University Health Network, Toronto, Ontario, Canada.
National Kidney Foundation, New York, NY.
Am J Kidney Dis. 2020 Jun;75(6):926-934. doi: 10.1053/j.ajkd.2019.11.007. Epub 2020 Feb 10.
Home dialysis modalities are used in a minority of patients with kidney failure in the United States. During the 2018 National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) Home Dialysis Conference, numerous ideas were suggested to help minimize barriers for the uptake and retention of home dialysis therapies. First, educational tools are needed to increase knowledge about home dialysis modalities (eg, continuous ambulatory peritoneal dialysis, continuous cycling peritoneal dialysis, and home hemodialysis). Implementation of a hub and spoke model, pairing smaller and/or newer home dialysis programs with larger more sophisticated programs that offer education and mentoring, may help dialysis programs to grow and prosper. This pairing can be facilitated by traditional conferences and newer modalities such as telemedicine and training applications. Peer support to patients, such as that offered through the NKF Peers Program, and support and respite to care partners can have beneficial effects toward both increasing the number of patients who choose home dialysis as a modality and improving retention in home dialysis programs. Anticipating and understanding both patient and care partner burden is important for the development and implementation of patient- and care partner-centered support programs that can be deployed before a patient ceases home therapy. Finally, aligning Medicare reimbursement to support appropriate increased home dialysis uptake to prioritize both transplantation and home dialysis as the first-line treatments for kidney failure.
在美国，只有少数肾衰竭患者使用家庭透析方式。在 2018 年全国肾脏基金会-肾脏疾病预后质量倡议 (NKF-KDOQI) 家庭透析会议上，提出了许多建议，以帮助尽量减少家庭透析治疗的采用和保留障碍。首先，需要教育工具来增加对家庭透析方式的了解（例如，持续流动腹膜透析、持续循环腹膜透析和家庭血液透析）。实施中心辐射模式，将较小和/或较新的家庭透析计划与提供教育和指导的较大、较复杂的计划配对，可以帮助透析计划发展和繁荣。这种配对可以通过传统会议和较新的模式（如远程医疗和培训应用程序）来实现。向患者提供同伴支持，例如 NKF 同伴计划提供的支持，以及为护理伙伴提供支持和喘息，可以对增加选择家庭透析作为治疗方式的患者数量和提高家庭透析计划的保留率产生有益影响。预测和理解患者和护理伙伴的负担对于制定和实施以患者和护理伙伴为中心的支持计划非常重要，这些计划可以在患者停止家庭治疗之前部署。最后，调整医疗保险报销以支持适当增加家庭透析的采用，优先将移植和家庭透析作为肾衰竭的一线治疗方法。
