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The changing landscape of home dialysis in the United States.

ABSTRACT: To discuss the changing landscape of home dialysis in the United States over the past decade, including recent research on clinical outcomes in patient undergoing peritoneal dialysis and home hemodialysis, and to describe the impact of recent payment reforms for patients with end-stage renal disease.Accumulating evidence supports the conclusion that clinical outcomes for patients treated with peritoneal dialysis or home hemodialysis are as good as or better than for patients treated with conventional in-center hemodialysis. The recent implementation of the Medicare-expanded prospective payment system for the care of end-stage renal disease patients has resulted in substantial growth in the utilization of peritoneal dialysis in the United States. Utilization of home hemodialysis has also grown, but the contribution of the expanded prospective payment system to this growth is less certain.Home dialysis, including peritoneal dialysis and home hemodialysis, represents an important alternative to in-center hemodialysis that is effective and patient-centered. Over the coming decade, the growth in the number of end-stage renal disease patient treated with home dialysis modalities should prompt further comparative and cost-effectiveness research, increased attention to racial and ethnic disparities, and investments in home dialysis education for both patients and providers.http://links.lww.com/CONH/A13.

SUBMITTER: Rivara MB

PROVIDER: S-EPMC4414038 | biostudies-literature | 2014 Nov

REPOSITORIES: biostudies-literature

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The changing landscape of home dialysis in the United States.

Rivara Matthew B MB Mehrotra Rajnish R

Current opinion in nephrology and hypertension 20141101 6

<h4>Purpose of review</h4>To discuss the changing landscape of home dialysis in the United States over the past decade, including recent research on clinical outcomes in patient undergoing peritoneal dialysis and home hemodialysis, and to describe the impact of recent payment reforms for patients with end-stage renal disease.<h4>Recent findings</h4>Accumulating evidence supports the conclusion that clinical outcomes for patients treated with peritoneal dialysis or home hemodialysis are as good a ...[more]

PMID: 25197946

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Project description:BackgroundAsians and Hispanics currently have the highest incidence rates of hepatocellular carcinoma (HCC) in the United States. The numbers of these minority populations are rapidly increasing, reshaping the demographic in the United States and particularly California, where approximately one-third of US Asians and Hispanics reside. With the changing demographic and rising incidence of HCC that has tripled during the past three decades, it is important to forecast the future burden of HCC by age, sex, and race/ethnicity to plan prevention and control strategies for HCC.MethodsWe used four Surveillance, Epidemiology, and End Results Program registries to obtain incidence data for California during 2000 to 2013, and 14 registries to represent non-California states. We applied age-period-cohort models to estimate future HCC incidence rates, and estimated HCC burden by multiplying incidence forecasts by corresponding US Census population projections.ResultsOur forecasts for California suggest that in 2030 Hispanics and blacks will have the highest HCC incidence rates and Asians the lowest. While incidence among whites, blacks, and Hispanics in California increased successively for each birth year cohort from 1915 through 1955, incidence among Asians in California decreased for each successive birth year cohort from 1915 through 1975. In contrast, consistent declines were not seen among Asians in the rest of the United States. In California, the estimated burden of HCC is 6482 new cases in 2030, where 80.0% of these patients are older than 65 years (vs 44.5% in 2014). The relative increase of burden in 2030 vs 2014 for this 65 years and older age group is especially high among Hispanics (318.3%), whereas it is the lowest among Asians (53.2%) in California.ConclusionsPrevention efforts in California should target persons currently ages 50 to 64 years who will make up the older age group (>65 years) in 2030, especially among Hispanics with the most rapid increase of HCC burden through 2030.

Dataset Information

The changing landscape of home dialysis in the United States.

Publications

The changing landscape of home dialysis in the United States.

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