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CADTH Expert Panel Recommends Home-Based Dialysis In Patients With End-Stage Kidney Disease

Published on: November 8, 2017
Result type: News

Ottawa, ON (November 8, 2017) — For Canadians living with end-stage kidney disease, undergoing dialysis at home should be considered as an alternative to regular visits to a dialysis centre, according to new evidence and expert recommendations from CADTH.

“The evidence tells us that in-centre and home-based dialysis offer similar benefits in terms of clinical outcomes,” said Dr. Brian O’Rourke, President and CEO of CADTH. “And in terms of offering patients and caregivers more choice around treatment options, and realizing some cost savings in the health system, this work tells us that we should be considering how home-based dialysis could be more effectively implemented.”

The CADTH recommendations are part of a comprehensive review the organization undertook to examine the appropriate use of dialysis modalities to treat end-stage kidney disease and shed light on the factors that influence the implementation of dialysis programs in Canada. On November 9, CADTH is hosting a national event to share its recommendations and discuss moving the evidence into action.

Key highlights from the CADTH report include:

  • Clinical Findings — Overall, home-based dialysis is just as beneficial as treatment in a clinical setting, such as a hospital or community-based dialysis unit. The report found no consistent differences in health-related quality of life outcomes or survival between home-based dialysis and   in-centre dialysis.
  • Economic Findings — The economic evidence shows that home-based therapies, including peritoneal dialysis (non-assisted) and all home hemodialysis modalities, are less costly than            in-centre hemodialysis for eligible patients. From a health system perspective, conventional home hemodialysis is the least costly form of treatment.
  • Patient Perspectives — People living with kidney disease want to be informed about all the available treatment options; however, patient preference for any specific treatment may vary according to individual circumstances.
  • Implementation Issues — Across various levels of decision-making — patient, caregiver, medical professional, policy-maker, and administrator — knowledge gaps exist. Educational opportunities, along with sharing successful local strategies, may support the implementation of more home-based programs where none currently exist.

“We know that patients and caregivers place a high value on treatment options that are least disruptive to their daily lives,” said Dr. Manish Sood, a nephrologist and associate scientist at The Ottawa Hospital and assistant professor at the University of Ottawa, who co-authored the CADTH clinical review and will speak at the upcoming event. “For many patients, home dialysis is a safe and preferred alternative to frequent hospital visits and I’m hopeful that, with these evidence-informed recommendations from CADTH, we can kick-start a national conversation about the role of home-based treatment in Canada.”

Kirk Kelly has been living with kidney disease for more than 20 years and was an early adopter of home dialysis. He has been a long-time renal patient advocate and will speak at the CADTH event to bring the patient perspective front and centre.

“Dialysis can be a life-saving treatment, but it’s also life-changing,” said Mr. Kelly. “I’m pleased to see CADTH recognized this reality and considered the diverse needs and perspectives of patients in the development of these recommendations.”

The CADTH event, entitled “Home-Based Dialysis in Canada: From Evidence to Practice,” will take place in Ottawa and be livestreamed across Canada. The event is free, but you must register to attend. The full roster of speakers includes:

  • Dr. Harindra Wijeysundera
    Vice-President, Medical Devices and Clinical Interventions, CADTH
  • Mr. Kirk Kelly
    Renal Patient Advocate
  • Dr. Manish Sood 
    Nephrologist and Associate Scientist, The Ottawa Hospital; Assistant Professor, University of Ottawa
  • Dr. Alison Sinclair 
    Clinical Research Officer, CADTH
  • Ms. Eftyhia Helis
    Knowledge Mobilization Officer, CADTH

How Dialysis Works:

Normally, the kidneys filter blood to remove harmful waste and excess fluid, and turn these into urine, which is passed out of the body. When the kidneys aren’t working, they may not be able to filter the blood properly and waste and fluid can build up to dangerous levels.

Hemodialysis (HD) is a medical procedure wherein blood is circulated to an external dialysis machine that filters waste and extra water from the blood before returning it to the body. It can be done in-centre or at home, either with the help of a health care professional or without professional assistance. Usually, treatment sessions last three or four hours and must be repeated several times a week.

Peritoneal Dialysis (PD) uses the lining of the abdomen and a solution called dialysate to filter and clean the blood. Dialysate absorbs waste and fluid from the blood, while the peritoneum (abdominal lining) acts as a filter. PD can be done at home while asleep or awake, and with or without the assistance of a health care professional. A permanent catheter in the abdomen is required.

End-Stage Kidney Disease Canada:

In 2015, there were 36,251 Canadians (excluding Quebec) living with end-stage kidney disease (ESKD), 58.5% of whom were receiving some form of dialysis. The remaining 41.5% had a functioning kidney transplant.

  • Of the 21,214 patients on dialysis, more than three-quarters were receiving institutional hemodialysis, the most expensive treatment option.
  • In 2015, a total of 5,438 ESKD patients started renal replacement therapy (dialysis or transplant).
  • More than half (53%) of the ESKD patients who started renal replacement therapy were aged 65 and older.
  • According to the latest available data, 44.8% of patients on dialysis treatments survived at least five years.

Source: Annual Statistics on Organ Replacement in Canada. Dialysis, Transplantation and Donation, 2006 to 2015. Canadian Institute for Health Information

CADTH: What Does the Evidence Say?

When Canada’s health care decision-makers need to know what the evidence says, they ask CADTH. CADTH is an independent, not-for-profit organization responsible for providing Canada’s health care decision-makers with objective evidence to help make informed decisions about the optimal use of drugs and medical devices in our health care system. CADTH receives funding from Canada’s federal, provincial, and territorial governments, with the exception of Quebec (www.cadth.ca).

The Ottawa Hospital: Inspired by Research. Driven by Compassion

The Ottawa Hospital is one of Canada’s largest learning and research hospitals, with more than 1,100 beds, approximately 12,000 staff, and an annual budget of more than $1.2 billion. Our focus on research and learning helps us develop new and innovative ways to treat patients and improve care. As a multi-campus hospital, affiliated with the University of Ottawa, we deliver specialized care to the Eastern Ontario region, but our techniques and research discoveries are adopted around the world. We engage the community at all levels to support our vision for better patient care. See www.ohri.ca for more information about research at The Ottawa Hospital.

Media Contacts

Andrea Tiwari
Communications Officer
CADTH
Office: 613 226 2553 ext. 1247
Cell: 613-614-6863
andreat@cadth.ca

Jennifer Ganton
Director, Communications and Public Relations
Ottawa Hospital Research Institute
Office: 613-798-5555 ext. 73325
Cell: 613-614-5253
jganton@ohri.ca