Áine Earley, Sinéad Lydon, Rachael C. Walker, Lisa Gannon, Donal Reddan, Lorna Durack, Paul O'Connor
Introduction
The growing prevalence of chronic kidney disease has led to an increased demand for kidney replacement therapies. Although a kidney transplant is the preferred treatment for patients, many patients require dialysis temporarily before receiving a transplant or are unsuitable transplant candidates requiring long-term dialysis. Home hemodialysis (home HD) is cost-effective and associated with improved patient outcomes; however, its adoption remains low. There is a need to understand the factors that may support or hinder the use of home HD. Accordingly, a systematic review of the qualitative literature was conducted to identify barriers and facilitators to home HD for patients, their carers/family, and healthcare professionals.
Methods
This systematic review was carried out following ENTREQ guidelines. Electronic searches were conducted on Medline (OVID), EMBASE, CINAHL (EBSCO), and PsycINFO. The COM-B and Theoretical Domains Framework (TDF) were used to collate the barriers and enablers identified within the papers through deductive content analysis.
Results
Thirteen studies met the inclusion criteria. Within the capability component of the COM-B model, lack of knowledge of home HD was identified as a barrier by healthcare professionals and patients. Within the opportunity component, the suitability of patients' homes (e.g., home modifications) and the healthcare system was identified as barriers to home HD. Fostering an environment of support and community was seen as a facilitator of home HD. Within the motivation component of the model, a lack of confidence and reluctance of patients to burden their family members with the responsibility of treatment were perceived as barriers. Improvements in the quality of life for the person receiving home HD were regarded as a motivator.
Conclusion
To encourage widespread home HD use, understanding its barriers and facilitators for patients and the healthcare system is key to developing and implementing effective interventions to increase uptake.
{"title":"A Systematic Review of the Qualitative Research on Barriers and Facilitators to Home Hemodialysis","authors":"Áine Earley, Sinéad Lydon, Rachael C. Walker, Lisa Gannon, Donal Reddan, Lorna Durack, Paul O'Connor","doi":"10.1111/hdi.13266","DOIUrl":"10.1111/hdi.13266","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The growing prevalence of chronic kidney disease has led to an increased demand for kidney replacement therapies. Although a kidney transplant is the preferred treatment for patients, many patients require dialysis temporarily before receiving a transplant or are unsuitable transplant candidates requiring long-term dialysis. Home hemodialysis (home HD) is cost-effective and associated with improved patient outcomes; however, its adoption remains low. There is a need to understand the factors that may support or hinder the use of home HD. Accordingly, a systematic review of the qualitative literature was conducted to identify barriers and facilitators to home HD for patients, their carers/family, and healthcare professionals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This systematic review was carried out following ENTREQ guidelines. Electronic searches were conducted on Medline (OVID), EMBASE, CINAHL (EBSCO), and PsycINFO. The COM-B and Theoretical Domains Framework (TDF) were used to collate the barriers and enablers identified within the papers through deductive content analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirteen studies met the inclusion criteria. Within the <i>capability</i> component of the COM-B model, lack of knowledge of home HD was identified as a barrier by healthcare professionals and patients. Within the <i>opportunity</i> component, the suitability of patients' homes (e.g., home modifications) and the healthcare system was identified as barriers to home HD. Fostering an environment of support and community was seen as a facilitator of home HD. Within the <i>motivation</i> component of the model, a lack of confidence and reluctance of patients to burden their family members with the responsibility of treatment were perceived as barriers. Improvements in the quality of life for the person receiving home HD were regarded as a motivator.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>To encourage widespread home HD use, understanding its barriers and facilitators for patients and the healthcare system is key to developing and implementing effective interventions to increase uptake.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"29 4","pages":"434-441"},"PeriodicalIF":1.2,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.13266","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gabriela Keiko Izumi, Caroline Vidal Paseto, Rafael Fiorese Costa, Gabrielle Delfrate, Aline Borsato Hauser, Daniel Fernandes, Maria Ângela Naval Machado, Reila Tainá Mendes
<div> <section> <h3> Background</h3> <p>The inflammatory processes associated with periodontitis have been implicated in the development and progression of systemic diseases, including chronic kidney disease (CKD). Notably, individuals with CKD frequently exhibit shared risk factors with those affected by periodontitis, such as hypertension, smoking, and diabetes mellitus. Nitric oxide (NO), a free radical with diverse physiological and pathological roles, exerts both anti-inflammatory (e.g., vasodilation, modulation of platelet function) and pro-inflammatory effects, the latter of which have been observed in patients with CKD.</p> </section> <section> <h3> Aims</h3> <p>This study aimed to investigate the relationship between nitric oxide levels in saliva and plasma and various periodontal parameters in patients with chronic kidney disease (CKD), in comparison to a control group without CKD.</p> </section> <section> <h3> Methods</h3> <p>This study enrolled 90 participants seeking dental treatment. The participants were divided into two groups: a CKD group (<i>n</i> = 40) consisting of patients undergoing dialysis or hemodialysis treatment at the Pró-Renal Foundation Dental Clinic, and a control group (<i>n</i> = 50) comprising individuals without CKD who were receiving treatment at the UFPR Dental Clinic. Two calibrated examiners conducted comprehensive periodontal examinations for all participants. Additionally, saliva samples were collected from each participant to assess pH, flow rate, and nitric oxide levels. Venous blood samples were also obtained to quantify plasma nitric oxide concentrations.</p> </section> <section> <h3> Results</h3> <p>Patients in the CKD group exhibited significantly poorer periodontal health compared to the control group (<i>p</i> < 0.05), characterized by a larger Periodontal Inflamed Surface Area, greater probing depth, increased clinical attachment level, and a higher visual plaque index (<i>p</i> < 0.05). Furthermore, the CKD group presented with significantly reduced salivary flow (<i>p</i> < 0.05). Notably, this group also showed elevated levels of both nitrate and nitrite in saliva and serum (<i>p</i> < 0.05) compared to the control group. Correlation analyzes revealed significant positive associations between nitrate and nitrite levels (in both plasma and saliva) and several periodontal variables: probing depth (<i>r</i> = 0.38 and 0.41, respectively), clinical attachment level (<i>r</i> = 0.40 and 0.38, respectively), and Periodontal Inflamed Surface Area (<i>r</i> = 0.27 and 0.48, respectively). Con
{"title":"Relationship Between Periodontitis and Nitric Oxide in Patients Undergoing Maintenance Hemodialysis","authors":"Gabriela Keiko Izumi, Caroline Vidal Paseto, Rafael Fiorese Costa, Gabrielle Delfrate, Aline Borsato Hauser, Daniel Fernandes, Maria Ângela Naval Machado, Reila Tainá Mendes","doi":"10.1111/hdi.13264","DOIUrl":"10.1111/hdi.13264","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The inflammatory processes associated with periodontitis have been implicated in the development and progression of systemic diseases, including chronic kidney disease (CKD). Notably, individuals with CKD frequently exhibit shared risk factors with those affected by periodontitis, such as hypertension, smoking, and diabetes mellitus. Nitric oxide (NO), a free radical with diverse physiological and pathological roles, exerts both anti-inflammatory (e.g., vasodilation, modulation of platelet function) and pro-inflammatory effects, the latter of which have been observed in patients with CKD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aimed to investigate the relationship between nitric oxide levels in saliva and plasma and various periodontal parameters in patients with chronic kidney disease (CKD), in comparison to a control group without CKD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study enrolled 90 participants seeking dental treatment. The participants were divided into two groups: a CKD group (<i>n</i> = 40) consisting of patients undergoing dialysis or hemodialysis treatment at the Pró-Renal Foundation Dental Clinic, and a control group (<i>n</i> = 50) comprising individuals without CKD who were receiving treatment at the UFPR Dental Clinic. Two calibrated examiners conducted comprehensive periodontal examinations for all participants. Additionally, saliva samples were collected from each participant to assess pH, flow rate, and nitric oxide levels. Venous blood samples were also obtained to quantify plasma nitric oxide concentrations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients in the CKD group exhibited significantly poorer periodontal health compared to the control group (<i>p</i> < 0.05), characterized by a larger Periodontal Inflamed Surface Area, greater probing depth, increased clinical attachment level, and a higher visual plaque index (<i>p</i> < 0.05). Furthermore, the CKD group presented with significantly reduced salivary flow (<i>p</i> < 0.05). Notably, this group also showed elevated levels of both nitrate and nitrite in saliva and serum (<i>p</i> < 0.05) compared to the control group. Correlation analyzes revealed significant positive associations between nitrate and nitrite levels (in both plasma and saliva) and several periodontal variables: probing depth (<i>r</i> = 0.38 and 0.41, respectively), clinical attachment level (<i>r</i> = 0.40 and 0.38, respectively), and Periodontal Inflamed Surface Area (<i>r</i> = 0.27 and 0.48, respectively). Con","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"29 4","pages":"617-625"},"PeriodicalIF":1.2,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.13264","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ana Sanchez-Escuredo, Klement Yeung, Daniela Arustei, Celine D'Gama, Rose Faratro, Eduardo Magtoto, Kalavani Renganathan, Christopher T. Chan
<div> <section> <h3> Introduction</h3> <p>Home hemodialysis (home HD) has demonstrated superior clinical outcomes, improved quality of life, and enhanced treatment flexibility in comparison to 3 days/week in-center HDs. Nonetheless, some patients are discordant with their dialysis prescription and require a coaching program in order to maintain their normal lifestyle and ameliorate their illness behavior.</p> </section> <section> <h3> Objective</h3> <p>To describe the feasibility of conducting a nurse-led coaching program for discordant home HD patients and its effect on hospitalization and technique complications.</p> </section> <section> <h3> Methods</h3> <p>This is a retrospective single center observational cohort study of all prevalent home HD patients at University Health Network (UHN) from the period of January 2018 to December 2022. Demographic and clinical data were extracted from chart review. Nurses conducted weekly motivational interviewing with patients by phone, email, or in-clinic visits in the home HD unit to discuss the importance of being concordant to treatment and adapting the length and schedule of dialysis to avoid clinical complications. Health coaching was defined as patient-centered, incorporating patient-determined goals, self-discovery processes, accountability, and content information in the context of an ongoing helping relationship. Patients were categorized as concordant, concordant with agreement doing at least 75% of dialysis prescription, or discordant for those skipping/shortening home HD sessions without prior agreement with the clinical team. Comparisons were carried out using chi-squared or ANOVA testing as appropriate. <i>p</i> < 0.05 was defined as statistical significance.</p> </section> <section> <h3> Results</h3> <p>From 94 patients, 61 were concordant and 33 (35%) required coaching: 15 (16%) were concordant patients with agreement and 18 (19%) were discordant patients. Patients' demographics were summarized respectively for concordant patients, concordant with agreement, and for discordant patients. Age was 51 (37–61), 53 (47–61), 46 (35–54) [<i>p</i> = 0.102]; male gender was 62%, 53%, 72% [<i>p</i> = 0.519]; diabetes status was 21%, 7%, 6% [<i>p</i> = 0.219] and proportions of patients living alone were 13%, 7%, 17% [<i>p</i> = 0.739]. Patients requiring coaching tended to have a higher median time on home HD, 7.6 versus 4.3 years [<i>p</i> = 0.145] and tended to be less likely to be listed for kidney transplant [<i>p</i> = 0.174]. There were no differences in hospitalization and technique complications among patients who required coaching versus standard care.</p> </sec
{"title":"The Effects of Nurse-Led Coaching on Discordant Home Hemodialysis Patients","authors":"Ana Sanchez-Escuredo, Klement Yeung, Daniela Arustei, Celine D'Gama, Rose Faratro, Eduardo Magtoto, Kalavani Renganathan, Christopher T. Chan","doi":"10.1111/hdi.13259","DOIUrl":"10.1111/hdi.13259","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Home hemodialysis (home HD) has demonstrated superior clinical outcomes, improved quality of life, and enhanced treatment flexibility in comparison to 3 days/week in-center HDs. Nonetheless, some patients are discordant with their dialysis prescription and require a coaching program in order to maintain their normal lifestyle and ameliorate their illness behavior.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe the feasibility of conducting a nurse-led coaching program for discordant home HD patients and its effect on hospitalization and technique complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective single center observational cohort study of all prevalent home HD patients at University Health Network (UHN) from the period of January 2018 to December 2022. Demographic and clinical data were extracted from chart review. Nurses conducted weekly motivational interviewing with patients by phone, email, or in-clinic visits in the home HD unit to discuss the importance of being concordant to treatment and adapting the length and schedule of dialysis to avoid clinical complications. Health coaching was defined as patient-centered, incorporating patient-determined goals, self-discovery processes, accountability, and content information in the context of an ongoing helping relationship. Patients were categorized as concordant, concordant with agreement doing at least 75% of dialysis prescription, or discordant for those skipping/shortening home HD sessions without prior agreement with the clinical team. Comparisons were carried out using chi-squared or ANOVA testing as appropriate. <i>p</i> < 0.05 was defined as statistical significance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 94 patients, 61 were concordant and 33 (35%) required coaching: 15 (16%) were concordant patients with agreement and 18 (19%) were discordant patients. Patients' demographics were summarized respectively for concordant patients, concordant with agreement, and for discordant patients. Age was 51 (37–61), 53 (47–61), 46 (35–54) [<i>p</i> = 0.102]; male gender was 62%, 53%, 72% [<i>p</i> = 0.519]; diabetes status was 21%, 7%, 6% [<i>p</i> = 0.219] and proportions of patients living alone were 13%, 7%, 17% [<i>p</i> = 0.739]. Patients requiring coaching tended to have a higher median time on home HD, 7.6 versus 4.3 years [<i>p</i> = 0.145] and tended to be less likely to be listed for kidney transplant [<i>p</i> = 0.174]. There were no differences in hospitalization and technique complications among patients who required coaching versus standard care.</p>\u0000 </sec","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"29 4","pages":"513-518"},"PeriodicalIF":1.2,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rachid Daoui, Paul Feustel, Christina Manning, Loay Salman
Background
Home hemodialysis (home HD) continues to be an underutilized dialysis modality despite its potential advantages when compared to peritoneal dialysis (PD) and in-center hemodialysis (HD).
Methods
We conducted a retrospective study to evaluate the feasibility of using the B. Braun Dialog+ HD machine to provide home HD with the necessary requirements and modifications at home to be able to provide such treatments. In this retrospective study, we compared data obtained from patients who received home HD using the B. Braun Dialog+ HD machine since we started utilizing it for home HD (n = 27 patients) to data obtained from eligible patients who received home HD using the NxStage System One machine around the same period (n = 36 patients).
Results
Our results showed that the B. Braun group had a better single treatment single-pool Kt/V (spKt/V) (1.48 ± 0.27 for B. Braun vs. 1.14 ± 0.32 for NxStage, p < 0.001), better standard weekly Kt/V (4.44 ± 0.82 for B. Braun vs. 2.65 ± 0.57 for NxStage, p < 0.001), and better urea reduction rate (URR) (71.4 ± 6.2 for B. Braun vs. 59.2 ± 9.1 for NxStage, p < 0.001). The duration for the HD treatments among the B. Braun group patients was significantly shorter than that of the NxStage group patients (3.48 ± 0.32 vs. 4.58 ± 1.52, p < 0.001) while the ultrafiltration rate for the B. Braun group patients was significantly larger than that of the NxStage group patients (1.83 ± 0.64 vs. 1.18 ± 0.66, p < 0.001). The average laboratory data for both groups showed that there was only a significant difference between the two groups in bicarbonate level, with B. Braun having a lower level (23.5 ± 2.0 for B. Braun vs. 24.9 ± 2.8 for NxStage, p = 0.021). There were no significant differences between the two groups in the average albumin, BUN, calcium, creatinine, hemoglobin, phosphorus, platelets, potassium, WBC, or PTH.
Conclusion
B. Braun HD machine is another HD device that can be considered to provide home HD. Our study has shown that B. Braun machine had higher spKt/V in addition to standard weekly Kt/V and URR when compared to the NxStage machine. Larger, well-designed, and well-powered studies are needed to confirm these results.
{"title":"Use of the B. Braun Hemodialysis Machine to Provide Home Hemodialysis","authors":"Rachid Daoui, Paul Feustel, Christina Manning, Loay Salman","doi":"10.1111/hdi.13254","DOIUrl":"10.1111/hdi.13254","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Home hemodialysis (home HD) continues to be an underutilized dialysis modality despite its potential advantages when compared to peritoneal dialysis (PD) and in-center hemodialysis (HD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective study to evaluate the feasibility of using the B. Braun Dialog+ HD machine to provide home HD with the necessary requirements and modifications at home to be able to provide such treatments. In this retrospective study, we compared data obtained from patients who received home HD using the B. Braun Dialog+ HD machine since we started utilizing it for home HD (<i>n</i> = 27 patients) to data obtained from eligible patients who received home HD using the NxStage System One machine around the same period (<i>n</i> = 36 patients).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our results showed that the B. Braun group had a better single treatment single-pool Kt/V (spKt/V) (1.48 ± 0.27 for B. Braun vs. 1.14 ± 0.32 for NxStage, <i>p</i> < 0.001), better standard weekly Kt/V (4.44 ± 0.82 for B. Braun vs. 2.65 ± 0.57 for NxStage, <i>p</i> < 0.001), and better urea reduction rate (URR) (71.4 ± 6.2 for B. Braun vs. 59.2 ± 9.1 for NxStage, <i>p</i> < 0.001). The duration for the HD treatments among the B. Braun group patients was significantly shorter than that of the NxStage group patients (3.48 ± 0.32 vs. 4.58 ± 1.52, <i>p</i> < 0.001) while the ultrafiltration rate for the B. Braun group patients was significantly larger than that of the NxStage group patients (1.83 ± 0.64 vs. 1.18 ± 0.66, <i>p</i> < 0.001). The average laboratory data for both groups showed that there was only a significant difference between the two groups in bicarbonate level, with B. Braun having a lower level (23.5 ± 2.0 for B. Braun vs. 24.9 ± 2.8 for NxStage, <i>p</i> = 0.021). There were no significant differences between the two groups in the average albumin, BUN, calcium, creatinine, hemoglobin, phosphorus, platelets, potassium, WBC, or PTH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>B. Braun HD machine is another HD device that can be considered to provide home HD. Our study has shown that B. Braun machine had higher spKt/V in addition to standard weekly Kt/V and URR when compared to the NxStage machine. Larger, well-designed, and well-powered studies are needed to confirm these results.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"29 4","pages":"507-512"},"PeriodicalIF":1.2,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manouk Dam, Laura M. M. de Haan, Tiny Hoekstra, Marc Vervloet, Frans J. van Ittersum, Peter J. M. Weijs, Brigit C. van Jaarsveld
<div> <section> <h3> Introduction</h3> <p>The cardiovascular biomarkers troponin T, N-terminal pro-B-type natriuretic peptide, and fibroblast growth factor 23 are elevated in hemodialysis patients and associated with an increased cardiovascular mortality risk. Nocturnal hemodialysis improves the fluid status in hemodialysis patients. Therefore, we investigated whether nocturnal hemodialysis (7–8 h sessions) was associated with lower levels of troponin T, N-terminal pro-B-type natriuretic peptide, and fibroblast growth factor 23 in comparison to conventional hemodialysis. Second, we investigated whether these biomarkers were independently associated with physical performance in hemodialysis patients.</p> </section> <section> <h3> Methods</h3> <p>A prospective cohort of 33 hemodialysis patients was compared to 32 patients who voluntarily switched from conventional hemodialysis to nocturnal hemodialysis. First, we studied the difference between the two cohorts in change over 12 months of troponin T, N-terminal pro-B-type natriuretic peptide, and fibroblast growth factor 23 with linear mixed models. Second, the associations between these biomarkers and physical-activity monitor, six minute walk test, and physical component summary score were assessed at baseline, 6 and 12 months.</p> </section> <section> <h3> Findings</h3> <p>N-terminal pro-B-type natriuretic peptide increased 122% during conventional hemodialysis, whereas it decreased 31% during nocturnal hemodialysis (<i>p</i> = 0.001). In conventional hemodialysis, fibroblast growth factor 23 rose numerically by 19% (23%–66%) in 12 months, while a decline of 44% (21%–58%) was found in nocturnal hemodialysis patients (<i>p</i> = 0.17). Troponin T did not differ between groups. Regarding physical performance, a higher N-terminal pro-B-type natriuretic peptide (per 1000 ng/L) and fibroblast growth factor 23 (per 1000 RU/mL) were associated with lower physical component summary scores of −0.02 (<i>p</i> = 0.02) and −0.04 (<i>p</i> = 0.05), respectively. Troponin T was not associated with physical performance.</p> </section> <section> <h3> Discussion</h3> <p>Our findings showed that nocturnal hemodialysis was associated with a decrease in N-terminal pro-B-type natriuretic peptide. This suggested that nocturnal hemodialysis diminished volume overload and thereby myocardial stretch. Additionally, lower levels of N-terminal pro-B-type natriuretic peptide and fibroblast growth factor 23 were found to be associated with better self-reported physical performance scores.</p> </section>
{"title":"Cardiovascular Biomarkers in Nocturnal Hemodialysis and Their Association With Physical Performance","authors":"Manouk Dam, Laura M. M. de Haan, Tiny Hoekstra, Marc Vervloet, Frans J. van Ittersum, Peter J. M. Weijs, Brigit C. van Jaarsveld","doi":"10.1111/hdi.13265","DOIUrl":"10.1111/hdi.13265","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The cardiovascular biomarkers troponin T, N-terminal pro-B-type natriuretic peptide, and fibroblast growth factor 23 are elevated in hemodialysis patients and associated with an increased cardiovascular mortality risk. Nocturnal hemodialysis improves the fluid status in hemodialysis patients. Therefore, we investigated whether nocturnal hemodialysis (7–8 h sessions) was associated with lower levels of troponin T, N-terminal pro-B-type natriuretic peptide, and fibroblast growth factor 23 in comparison to conventional hemodialysis. Second, we investigated whether these biomarkers were independently associated with physical performance in hemodialysis patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective cohort of 33 hemodialysis patients was compared to 32 patients who voluntarily switched from conventional hemodialysis to nocturnal hemodialysis. First, we studied the difference between the two cohorts in change over 12 months of troponin T, N-terminal pro-B-type natriuretic peptide, and fibroblast growth factor 23 with linear mixed models. Second, the associations between these biomarkers and physical-activity monitor, six minute walk test, and physical component summary score were assessed at baseline, 6 and 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>N-terminal pro-B-type natriuretic peptide increased 122% during conventional hemodialysis, whereas it decreased 31% during nocturnal hemodialysis (<i>p</i> = 0.001). In conventional hemodialysis, fibroblast growth factor 23 rose numerically by 19% (23%–66%) in 12 months, while a decline of 44% (21%–58%) was found in nocturnal hemodialysis patients (<i>p</i> = 0.17). Troponin T did not differ between groups. Regarding physical performance, a higher N-terminal pro-B-type natriuretic peptide (per 1000 ng/L) and fibroblast growth factor 23 (per 1000 RU/mL) were associated with lower physical component summary scores of −0.02 (<i>p</i> = 0.02) and −0.04 (<i>p</i> = 0.05), respectively. Troponin T was not associated with physical performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our findings showed that nocturnal hemodialysis was associated with a decrease in N-terminal pro-B-type natriuretic peptide. This suggested that nocturnal hemodialysis diminished volume overload and thereby myocardial stretch. Additionally, lower levels of N-terminal pro-B-type natriuretic peptide and fibroblast growth factor 23 were found to be associated with better self-reported physical performance scores.</p>\u0000 </section>\u0000 ","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"29 4","pages":"519-529"},"PeriodicalIF":1.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.13265","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A functional arteriovenous access is crucial for hemodialysis patients. Regular monitoring of vascular access allows for early detection and treatment of complications, which helps the access last longer and improves the effectiveness of dialysis. Clinical guidelines emphasize physical examination as the main way to monitor vascular access. To highlight the importance of physical examination among hemodialysis clinicians, this review investigates its application in AV access assessment.
Methods
We searched the China National Knowledge Infrastructure (CNKI), Wanfang, PubMed, Web of Science, Cochrane Library, Embase, ProQuest, and UpToDate databases from their inception to November 25, 2022, for studies on the physical examination of arteriovenous access.
Results
Physical examination exhibits acceptable sensitivity and specificity for detecting AV fistula maturation and stenosis. Quantitative physical examination indicators demonstrate high accuracy in assessing AV fistula stenosis and thrombosis. While widely used to evaluate vascular access function, dialysis practitioners often lack sufficient training and knowledge in physical examination. Therefore, comprehensive training for dialysis professionals in this area is essential.
Conclusions
Several factors hinder the widespread use of physical examination in clinical settings. To optimize AV access care, hemodialysis managers should prioritize the development of standardized physical examination protocols that include quantitative indicators and assessment tools. Furthermore, regular training and competency assessments for dialysis staff are vital. Strengthening practitioners' physical examination proficiency will lead to earlier identification of AV access issues, greater access durability, and improved patient well-being.
背景：功能性动静脉通道对血液透析患者至关重要。定期监测血管通路可以早期发现和治疗并发症，这有助于延长通道并提高透析的有效性。临床指南强调体格检查是监测血管通路的主要途径。为了强调身体检查在血液透析临床医生中的重要性，本文综述了其在房颤通路评估中的应用。方法：检索中国知网（CNKI）、万方、PubMed、Web of Science、Cochrane Library、Embase、ProQuest和UpToDate等数据库，检索自其成立至2022年11月25日的动静脉通路体检研究。结果：体格检查对检测房瘘成熟和狭窄具有可接受的敏感性和特异性。定量体格检查指标在评估房室瘘狭窄和血栓形成方面具有较高的准确性。虽然透析被广泛用于评估血管通路功能，但透析从业人员在体检方面往往缺乏足够的培训和知识。因此，对透析专业人员进行全面的培训是必不可少的。结论：有几个因素阻碍了体检在临床的广泛应用。为了优化房颤通道护理，血液透析管理人员应优先制定标准化的体检方案，其中包括定量指标和评估工具。此外，对透析工作人员进行定期培训和能力评估至关重要。加强从业人员的身体检查能力将导致早期识别房室通道问题，更大的访问持久性，并改善患者的福祉。
{"title":"Application of Physical Examination in Assessing Arteriovenous Access: A Narrative Review","authors":"Jingying Chen, Jinghua Lu, Xia Fu, Hongzhen Zhou","doi":"10.1111/hdi.13256","DOIUrl":"10.1111/hdi.13256","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A functional arteriovenous access is crucial for hemodialysis patients. Regular monitoring of vascular access allows for early detection and treatment of complications, which helps the access last longer and improves the effectiveness of dialysis. Clinical guidelines emphasize physical examination as the main way to monitor vascular access. To highlight the importance of physical examination among hemodialysis clinicians, this review investigates its application in AV access assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched the China National Knowledge Infrastructure (CNKI), Wanfang, PubMed, Web of Science, Cochrane Library, Embase, ProQuest, and UpToDate databases from their inception to November 25, 2022, for studies on the physical examination of arteriovenous access.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Physical examination exhibits acceptable sensitivity and specificity for detecting AV fistula maturation and stenosis. Quantitative physical examination indicators demonstrate high accuracy in assessing AV fistula stenosis and thrombosis. While widely used to evaluate vascular access function, dialysis practitioners often lack sufficient training and knowledge in physical examination. Therefore, comprehensive training for dialysis professionals in this area is essential.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Several factors hinder the widespread use of physical examination in clinical settings. To optimize AV access care, hemodialysis managers should prioritize the development of standardized physical examination protocols that include quantitative indicators and assessment tools. Furthermore, regular training and competency assessments for dialysis staff are vital. Strengthening practitioners' physical examination proficiency will lead to earlier identification of AV access issues, greater access durability, and improved patient well-being.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"29 4","pages":"442-449"},"PeriodicalIF":1.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Uncuffed, non-tunneled dual-lumen catheters are often required for kidney replacement therapy (KRT), but catheter-related bloodstream infections (CRBSIs) remain a serious complication. Whether the jugular site poses a lower CRBSI risk than the femoral site is unclear.
Methods
This retrospective cohort study analyzed patients with uncuffed, non-tunneled dual-lumen catheters. CRBSI incidence, catheter dwelling time, and mortality rates were compared between jugular and femoral sites. Regression analyses identified CRBSI risk factors.
Results
A total of 572 patients were included in the study. The incidence proportion of CRBSI was 3.5% in both the femoral and jugular groups (10 of 286 patients in each group; p = 1.0). The incidence rates of CRBSI were 1.7 and 0.9 per 1000 patient-days for the femoral and jugular sites, respectively (p = 0.154). The median catheter dwelling time was significantly longer for jugular catheters (25 days) compared to femoral catheters (12 days; p < 0.001). The 30-day incidence proportion of death at the jugular site was significantly lower than at the femoral site (0.105 vs. 0.608, p < 0.001). Pre-existing cerebrovascular disease and congestive heart failure were identified as significant risk factors for CRBSI.
Conclusion
For uncuffed, non-tunneled dual-lumen catheters used for dialysis vascular access, the jugular insertion site does not demonstrate a reduced risk of CRBSI compared to the femoral site. However, jugular catheter placement is associated with a longer dwelling time and a lower mortality rate.
{"title":"Catheter-Related Infection in Uncuffed, Non-Tunneled Dual-Lumen Catheters: Incidence and Risk Factors by Internal Jugular Versus Femoral Site in a Retrospective Cohort","authors":"Tanwaporn Phatpituk, Suthiya Anumas, Aphichat Chatkrailert","doi":"10.1111/hdi.13261","DOIUrl":"10.1111/hdi.13261","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Uncuffed, non-tunneled dual-lumen catheters are often required for kidney replacement therapy (KRT), but catheter-related bloodstream infections (CRBSIs) remain a serious complication. Whether the jugular site poses a lower CRBSI risk than the femoral site is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study analyzed patients with uncuffed, non-tunneled dual-lumen catheters. CRBSI incidence, catheter dwelling time, and mortality rates were compared between jugular and femoral sites. Regression analyses identified CRBSI risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 572 patients were included in the study. The incidence proportion of CRBSI was 3.5% in both the femoral and jugular groups (10 of 286 patients in each group; <i>p</i> = 1.0). The incidence rates of CRBSI were 1.7 and 0.9 per 1000 patient-days for the femoral and jugular sites, respectively (<i>p</i> = 0.154). The median catheter dwelling time was significantly longer for jugular catheters (25 days) compared to femoral catheters (12 days; <i>p</i> < 0.001). The 30-day incidence proportion of death at the jugular site was significantly lower than at the femoral site (0.105 vs. 0.608, <i>p</i> < 0.001). Pre-existing cerebrovascular disease and congestive heart failure were identified as significant risk factors for CRBSI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>For uncuffed, non-tunneled dual-lumen catheters used for dialysis vascular access, the jugular insertion site does not demonstrate a reduced risk of CRBSI compared to the femoral site. However, jugular catheter placement is associated with a longer dwelling time and a lower mortality rate.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"29 4","pages":"557-564"},"PeriodicalIF":1.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jos N. M. Barendregt, Tizza P. Zomer, Yolande M. Vermeeren, Paul A. Rootjes, Brigit C. van Jaarsveld
Introduction
Nocturnal in-center hemodialysis (HD) offers a higher dialysis dose and longer ultrafiltration time than regular HD, which potentially benefits at least a selection of patients. Currently, only a minority of HD patients have access to in-center nocturnal HD. Many practical and logistical problems must be overcome by an HD center before the treatment can become operational.
Methods
For assessing the detailed organization of in-center nocturnal HD in the Netherlands, an observational cross-sectional study was performed using Nefrodata (Dutch Registry of dialysis patients) and structured questionnaires for center managers and nephrologists. Descriptive analyses were performed, followed by an analysis of best practices.
Findings
Out of 55 Dutch dialysis centers, 27 offer in-center nocturnal HD, treating 255 out of 5200 patients treated with intermittent HD. Of these 27 centers, 4 stopped providing in-center nocturnal HD, mostly due to organizational problems. Our survey showed that some aspects of treatment were similar in the various centers, such as duration of sessions (7–8 h), patient education at the pre-dialysis outpatient department, treatment prescription, and blood pressure monitoring. In contrast, patient selection varied between centers, for example, regarding functional vascular access: non-tunneled catheters were not allowed during in-center nocturnal HD in some centers. Also, hemodynamic instability observed during daytime treatment was, by some centers, considered a problem for starting in-center nocturnal HD. Furthermore, large differences regarding the organization of nursing staff exist. Importantly, all nephrologists agree that in-center nocturnal HD is a useful part of the treatment repertoire offered in their centers.
Discussion
Practical guidance to organize a successful and safe in-center nocturnal HD program is provided. Patients' safety should be guaranteed without affecting the patient's night's sleep. In-center nocturnal HD offers patients the most optimal metabolic control, excellent intradialytic hemodynamic stability, and volume control with more free time during the day.
{"title":"Characteristics and Organization of In-Center Nocturnal Hemodialysis in the Netherlands: Practical Guidance for Centers Willing to Initiate Nocturnal Hemodialysis","authors":"Jos N. M. Barendregt, Tizza P. Zomer, Yolande M. Vermeeren, Paul A. Rootjes, Brigit C. van Jaarsveld","doi":"10.1111/hdi.13253","DOIUrl":"10.1111/hdi.13253","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Nocturnal in-center hemodialysis (HD) offers a higher dialysis dose and longer ultrafiltration time than regular HD, which potentially benefits at least a selection of patients. Currently, only a minority of HD patients have access to in-center nocturnal HD. Many practical and logistical problems must be overcome by an HD center before the treatment can become operational.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>For assessing the detailed organization of in-center nocturnal HD in the Netherlands, an observational cross-sectional study was performed using Nefrodata (Dutch Registry of dialysis patients) and structured questionnaires for center managers and nephrologists. Descriptive analyses were performed, followed by an analysis of best practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Out of 55 Dutch dialysis centers, 27 offer in-center nocturnal HD, treating 255 out of 5200 patients treated with intermittent HD. Of these 27 centers, 4 stopped providing in-center nocturnal HD, mostly due to organizational problems. Our survey showed that some aspects of treatment were similar in the various centers, such as duration of sessions (7–8 h), patient education at the pre-dialysis outpatient department, treatment prescription, and blood pressure monitoring. In contrast, patient selection varied between centers, for example, regarding functional vascular access: non-tunneled catheters were not allowed during in-center nocturnal HD in some centers. Also, hemodynamic instability observed during daytime treatment was, by some centers, considered a problem for starting in-center nocturnal HD. Furthermore, large differences regarding the organization of nursing staff exist. Importantly, all nephrologists agree that in-center nocturnal HD is a useful part of the treatment repertoire offered in their centers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Practical guidance to organize a successful and safe in-center nocturnal HD program is provided. Patients' safety should be guaranteed without affecting the patient's night's sleep. In-center nocturnal HD offers patients the most optimal metabolic control, excellent intradialytic hemodynamic stability, and volume control with more free time during the day.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"29 4","pages":"571-578"},"PeriodicalIF":1.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recently, hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) have been introduced as a therapeutic option for anemia, a common complication of chronic kidney disease. Although HIF-PHIs demonstrate efficacy in managing anemia, their administration may lead to dependence on upregulated hypoxia-inducible factors. Here, we report two maintenance hemodialysis cases that experienced temporary erythropoiesis hypoactivity following HIF-PHI discontinuation.
{"title":"Temporary Erythropoiesis Hypoactivity Following Hypoxia-Inducible-Factor-Prolyl-Hydroxylase-Inhibitor Discontinuation","authors":"Masayuki Tanemoto","doi":"10.1111/hdi.13258","DOIUrl":"10.1111/hdi.13258","url":null,"abstract":"<div>\u0000 \u0000 <p>Recently, hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) have been introduced as a therapeutic option for anemia, a common complication of chronic kidney disease. Although HIF-PHIs demonstrate efficacy in managing anemia, their administration may lead to dependence on upregulated hypoxia-inducible factors. Here, we report two maintenance hemodialysis cases that experienced temporary erythropoiesis hypoactivity following HIF-PHI discontinuation.</p>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"29 4","pages":"724-726"},"PeriodicalIF":1.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kristina K. Knudsen, Carolina V. Adrian, Mathilde H. Jensen, Siw Ilsøe, Jeanett Rugaard, Selina Emilie Poulsen, Krista Dybtved Kjærgaard, Jeanette Finderup
Introduction
In 2018, our home hemodialysis training program required 3–4 months to complete, with sessions lasting 4 h, three times a week. Due to the time commitment, some patients who preferred home hemodialysis decided on alternative dialysis modalities. This study aimed to (1) identify potential improvements to Training Program 1.0, (2) develop Training Program 2.0, and (3) assess the outcomes of Training Program 2.0.
Method
We reviewed literature, conducted focus groups with home hemodialysis nurses in Helsinki, Finland, and interviewed patients who participated in Training Program 1.0. Training Program 2.0 was developed in collaboration with patients and clinicians, using a “learning by doing” approach. Evaluation included both qualitative interviews and quantitative analysis of patient records.
Findings
Patients' feedback, aligned with the literature and Helsinki's program, led to six major changes: (1) more frequent training sessions, (2) earlier introduction of self-cannulation, (3) a permanent team of training nurses, (4) a shorter and more structured program, (5) individualized weekly schedules, and (6) clearer instructions. Training frequency increased to four sessions per week, with self-cannulation introduced in the second week. The quantitative results showed a trend toward a reduction in the number of training sessions and total training time. The qualitative data indicated a marked improvement in patient experience.
Discussion
The modifications in Training Program 2.0 created a more effective learning environment, as evidenced by improved patient satisfaction. While quantitative measures did not show significant reductions in training time, the qualitative improvements suggest that these changes positively impact the patient experience, aligning with findings from other home hemodialysis studies. These results underscore the importance of tailoring training programs to patient needs and preferences, contributing to better engagement and potentially higher adoption of home hemodialysis.
{"title":"Developing and Evaluating a Home Hemodialysis Training Program—A Quality Improvement Study","authors":"Kristina K. Knudsen, Carolina V. Adrian, Mathilde H. Jensen, Siw Ilsøe, Jeanett Rugaard, Selina Emilie Poulsen, Krista Dybtved Kjærgaard, Jeanette Finderup","doi":"10.1111/hdi.13252","DOIUrl":"10.1111/hdi.13252","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In 2018, our home hemodialysis training program required 3–4 months to complete, with sessions lasting 4 h, three times a week. Due to the time commitment, some patients who preferred home hemodialysis decided on alternative dialysis modalities. This study aimed to (1) identify potential improvements to Training Program 1.0, (2) develop Training Program 2.0, and (3) assess the outcomes of Training Program 2.0.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We reviewed literature, conducted focus groups with home hemodialysis nurses in Helsinki, Finland, and interviewed patients who participated in Training Program 1.0. Training Program 2.0 was developed in collaboration with patients and clinicians, using a “learning by doing” approach. Evaluation included both qualitative interviews and quantitative analysis of patient records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Patients' feedback, aligned with the literature and Helsinki's program, led to six major changes: (1) more frequent training sessions, (2) earlier introduction of self-cannulation, (3) a permanent team of training nurses, (4) a shorter and more structured program, (5) individualized weekly schedules, and (6) clearer instructions. Training frequency increased to four sessions per week, with self-cannulation introduced in the second week. The quantitative results showed a trend toward a reduction in the number of training sessions and total training time. The qualitative data indicated a marked improvement in patient experience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The modifications in Training Program 2.0 created a more effective learning environment, as evidenced by improved patient satisfaction. While quantitative measures did not show significant reductions in training time, the qualitative improvements suggest that these changes positively impact the patient experience, aligning with findings from other home hemodialysis studies. These results underscore the importance of tailoring training programs to patient needs and preferences, contributing to better engagement and potentially higher adoption of home hemodialysis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"29 4","pages":"496-506"},"PeriodicalIF":1.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.13252","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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