 Home patients are required to come to the ESRD facility once per month for a Clinic Visit ESAs are administered according to the physician s prescription Epoetin alpha is dosed 3 times weekly Darbepoetin is dosed weekly/every two weeks Patients sometimes choose a home therapy because they live distances from the center Epogen package insert; Aranesp package insert 31

32 A dialysis facility that is certified to provide services to home patients must ensure through its interdisciplinary team, that home dialysis services. meet all applicable conditions of this part. Standard: Training..The training must.address the specific needs of the patient in the following areas: iii..the effective administration of erythropoesis stimulating agent(s) (if prescribed) to achieve and maintain a target level hemoglobin or hematocrit as written in the patient s plan of care. (a) CMS,

33 Patients may progress through several different modalities during their life span on dialysis Dialysis units are required to present all options Home hemodialysis or CCPD may be the most appropriate modality to meet a patient s individual medical needs Dialysis units are required to educate patients on administration of erythropoesis stimulating agents (ESAs) Administration may need to be in the home 33

34 Questions?