Excerpt

Home-based dialysis (defined for this review as in-home hemodialysis [HHD] or peritoneal dialysis [PD] outside of a dialysis facility) may offer advantages over in-center hemodialysis (HD), including patient convenience, expanded capacity for VA to deliver fully integrated care to Veterans with end-stage renal disease (ESRD), a reduction in fee-basis costs associated with dialysis, and potentially improved patient quality of life and blood pressure control with greater survival and fewer hospitalizations. As the number of patients requiring renal replacement therapy (RRT) increases, there is need for a current review of the benefits and harms of home-based dialysis (HHD or PD) versus in-center HD, the benefits and harms of different home-based dialysis modalities, and the predictors of successful home-based dialysis to allow VA to better serve patient needs. We reviewed the evidence from studies of adults with chronic kidney disease requiring dialysis and comparing home-based and in-center HD. Due to between-country differences in health care systems, we focused our review on studies most relevant to the VA, ie, those from North America, Europe, or Australia/New Zealand.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • INTRODUCTION
  • METHODS
  • RESULTS
  • DISCUSSION
  • ABBREVIATIONS TABLE
• INTRODUCTION
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • RATING THE BODY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • KEY QUESTION 1 What are the benefits and harms (ie, all-cause mortality, cardiovascular events, hospitalizations, depression, cognitive impairment, quality of life, conversion to a different type of dialysis, complications related to vascular access, complications of dialysis) of in-home compared to in-center hemodialysis?
  • KEY QUESTION 1A What are the benefits and harms (ie, all-cause mortality, cardiovascular events, hospitalizations, depression, cognitive impairment, quality of life, conversion to a different type of dialysis, complications related to vascular access, complications of dialysis) of the various modalities of in-home hemodialysis (ie, short daily, nocturnal) compared to conventional hemodialysis?
  • KEY QUESTION 2 What are the benefits and harms (ie, all-cause mortality, cardiovascular events, hospitalizations, depression, cognitive impairment, quality of life, conversion to a different type of dialysis, complications related to vascular access, complications of dialysis) of peritoneal dialysis compared to in-home hemodialysis or in-center hemodialysis?
  • KEY QUESTION 2A Do results differ depending on whether peritoneal dialysis was the initial therapy or the therapy used following failed in-center dialysis?
  • KEY QUESTION 3 What are the a) health care system, b) provider, and c) patient factors associated with selection of and technique survival for home-based dialysis (including peritoneal dialysis)?
  • KEY QUESTION 4 In the published literature, what are the costs of home hemodialysis or peritoneal dialysis compared to in-center hemodialysis?
• SUMMARY AND DISCUSSION
  • Key Findings and Strength of Evidence
  • DISCUSSION
  • LIMITATIONS
  • RESEARCH GAPS/FUTURE RESEARCH
  • CONCLUSIONS
• REFERENCES
• APPENDIX A SEARCH STRATEGY
• APPENDIX B PEER REVIEW COMMENTS/AUTHOR RESPONSES
• APPENDIX C EVIDENCE TABLES

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Minneapolis VA Medical Center, Minneapolis, MN, Timothy J. Wilt, MD, MPH, Director

Suggested citation:

Ishani A, Slinin Y, Greer N, MacDonald R, Messana J, Rutks I, Wilt TJ. Comparative Effectiveness of Home-based Kidney Dialysis versus In-center or Other Outpatient Kidney Dialysis Locations - A Systematic Review. VA ESP Project #09-009; 2015.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Minneapolis VA Medical Center, Minneapolis, MN funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.