Why the study?
Patients on home dialysis remain at high risk of transfer to facility-hemodialysis, prompting interest in an integrated model transitioning patients from peritoneal dialysis to home hemodialysis.
Does the integrated home dialysis model provide clinical and cost benefits compared to facility hemodialysis for patients ending peritoneal dialysis?
Does the integrated home dialysis model provide clinical and cost benefits compared to facility hemodialysis for patients ending peritoneal dialysis?
The integrated home dialysis model, transitioning patients from peritoneal to home hemodialysis, is underutilized but offers clinical and economic benefits.
Integrated PD-to-HHD transitions may reduce facility HD transfers; leaves open need for prospective outcome trials.
PURPOSE OF REVIEW: Home dialysis has been promoted for several years for patients starting dialysis. Although incident use of peritoneal dialysis (PD) and home hemodialysis (HHD) is increasing in several regions, patients on home dialysis remain at high risk of transfer to facility-hemodialysis (HD). The integrated home dialysis model, where patient start dialysis on PD and eventually transition to HHD when PD cannot be optimally continued has gain interest from dialysis stakeholders. RECENT FINDINGS: Transfers from PD to HHD are infrequently used among patients ending PD, representing between 2% and 6% of transfers to HD in registry studies. Nonetheless, this approach is associated with several clinical benefits as well as favorable cost-effectiveness. SUMMARY: In this review, we will present data pertaining to home dialysis and the integrated home dialysis model, with broad discussion of the implementation challenges, including identifying patients who could most benefit from this approach, timely planning of the transitions and challenges relating to unexpected PD endings.
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Pecce et al. (2024) studied this question.
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