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Q1. For patients with a diagnosis of ESRD what are the comparative effectiveness risks and benefits of in center dialysis versus home dialysis home hemodialysis and peritoneal dialysis Q2. What are the barriers to delivery of home dialysis…

Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

Q1. For patients with a diagnosis of ESRD what are the comparative effectiveness risks and benefits of in center dialysis versus home dialysis home hemodialysis and peritoneal dialysis Q2. What are the barriers to delivery of home dialysis and what are predictors and consequences of home dialysis failure Relevant patients groups include those with a diagnosis of ESRD and concomitant comorbidities including diabetes obesity hypertension CVD and other chronic diseases.Relevant patient subgroups include1 Racial and ethnic minority populations 2 Elderly and malnourished3 Patients of differing socioeconomic and education levels.4 Patients with differing insurance payors public vs. private5 Patients who are employed at onset of ESRDHealth related outcomes of interest includeAllcause mortality with subanalysis to the cause of death Sepsis from Health care Associated Infections HAI and non HAI infections cardiovascular disease and transition to comfort care.Kidney transplantation.All cause hospital admissions and readmissions with subanalysis relating to common causes of hospitalization in patients receiving dialysis such as sepsis from local and systemic HAI and nonHAI infections cardiovascular events abnormalities in electrolytes and mineral metabolism Hypercalcemiaparathyroidectomy fluid overload anemia and dialysis access complications. Patientcentered outcomes such as quality of life patient preferences and challenges and employment.Preservation of residual renal function.Failure of home dialysis and health consequences of treatment failures.Utilization of healthcare resources such as intravenous iron erythropoietin stimulating agents other injectable medications.

Describe why this topic is important.

Mortality infections hospitalization and rehospitalization rates are high among patients receiving dialysis. It is in the best interest of these patients to identify ways to improve quality of care and access to effective treatments.Preliminary research suggests that 90 day mortality after initiation of peritoneal dialysis one type of home dialysis therapy in ESRD patients is lower than in those undergoing incenter hemodialysis although research has not conclusively found one dialysis modality to be superior in terms of survival when considering the entire duration of dialysis therapy. Compared to incenter hemodialysis home dialysis modalities can provide some patients with improved quality of life and more flexibility in their schedules. However home dialysis failure may be lead to reduced survival. It is unclear which patient populations are at highest risk for home dialysis failure. Certain racial minorities as well as patients with lower SES are less likely to use home dialysis. The underlying cause of these disparities is not known. Greater use of home dialysis therapies in these populations may provide some patients with improved quality of life.Understanding geographical variation to adoption of home dialysis modalities could improve access to dialysis care for the ESRD patients living in rural areas.

How will an answer to your research question be used or help inform decisions for you or your group?

Dialysis modality and location has a large effect on patient lifestyle and understanding which modality is best for certain characteristics of patients could improve patient quality of life.Dialysis modality and location also has an effect on the health care resources which helps to guide future policy. The research could provide evidencebased justification for CMS to implement quality improvement initiatives and adopt quality improvement measures for QI programs. Systematic review could identify knowledge gaps that could inform research priorities for the ESRD population.

Other Information About You: (optional)
Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)
I serve as a medical officer at the Center for Medicare and Medicaid Services Quality Improvement Group in the Division of ESRD and Population Health
If you are you making a suggestion on behalf of an organization, please state the name of the organization
Centers for Medicare and Medicaid Services
Please tell us how you heard about the Effective Health Care Program
Collaborative networking between Dr. Christine Chang Medical Officer AHRQ and Dr. Indira Jevaji Medical Officer CMS at a conference of mutual interest.
Page last reviewed November 2017
Page originally created May 2015

Internet Citation: Q1. For patients with a diagnosis of ESRD what are the comparative effectiveness risks and benefits of in center dialysis versus home dialysis home hemodialysis and peritoneal dialysis Q2. What are the barriers to delivery of home dialysis…. Content last reviewed November 2017. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.
https://effectivehealthcare.ahrq.gov/get-involved/nominated-topics/q1-for-patients-with-a-diagnosis-of-esrd-what-are-the-comparative-effectiveness-risks-and-benefits-of-in-center-dialysis-versus-home-dialysis-home-hemodialysis-and-peritoneal-dialysis-q2-what-are-the-barriers-to-delivery-of-

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