How to Overcome Barriers and Establish a Successful Home HD Program

Abstract

Summary Home hemodialysis (HD) is an underused dialysis modality in the United States, even though it provides an efficient and probably cost-effective way to provide more frequent or longer dialysis. With the advent of newer home HD systems that are easier for patients to learn, use, and maintain, patient and provider interest in home HD is increasing. Although barriers for providers are similar to those for peritoneal dialysis, home HD requires more extensive patient training, nursing education, and infrastructure support in order to maintain a successful program. In addition, because many physicians and patients do not have experience with home HD, reluctance to start home HD programs is widespread. This in-depth review describes barriers to home HD, focusing on patients, individual physicians and practices, and dialysis facilities, and offers suggestions for how to overcome these barriers and establish a successful home HD program.

Association of Vascular Access Type with Mortality, Hospitalization, and Transfer to In-Center Hemodialysis in Patients Undergoing Home Hemodialysis

“…One of the persistent barriers to greater adoption of home HD is the need for patients or caregivers to perform frequent cannulation of arteriovenous (AV) access (fistula or graft) (6)(7)(8). Data from the Frequent Hemodialysis Network Trial have also shown a higher incidence of interventions on AV access with higher frequency of use as occurs with home HD (9).…”

Hemodialysis services: are public policies turned to guaranteeing the access?

“…In some European countries, up to 40% of patients receive this type of dialysis, with access to this modality increasing. Portugal is also expanding the service; in the United States and Canada, there are studies that have assessed the differences in costs and quality of life resulting from these different modalities of dialysis 31,35 .…”

“…Doctors may not offer patients the procedure due to this. In relation to patients, the level of schooling, understanding their health condition, family involvement, and the physical and hygienic conditions in the household need to be considered before deciding the appropriate treatment 31,32,35 .…”

The home hemodialysis hub: Physical infrastructure and integrated governance structure

“…7,8 In published reports and cumulative clinical experience, the number of sessions needed to complete training requirements is 20-40 sessions, but occasionally more may be needed (see the supplement article, "Patient Selection and Training for Home Hemodialysis"). [8][9][10][11][12][13][14][15] In the anecdotal experience of the authors, the duration of training tends to be consistent across countries: those with a lower prevalence of home HD, such as the United States, report a lower number of home HD training sessions (<30) than countries with a higher prevalence of home HD patients, such as New Zealand (>30).…”