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  1. Article ; Online: Setting Up Home Dialysis Programs: Now and in the Future.

    Abra, Graham E / Weinhandl, Eric D / Hussein, Wael F

    Clinical journal of the American Society of Nephrology : CJASN

    2023  Volume 18, Issue 11, Page(s) 1490–1496

    Abstract: Home dialysis utilization has been growing in the United States over the past decade but still lags behind similar socioeconomic nations. More than half of dialysis facilities in the United States either are not licensed to offer home dialysis or, ... ...

    Abstract Home dialysis utilization has been growing in the United States over the past decade but still lags behind similar socioeconomic nations. More than half of dialysis facilities in the United States either are not licensed to offer home dialysis or, despite a license, have no patients dialyzing at home, and many programs have a relatively small census. Multiple stakeholders, including patients, health care providers, and payers, have identified increased home dialysis use as an important goal. To realize these goals, nephrologists and kidney care professionals need a sound understanding of the key considerations in home dialysis center operation. In this review, we outline the core domains required to set up and operate a home dialysis program in the United States now and in the future.
    MeSH term(s) Humans ; United States ; Hemodialysis, Home ; Kidney Failure, Chronic ; Health Facilities ; Nephrologists ; Motivation ; Renal Dialysis
    Language English
    Publishing date 2023-08-21
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 2226665-3
    ISSN 1555-905X ; 1555-9041
    ISSN (online) 1555-905X
    ISSN 1555-9041
    DOI 10.2215/CJN.0000000000000284
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Home-Based Dialysis: A Primer for the Internist.

    Rope, Robert / Ryan, Eric / Weinhandl, Eric D / Abra, Graham E

    Annual review of medicine

    2023  Volume 75, Page(s) 205–217

    Abstract: Home-based dialysis modalities offer both clinical and practical advantages to patients. The use of the home-based modalities, peritoneal dialysis and home hemodialysis, has been increasing over the past decade after a long period of decline. Given the ... ...

    Abstract Home-based dialysis modalities offer both clinical and practical advantages to patients. The use of the home-based modalities, peritoneal dialysis and home hemodialysis, has been increasing over the past decade after a long period of decline. Given the increasing frequency of use of these types of dialysis, it is important for clinicians to be familiar with how these types of dialysis are performed and key clinical aspects of care related to their use in patients with end-stage kidney disease.
    MeSH term(s) Humans ; Hemodialysis, Home ; Renal Dialysis ; Kidney Failure, Chronic/therapy
    Language English
    Publishing date 2023-12-01
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 207930-6
    ISSN 1545-326X ; 0066-4219
    ISSN (online) 1545-326X
    ISSN 0066-4219
    DOI 10.1146/annurev-med-050922-051415
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: The effect of blood flow rate on dialysis recovery time in patients undergoing maintenance hemodialysis: A prospective, parallel-group, randomized controlled trial.

    Duggal, Vishal / Hussein, Wael F / Reiterman, Marc / Sun, Sumi J / Abra, Graham E / Schiller, Brigitte

    Hemodialysis international. International Symposium on Home Hemodialysis

    2019  Volume 23, Issue 2, Page(s) 223–229

    Abstract: Introduction: A majority of patients with end-stage renal disease (ESRD) on in-center hemodialysis (HD) require several hours to recover from an HD session. Patients and caregivers identify fatigue as a high priority for improvement. However, evidence ... ...

    Abstract Introduction: A majority of patients with end-stage renal disease (ESRD) on in-center hemodialysis (HD) require several hours to recover from an HD session. Patients and caregivers identify fatigue as a high priority for improvement. However, evidence for practical interventions to improve recovery time from conventional in-center HD is lacking. The effect of blood flow rate reduction on dialysis recovery time (DRT) is unknown.
    Methods: Multicenter, single-blinded, randomized, parallel-design controlled trial of blood flow rate reduction vs. usual care. One-hundred two patients with ESRD undergoing maintenance HD in 18 centers with baseline DRT of greater than 6 hours were included as subjects. The intervention was a blood flow rate reduction of 100 mL/min, to a minimum of 300 mL/min. The primary outcome was the between-group difference in change in DRT. Secondary outcomes were changes in London Evaluation of Illness (LEVIL) survey responses from baseline.
    Findings: Baseline median DRT was 720 (IQR 360-1013) minutes in controls and 720 (IQR 360-1106) minutes in the intervention group. DRT decreased in both groups. Mean change from baseline (95% confidence interval) at Week 4 in the study was -324 (-473, -175) minutes in the control group and -120 (-329, 90) minutes in the intervention group. The change from baseline was more profound in the control group (P = 0.05). Secondary outcomes of measures of quality of life reported on the LEVIL survey showed more improvement in patients' feelings of general well-being in the control group (P = 0.01). Differences between groups in pain, feeling washed out or drained, sleep quality, shortness of breath, and appetite were not statistically significant.
    Discussion: Blood flow rate reduction did not improve DRT over usual care. Though more work needs to be done to address patient-reported fatigue, a significant positive impact may not be achieved without substantial changes in dialysis prescription.
    MeSH term(s) Blood Flow Velocity/physiology ; Female ; Humans ; Kidney Failure, Chronic/complications ; Male ; Middle Aged ; Prospective Studies ; Renal Dialysis/adverse effects ; Renal Dialysis/methods ; Surveys and Questionnaires
    Language English
    Publishing date 2019-03-04
    Publishing country Canada
    Document type Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 2192458-2
    ISSN 1542-4758 ; 1492-7535
    ISSN (online) 1542-4758
    ISSN 1492-7535
    DOI 10.1111/hdi.12741
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 6091: Show issues Location:
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  4. Article ; Online: Use of a gentamicin-citrate lock leads to lower catheter-related bloodstream infection rates and reduced cost of care in hemodialysis patients.

    Hussein, Wael F / Gomez, Norma / Sun, Sumi J / Yu, Junhua / Yang, Fang / Ajuria, Michael / Abra, Graham E / Schiller, Brigitte

    Hemodialysis international. International Symposium on Home Hemodialysis

    2020  Volume 25, Issue 1, Page(s) 20–28

    Abstract: Introduction: Central venous catheters (CVC) are a major contributor to infections in hemodialysis (HD) patients, leading to high morbidity and mortality. Gentamicin-citrate (GC) lock is used as standard of care at centers belonging to a mid-size ... ...

    Abstract Introduction: Central venous catheters (CVC) are a major contributor to infections in hemodialysis (HD) patients, leading to high morbidity and mortality. Gentamicin-citrate (GC) lock is used as standard of care at centers belonging to a mid-size dialysis organization. Four outpatient HD centers acquired by the organization continued to use heparin for catheter locks for a period of time before converting to the provider's standard of using GC lock.
    Methods: In this retrospective observational study, we included patients receiving HD by CVC at these four centers. We report rates of CVC-related bloodstream infections (CVC-BSI) during the heparin lock and the GC lock periods; crude rate ratios and adjusted rate ratios using Cox survival analyses adjusting for potential confounders; microbiology patterns; safety signals (gentamicin resistance, hospitalizations and deaths); and financial impact on payer.
    Findings: A total of 220 and 281 patients used tunneled CVCs, accounting for 25,245 and 44,550 catheter days in the heparin and the GC lock periods, respectively. CVC-BSI event rates were 66% lower in the GC lock period (CVC-BSI event rate: 0.20 per 1000 catheter-days) than the heparin lock period (rate: 0.59 per 1000 catheter days); rate ratio 0.34 (95% confidence interval (CI) 0.15-0.78, P = 0.01). In the fully adjusted multivariable Cox model, use of GC lock was associated with 70% reduction in CVC-BSI events (HR 0.30, 95% CI 0.12-0.72, P = 0.01). No increased risk of gentamicin resistance, hospitalizations, or death associated with use of GC lock were observed. Use of GC lock was associated with an estimated saving of $1533 (95% CI: $259-$4882) per patient per year.
    Discussion: Use of GC lock led to significant reductions in CVC-BSIs with no signal for harm, and is associated with significant cost savings in dialysis care.
    MeSH term(s) Catheter-Related Infections/prevention & control ; Catheterization, Central Venous ; Central Venous Catheters/adverse effects ; Citrates ; Citric Acid ; Gentamicins/therapeutic use ; Humans ; Renal Dialysis ; Sepsis
    Chemical Substances Citrates ; Gentamicins ; Citric Acid (2968PHW8QP)
    Language English
    Publishing date 2020-10-01
    Publishing country Canada
    Document type Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 2192458-2
    ISSN 1542-4758 ; 1492-7535
    ISSN (online) 1542-4758
    ISSN 1492-7535
    DOI 10.1111/hdi.12880
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 6091: Show issues Location:
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  5. Article ; Online: Self-care training using the Tablo hemodialysis system.

    Plumb, Troy J / Alvarez, Luis / Ross, Dennis L / Lee, Joseph J / Mulhern, Jeffrey G / Bell, Jeffrey L / Abra, Graham E / Prichard, Sarah S / Chertow, Glenn M / Aragon, Michael A

    Hemodialysis international. International Symposium on Home Hemodialysis

    2020  Volume 25, Issue 1, Page(s) 12–19

    Abstract: Introduction: Recently published results of the investigational device exemption (IDE) trial using the Tablo hemodialysis system confirmed its safety and efficacy for home dialysis. This manuscript reports additional data from the Tablo IDE study on the ...

    Abstract Introduction: Recently published results of the investigational device exemption (IDE) trial using the Tablo hemodialysis system confirmed its safety and efficacy for home dialysis. This manuscript reports additional data from the Tablo IDE study on the training time required to be competent in self-care, the degree of dependence on health care workers and caregivers after training was complete, and participants' assessment of the ease-of-use of Tablo.
    Methods: We collected data on the time required to set up concentrates and the Tablo cartridge prior to treatment initiation. We asked participants to rate system setup, treatment, and takedown on a Likert scale from 1 (very difficult) to 5 (very simple) and if they had required any assistance with any aspect of treatment over the prior 7 days. In a subgroup of 15 participants, we recorded the number of training sessions required to be deemed competent to do self-care dialysis.
    Findings: Eighteen men and 10 women with a mean age of 52.6 years completed the study. Thirteen had previous self-care experience using a different dialysis system. Mean set up times for the concentrates and cartridge were 1.1 and 10.0 minutes, respectively. Participants with or without previous self-care experience had similar set-up times. The mean ease-of-use score was 4.5 or higher on a scale from 1 to 5 during the in-home phase. Sixty-five percent required no assistance at home and on average required fewer than four training sessions to be competent in managing their treatments. Results were similar for participants with or without previous self-care experience.
    Conclusions: Participants in the Tablo IDE trial were able to quickly learn and manage hemodialysis treatments in the home, found Tablo easy to use, and were generally independent in performing hemodialysis.
    MeSH term(s) Adult ; Aged ; Caregivers ; Cognition ; Female ; Hemodialysis, Home ; Humans ; Male ; Middle Aged ; Renal Dialysis ; Self Care
    Language English
    Publishing date 2020-10-12
    Publishing country Canada
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2192458-2
    ISSN 1542-4758 ; 1492-7535
    ISSN (online) 1542-4758
    ISSN 1492-7535
    DOI 10.1111/hdi.12890
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  6. Article ; Online: Reversible hepatic and lipid abnormalities with nonprescription anabolic-androgenic steroid use in 2 HIV-infected men.

    Abra, Graham E / Lonergan, Joseph T

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2006  Volume 42, Issue 1, Page(s) 151–152

    MeSH term(s) Adult ; Anabolic Agents/adverse effects ; Androgens/adverse effects ; HIV Infections/complications ; HIV Infections/metabolism ; Humans ; Lipid Metabolism ; Lipoproteins, LDL/blood ; Liver/metabolism ; Male ; Steroids/adverse effects ; Transaminases/blood
    Chemical Substances Anabolic Agents ; Androgens ; Lipoproteins, LDL ; Steroids ; Transaminases (EC 2.6.1.-)
    Language English
    Publishing date 2006-01-01
    Publishing country United States
    Document type Case Reports ; Letter
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1086/498748
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