Table 2 Patient population, intervention type and major findings of studies

• 18 HC assisted PD^α

• 61

• HC^β (Nurse) assisted PD: Publicly funded program where nurses visit homes for PD exchanges and clinical and social support

Peritonitis Rate:

• One episode of peritonitis per 33.8 patients-months (excluding 1 low white blood and 1 AIDS patient); if included, one episode of peritonitis per 20.1 patients-months

• CAPD^γ required 1–4 visits / day based on severity of disability

Hospitalization Rate:

• One hospital admission per 15.3 patient-months (excluding 5 palliative care patients)

• CCPD^δ required 2 visits / day

Costs:

• Reporting on 3 years of experience

• Annual costs were $27,263 for home CAPD, $29,763 for home CCPD and $29,915 for HD^ϵ

• 1232 HC assisted PD

• 83 (HC assisted PD)

• HC (Nurse) assisted PD: Publicly funded home visits by private sector nurses for assisted PD

Peritonitis Rate:

• Compared to self care PD, HC (nurse) assisted PD had similar risks of peritonitis rates (Bivariate results)

• 87 Family assisted PD

• 81 (Family assisted PD)

• Study end point allowed for at least 2 years of follow-up for patients who are on PD continuously (Frequency of visits not reported)

Patient Survival:

• Compared to self care PD, HC (nurse) assisted PD was associated with a higher risk of mortality (RH^ζ = 2.35)

• 294 Self care PD

• 80 (Self care PD)

Technique Survival:

* Elderly

• Compared to self care PD, HC (nurse) assisted PD had similar risks of technique failure (=transfer to HD)

• 30 HC assisted PD

• 72 (Median)

• HC (Nurse Assistant) assisted PD: Home visits by nurse assistants for assisted PD

Peritonitis Rate:

• One episode of peritonitis per 37 patient-months

• Study end point allowed for at least 16 months of follow-up for patients who are on PD continuously (Frequency of visits not reported)

Patient Survival:

• Patient survival was 60% at 12 months, 23% at 24 month, 3% at 48 months

• Each nurse assistant was responsible for 4 patients

• 32 HC assisted PD

• 76 (HC assisted PD)

• HC (Home Assistant) assisted PD: Home assistants (a background in healthcare was not required) paid by the family assisted with PD.

Peritonitis Rate:

• Peritonitis rates of 1 episode per 24 (HC-home assistant-assisted PD), 37 (family assisted PD) and 39 (self PD) patient months were not significantly different

• 44 Family assisted PD

• 74 (Family assisted PD)

• HC assisted PD patients followed for 93 to 1832 days (Frequency of visits not reported)

• Probability of a 12 month peritonitis-free periods of 62.5% (HC-home assistant-assisted PD), 75.0% (family assisted PD) and 80.8% (self PD) were not significantly different

• 26 Self care PD

• 69 (Self care PD)

Patient Survival:

* Elderly

• Peritonitis-related deaths of 13.8% (HC-home assistant-assisted PD), 8.0% (family assisted PD) and 8.0% (self PD) were not significantly different

Technique Survival:

• Following peritonitis, technique failures of 34.5% (HC-home assistant-assisted PD), 16.0% (family assisted PD) and 16.0% (self PD) were not significantly different

• 36 HC assisted PD

• 74 (HC assisted PD)

• HC (Nurse) assisted PD: Publicly funded home visits by private sector nurses for assisted PD

PD Eligibility/Utilization/Uptake:

• HC (nurse) assisted PD enables increased use of PD in incident dialysis patients

• 61 Self care PD

• 52 (Self care PD)

• HC assisted PD patients followed for 0.5 to 51 months (Frequency of visits not reported)

Peritonitis Rate:

• HC (nurse) assisted PD patients: Actuarial survival free of peritonitis was 72% at 6 months, 50% at 12 months

• 36 Satellite HD

• 47 (Satellite HD)

Hospitalization Rate:

• 106 In-center HD

• 67 (In-center HD)

• HC (nurse) assisted PD patients:

  • Actuarial survival free of hospitalization 46% at 6 months, 21% at 12 months

  • Hospitalization rate was 0.4 admissions/patient/month

Technique Survival:

• HC (nurse) assisted PD patients: Technique survival 85% at 6 months, 58% at 12 months

Charlson Comorbidity Index:

• Charlson Comorbidity Index higher for HC (nurse) assisted PD (7.0) when compared to self care PD (4.3) and similar when compared to in-center HD (7.7)

• 4230 HC assisted PD

• 79 (Median, HC assisted PD)

• HC (Nurse) assisted PD: Publicly funded home visits by private sector nurses for assisted PD

Patient Survival:

• Compared to self care PD, HC (nurse) assisted PD was associated with a higher risk of mortality (cs-RH^η = 4.52)

• 1056 Family PD

• 74 (Median, Family assisted PD)

• Study end point allowed for at least 5 months of follow-up for patients who are on PD continuously (Frequency of visits not reported)

• Compared to self care PD + family assisted PD, HC (nurse) assisted PD was associated with a higher risk of mortality (cs-RH = 2.18)

• 4515 Self care PD

• 56 (Median, Self care PD)

• Interquartile range of PD duration 7.78 to 29.70 months

Technique Survival:

• Compared to self care PD, HC (nurse) assisted PD was associated with a lower risk of technique failure (=transfer to HD, cs-RH = 0.84, sd-RH^θ = 0.72)

• Compared to self care PD + family assisted PD, HC (nurse) assisted PD was associated with a lower risk of technique failure (=transfer to HD, cs-RH = 0.85, sd-RH = 0.72)

Renal Transplantation:

• Compared to self care PD, HC (nurse) assisted PD was associated with a lower risk of renal transplantation (cs-RH = 0.04)

• Compared to self care PD + family assisted PD, HC (nurse) assisted PD was associated with a lower risk of renal transplantation (cs-RH = 0.16)

Renal Recovery:

• Compared to self care PD, HC (nurse) assisted PD was associated with a similar risk of renal recovery (Bivariate results)

• Compared to self care PD + family assisted PD, HC (nurse) assisted PD was associated with a similar risk of renal recovery

• 3689 HC assisted PD

• 71 (Median, Planned PD Start)

• HC (Nurse) assisted PD: Publicly funded home visits by private sector nurses for assisted PD

Peritonitis Rate:

• Compared to self care PD, HC (nurse) assisted PD was associated with a lower risk of peritonitis (sd-RH = 0.81)

• 902 Family PD

• 69 (Median, Sub-optimal PD Start)

• Study end point allowed for at least 5 months of follow-up for patients who are on PD continuously (Frequency of visits not reported)

Patient Survival:

• Compared to self care PD, HC (nurse) assisted PD was associated with a higher risk of mortality (sd-RH = 6.30)

• 3891 Self care PD

• Interquartile range of PD duration 8.08 to 29.99 months

Technique Survival:

• Compared to self care PD, HC (nurse) assisted PD was associated with a lower risk of technique failure (=transfer to HD, sd-RH = 0.67)

*Additional exclusions compared o Lobbedez et al., 2012 to focus on sub-optimal PD starts

Renal Transplantation:

• Compared to self care PD, HC (nurse) assisted PD was associated with a lower risk of renal transplantation (sd-RH = 0.03) (Bivariate results)

• 22 HC assisted PD

• 76 (Median, HC assisted PD)

• HC (Nurse) assisted PD: Publicly funded program where nurses visit homes for PD exchanges and clinical and social support

PD Eligibility/Utilization/Uptake:

• More elderly patients were considered eligible for PD (OR^ι = 2.6) if they lived in a HC support region than if they did not

• 4 Self care PD

• 76 (Median, Other Modalities)

• First year of dialysis, HC assisted PD patients received, on average, 5.8 visits / week

Hospitalization Rate & Days:

• Hospitalization rate was not significantly different between HC (nurse) assisted PD (1.4 per patient-year) and other modalities (1.0 per patient-year)

• 16 In-center HD

*Elderly

• HC assisted PD patients offered 2 visits / day 7 days a week

• Hospital days were not significantly different between HC (nurse) assisted PD (23.5 per patient-year) and other modalities (13.1 per patient-year)

• Mean follow-up for HC assisted PD patients were 413 days

Patient Survival:

• Mortality was not significantly different between HC (nurse) assisted PD (0.12 per patient-year) and other modalities (0.18 per patient-year)

Technique Survival:

• Modality changes were not significantly different between HC (nurse) assisted PD (0.04 per patient-year) and other modalities (0.19 per patient-year)

• 56 HC assisted PD

• 66 (Overall)

• HC (Nurse or Healthcare Aid) assisted PD: Publicly funded program where nurses or healthcare aids visit homes for assisted PD

PD Eligibility/Utilization/Uptake:

• Even when HC (nurse or healthcare aid) assisted PD is available, family support remains to be an important driver of PD utilization.

• 8 Family and HC assisted PD

• Maximum 2 nurse or healthcare aid visits/day

• Among patients with barriers to PD who live in areas with HC assisted PD availability, PD utilization was higher (39%) among those who had family support compared to those without family support (23%)

• 26 Family assisted PD

• Mean (median) follow-up for PD patients were 521 (376) days

• 1 Friend assisted PD

• 56 Self care PD

• 36 HC assisted PD

• 55

• HC (Team) assisted PD: Home visits by home care team (nurse, dietician & social worker) for assisted PD and patient assessments

Critical Elements of Home Visits:

• Dialysis programs should retain the option of making home visits to home dialysis patients

• Reporting on evaluation over a 18-month period

• To evaluate internal policy and identify critical elements of a home visit

• Study recommendations: One routine visit for new patients and additional non-routine visits only if there are significant problems

• A visit took approximately 4 hours

• 5284 HC assisted PD

• 66 (Overall)

• HC (Nurse) assisted PD: Publicly funded home visits by private sector nurses for assisted PD

PD Eligibility/Utilization/Uptake:

• Provides a description of the PD population

• 822 Family assisted PD

• Nurse time at patient’s home for: a) non-disconnect CAPD ultraviolet system between 10–15 minutes, and b) double-bag disconnect CAPD system between 30–45 minutes (Frequency of visits not reported)

• Over the decade studied, 45% of all incident PD patients received HC (nurse) assisted PD and 87% of incident PD patients over 90 years of age received HC (nurse) assisted PD

• 8285 Self care PD

Charlson Comorbidity Index:

• Among prevalent PD patients, Charlson comorbidity index, on average, was 7.6 for HC (nurse) assisted PD, 6.6 for family assisted PD and 4.8 for self care PD

• 352 Other / Undefined PD

• 232 HC assisted PD

• 73 (HC assisted PD)

• HC (Nurse) assisted PD: Publicly funded home visits by private sector nurses for assisted PD

Peritonitis Rate:

• The probability of being peritonitis free at 24 months better for family assisted PD (76.7%) compared to HC (nurse) assisted PD (41.2%) when nurse visits from dialysis centers are not considered

• 127 Family assisted PD

• 65 (Family assisted PD)

• Study end point allowed for at least 13 months of follow-up for patients who are on PD continuously

• The probability of being peritonitis free at 24 months similar between family assisted PD (57.7%) and HC (nurse) assisted PD (60.7%) when nurse visits from dialysis centers are considered

• 1265 Self care PD

• 51 (Self care PD)

• 1–2 nurse visits / day

• For HC (nurse) assisted PD, the probability of being peritonitis free better for those affiliated with dialysis centers with nurse visits

*Automated PD patients only

• For family assisted PD, the probability of being peritonitis free similar across centers with and without nurse visits

• 21 HC assisted PD

• 62

• HC (Nurse) assisted PD: Home visits by nurses for assisted PD and clinical support

Peritonitis Rate:

• One episode of peritonitis per 13 patient-months

• Mean number of nursing hours per day was 13 (Frequency of visits not reported)

Hospitalization Rate & Days:

• One hospital admission per 6 patient-months

• Mean hospitalization days of 9 per admission

• 36 HC assisted PD

• 71 (HC assisted PD)

• HC (Home Assistant) assisted PD: Home assistants (a healthcare background was not required) paid by the family assisted with PD

Peritonitis Rate:

• First episode of peritonitis was not significantly different between HC (home assistant) assisted PD and family assisted PD

• 86 Family assisted PD

• 66 (Family assisted PD)

• PD patients followed for 1 to 88 months (Frequency of visits not reported)

Patient Survival:

• Compared to family assisted PD, HC (home assistant) assisted PD was associated with higher risk of mortality (HR = 2.14)

• 191 Self care PD

• 55 (Self care PD)

Technique Survival:

• Technique survival was not significantly different between HC (home assistant) assisted PD (69.8 months) and family assisted PD (74.8 months)

• 28 HC assisted HD

• 69

• HC (Nurse) Assisted HD: Home visit by registered nurse for dialysis and clinical support

Hospital Days:

• Mean hospitalization days of 9.43+/−1.83

• Nephrologists also made home visits

Costs:

• HD patients followed for 2 to 71 weeks

• Weekly ongoing costs of HC(nurse) assisted HD were $1200, in-center HD with ambulance transportation were $2640 and in-hospital dialysis were $5241

• Frequency of visits determined by the nephrologist upon patient’s discharge from the hospital

• 19 HC assisted HD

• 56 (HC assisted HD)

• HC (Nurse) Assisted HD: Visits every week before HD schedule for clinical support and retraining

19 Clinical Outcomes:

• 15 out of the 19 items studied improved for home care group (weight gain, nausea, vomiting, headache, bone pain, weakness and fatigue, and itching decreased and general condition and levels of BUN, creatinine, potassium and phosphorus of the blood improved significantly. Changes in the mean values of blood pressure, pulse, temperature, sodium and calcium and hematocrit were not significant)

• 18 HD without HC

• 58 (HD without HC)

• Mean follow-up for HC assisted HD patients were 27.1 months

• 4 visits / month

• 57 HC assisted PD or HD

• Not described

• HC (Team): Home care team (3 nurses & 1 renal care assistant) visits during pre-dialysis and dialysis phase of care for PD and HD patients

Satisfaction with Home Care:

• Overall satisfaction with home care program: a) pre-dialysis phase of care − 76% very satisfied, 20% partly satisfied and b) dialysis phase of care − 80% very satisfied, 20% partly satisfied

• Visits until transplantation, switch to hospital-based dialysis or death (Frequency of visits not reported)