There’s No Place Like Home—for Dialysis

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WASHINGTON—Most patients with chronic kidney disease (CKD) who undergo hemodialysis put up with a grueling treatment regimen that involves going into a clinic several days a week and sitting through a three-to-four hour dialysis session at each visit. Home hemodialysis (HHD) is more accessible than ever, though, with the advent of newer systems that are easier for patients to learn, use, and maintain, according to a review appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The authors offer suggestions for how to overcome barriers and establish a successful HHD program.

“There is virtually no other disease that requires patients to make such considerable changes in their lifestyle as a diagnosis of end-stage renal disease and the need for dialysis therapy does,” said Rajnish Mehrotra, MD, from the University of Washington, Seattle. “To ease the challenge associated with such a diagnosis, offering patients choice allows them to select a dialysis therapy that best fits into their lifestyle and their expectations.”

HHD is one type of dialysis therapy, but it is available to less than 2 percent of dialysis patients in the country. It requires extensive patient training, nursing education, and infrastructure support to maintain a successful program. Also, reluctance to start such programs is widespread because many physicians do not have experience with HHD.

Bessie Young, MD, from the University of Washington, Seattle worked with Mehrotra and others to provide an in-depth review to describe the benefits and barriers to HHD, focusing on patients, physicians, practices, and dialysis facilities.

Benefits of HHD include:

• Potential for greater dialysis delivery (more frequent or overnight treatments)
• Improved quality of life
• Patient independence and employment potential
• Greater ability to travel
• 20-50 percent less costly than in-center hemodialysis depending on the machine.

Barriers to HHD include:

  • Lack of patient awareness and education about HHD
  • Patients’ perceptions, including fear of change and lack of self-confidence
  • Physicians’ education about HHD
  • Machine complexity, which is now minimal with newer, easier-to-use systems
  • Inadequate payment to providers for HHD training.

“Home hemodialysis has been successfully used by thousands of patients and should be available to everyone on or initiating dialysis. It is a safe, efficient modality that allows patients the ability to increase their frequency of dialysis, which may provide a potential survival benefit,” said  Young.



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