Home haemodialysis

Abstract

Haemodialysis (HD) began as an intensive care treatment offered to a very select number of patients in an attempt to keep them alive. Outcomes were extremely poor, and the procedure was cumbersome and labor intensive. With increasing expertise and advances in dialysis equipment, HD is now recognised as a life-sustaining treatment that is considered a standard of care for children with end stage renal disease (ESRD). Assessment of efficacy has evolved from mere survival, through achieving minimal standards of "adequate" dialysis with reduced morbidity, towards the provision of "optimal dialysis", which includes attempts to more closely mimic normal renal function, and of individualised care that maximizes the patient's health, psychosocial well-being and life potential. There is a renewed interest in dialysis, and the research profile has extended, exploring themes around convective versus diffusive treatments, HD time versus frequency and home versus in-centre dialysis. The results thus far have led dialysis care full circle from prolonged, home-based therapies to shorter, intense in-centre dialysis back to the belief that long or frequent HD at home achieves the best outcomes.

Psychosocial support for children and families requiring renal replacement therapy

“…Home visits to review children on CPD has a proven advantage in detecting and anticipating poor practice that might lead to complications such as peritonitis [39]. Increasing interest in home haemodialysis certainly necessitates robust home support mechanisms [40].…”

Hemodialysis in Children

“…One study in children demonstrated an improvement in the risk for hospitalization up to a Kt/V of Pediatric Nephrology DOI 10.1007/978-3-642-27843-3_63-1 # Springer-Verlag Berlin Heidelberg 2015 that level, but above 1.4, no further improvement occurred [48]. However, the improvement in all aspects of patient well-being with daily or frequent short hemodialysis suggests that a higher Kt/V must be better [12,[16][17][18][19][20][21][22][23].…”

“…However, attainment of optimum weight with conventional three times a week dialysis can be difficult in the child who has high interdialytic weight gains requiring large UF volumes. Much better results have been obtained with daily dialysis, with most children no longer needing antihypertensives at all [12].…”

“…Intensified dialysis is particularly indicated in those with chronic fluid overload or hyperphosphatemia, because of poor growth, or for infants, whose predominantly liquid diet requires removal of relatively large fluid volumes, although it is likely to benefit all children. Reports demonstrate better phosphate and BP control, with many patients being able to come off all their medications, improved appetite and growth, and, despite increased time spent dialyzing, improved quality of life [12,[17][18][19][20][21][22][23].…”

“…Dialysate is either available as preprepared 5-L bags or prepared by the System from tap water. This offers families the freedom of a portable machine that does not rely on plumbing of the home water supply [12].…”