Adaptation of home nocturnal hemodialysis for a patient with epidermolysis bullosa: A call to personalized care!

Epidermolysis bullosa (EB) is a genetic disease characterized by skin fragility presenting with blistering and skin erosions. Recurrent skin infections are noted to be associated with the pathogenesis of IgA nephropathy. End stage kidney disease (ESKD) is a rare complication in patients with EB (Ducret F.

The need for outpatient back-up for home hemodialysis patients: Implications for resource utilization.

Introduction: The provision of sufficient support contributes to home hemodialysis (HHD) technique survival. The need for back-up treatment in incident and prevalent patients on HHD has not been well described previously, and is important from both technique survival and resource allocation. We aimed to quantify the amount of back-up treatment given to patients in our HHD unit, and hypothesized that the provision of back-up HD facilitated technique survival.

Changes in pulmonary restrictive parameters by intensive home hemodialysis: a case report.

Background: Patients with End-Stage Renal Disease (ESRD) are at an increased risk for restrictive lung disease due to accumulation of uremic toxins and volume overload. Hemodialysis is the preferred treatment for improving lung function in dialysis patients. However, the effects of fluid removal and solute clearance by hemodialysis on lung function remain unclear.

A prototype line clamp for venous access bleeding in hemodialysis: A prospective cohort study.

Introduction: Venous needle dislodgement (or venous port disconnection) during hemodialysis (HD) may lead to catastrophic blood loss, particularly during unsupervised home HD. A prototype venous line clamp was developed for use in conjunction with the Redsense blood loss sensor. We hypothesize that this prototype device will provide additional safety to dialysis without excessive burden.

The use of nurse-administered vascular access audit in home hemodialysis patients: A quality initiative.

Introduction: Vascular access complications are associated with increased morbidity and mortality in home hemodialysis (HHD). Nurse-administered vascular access checklist is a feasible quality improvement strategy aimed to lower HHD access errors.

Methods: We conducted a prospective quality improvement initiative for consecutive HHD patients between April 2013 and December 2016 at the Toronto General Hospital.

Self-cannulation of the vascular access in home hemodialysis: Overcoming patient-level barriers.

Patients with end-stage kidney disease who are considering home hemodialysis (HHD) face the challenge of learning to self-cannulate their arteriovenous access. Current practice discourages the use of tunneled central venous catheters, with recent indications that self-cannulating patients have superior outcomes. Patient-level barriers do not appear to preclude a successful HHD program and should not be viewed as insurmountable by healthcare staff or patients.

Ultrasound-Guided Cannulation of the Hemodialysis Arteriovenous Access.

Successful cannulation of the arteriovenous access for patients with end-stage kidney failure to allow catheter-free hemodialysis is associated with superior patient outcomes. With an increasing rate of arteriovenous access creation, coupled with increasing dialysis patient age, the "difficult-to-cannulate" access is becoming more commonplace. Ultrasound-guided cannulation aims to improve first-time successful cannulations and minimize cannulation-associated complications such as infiltration and hematoma formation, minimizing delays in access use and reducing catheter dependency.

The impact of simulation-based teaching on home hemodialysis patient training.

Background: Simulation has been associated with positive educational benefits in the training of healthcare professionals. It is unknown whether the use of simulation to supplement patient training for home hemodialysis (HHD) will assist in improving a patient's transition to home. We aim to assess the impact of simulation training on home visits, retraining and technique failure.

Utility of Baseline Home Visit Audit in Home Hemodialysis.

We conducted a retrospective cohort study in a university hospital-based home hemodialysis (HHD) program to evaluate the effectiveness of a home visit audit tool. We aimed to delineate safety risk in HHD patients and to ascertain whether this is associated with clinical outcomes. All incident HHD patients between July 18, 2008, and June 30, 2013 with follow-up until December 31, 2013, were included in the cohort.

The care and keeping of vascular access for home hemodialysis patients.

Creating and maintaining a healthy vascular access is a critical factor in successful home hemodialysis (HD). This article aims to serve as a "how-to manual" regarding vascular access issues for both patients and health-care providers in a home HD program. This document outlines cannulation options for patients with arteriovenous access and describes troubleshooting techniques for potential complications; strategies are suggested to help patients overcome fear of cannulation and address problems associated with difficult cannulation.

Patient selection and training for home hemodialysis.

Patient selection and training is arguably the most important step toward building a successful home hemodialysis (HD) program. We present a step-by-step account of home HD training to guide providers who are developing home HD programs. Although home HD training is an important step in allowing patients to undergo dialysis in the home, there is a surprising lack of systematic research in this field.

Frequent hemodialysis fistula infectious complications.

Background: Few studies have examined if infectious arteriovenous access complications vary with the cannulation technique and whether this is modified by dialysis frequency. We compared the infection rate between fistulas cannulated using buttonhole versus stepladder techniques for patients treated with short daily (SDH) or nocturnal hemodialysis at home (NHD). We also compared patients receiving conventional intermittent hemodialysis (CIHD) using stepladder cannulation.

Adverse technical events in home hemodialysis.

Background: There is a growing interest in home hemodialysis because of its clinical benefits. However, given that patients are responsible for performing a complex medical procedure at home, adverse-event reporting is important to ensure patient safety. The purpose of this study was to describe adverse technical events in a large cohort of home hemodialysis patients.

The use of alternative anti-coagulation strategies for a nocturnal home hemodialysis patient with heparin-induced thrombocytopenia.

Heparin-induced thrombocytopenia (HIT) is a potentially catastrophic hyercoagulable state. The prevalence of HIT in individuals doing nocturnal home hemodialysis (NHD) is unknown and the appropriate treatment protocol has yet to be determined. The objective is to describe the clinical course and treatment plan ofa patient who developed HIT while undergoing NHD.

Improvement in lower-extremity peripheral arterial disease by nocturnal hemodialysis.

A 42-year-old man with end-stage renal disease (ESRD) was referred for conversion to nocturnal hemodialysis (NHD) therapy from conventional hemodialysis (CHD) therapy because of refractory intermittent claudication secondary to peripheral arterial disease (PAD). The patient was initiated on CHD therapy in 1976 and subsequently had undergone two unsuccessful renal transplantations. While on CHD therapy, his clinical course was complicated by worsening vascular and soft-tissue calcification.