A Single-Centre Experience with Assisted Home Hemodialysis in Long-Term Care Facilities
Bibliographic record
Abstract
Background: To address challenges imposed by the COVID-19 pandemic, our renal program expanded assisted home hemodialysis (HD) services to provide on-site HD to patients residing in long-term care (LTC) facilities. The purpose of this study was to describe the patient and treatment characteristics and outcomes in a cohort of patients undergoing home HD in LTC facilities. Methods: We conducted a retrospective review of all consecutive patients across 15 LTC facilities within our catchment area in Toronto who converted from in-centre HD to LTC-HD between March 2020 and March 31, 2023. We included all adult patients who received assisted conventional (3 HD/week, 3-4 hr) and short-daily (5-7 HD/week, 2-3 hr) HD provided by a registered nurse, registered practical nurse, or personal support worker during the study period. We extracted all data from our hospital electronic record system, including baseline demographics, comorbidities, dialysis prescriptions, deaths, hospitalizations, COVID-19 related and unrelated infections. Results: The mean age among 44 eligible patients was 75.6 years with 30 (70%) male patients and 13 (30%) female patients. Thirty-one (67%) patients had type two diabetes. There were 20 patients (45%) on conventional HD and 24 patients (54%) on daily HD at the time of enrolment. Eighty-five percent had limited mobility or were bedbound and 33% had dementia.During follow-up, there were 23 deaths with a one-year mortality rate of 45%. There were 69 hospitalization events, including 13 intensive care unit (ICU) admissions, with an average length of stay of 11 days. The number of access related complications was 18. There were 10COVID-19 infections. Conclusion: Assisted hemodialysis in LTC facilities is a patient-centered means by which to provide dialysis to a frail and vulnerable patient population. As expected, clinical outcomes were relatively poor. Additional analyses with control data as well as costing and ethical evaluations are ongoing and will be reported separately.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".