Starting a home hemodialysis program: single center experiences.

Abstract

OBJECTIVES:

Home hemodialysis (HHD) has been used only in a minority of patients over past years although it may offer significant advantages over the other renal replacement therapies. This study describes the systems for and the initial results of starting a HHD program.

MATERIAL AND METHODS:

A program for HHD was instituted at a university hospital having more than 20 years of experience in training patients for self-care hemodialysis. A working group designed the patient and partner education program, installations, water quality assurance, logistics, and control systems.

RESULTS:

Between May 1998 and May 2001, 37 patients with a mean age of 48.3 +/- 12.5 (24-71) years were trained for HHD (1.0 patient/month) the mean training time being 2.0 +/- 0.6 (1-3) months. Four patients had no helper at home. The dialysis schedules (timing, frequency, duration) were individualized at home 41% of the patients having more frequent and/or longer treatments (including long-slow night and daily short HHD). The weekly dialysis time increased from 13.9 +/- 1.5 (CI 13.4-14.4) initially to 15.5 +/- 3.7 (CI 14.2-16.7) h (p = 0.008) at the end of follow-up. Significantly (p < 0.05) increased serum creatinine concentration was observed during the follow-up suggesting for an increased muscle mass. Initially 32% and at the end of follow-up 60% of the patients required no antihypertensive drugs (p < 0.05). Seventeen of the 21 drop-outs were caused by renal transplantation and the most common causes necessitating hospital back-up were related to vascular access.

CONCLUSIONS:

In conclusion the HHD program started in a unit having experience on and commitment for training self-care hemodialysis enabled individualization of the dialysis schedules resulting in the institution of long-slow (night) and alternate day as well as daily HHD therapies. It improved the control of hypertension renal transplantation being the single most common cause of drop-out.

• Authors: Eero Honkanen, R Muroma-Karttunen, R-M Taponen, C Grönhagen-Riska
• Journal: Scandinavian journal of urology and nephrology (Scand J Urol Nephrol) Vol. 36 Issue 2 Pg. 137-44 ( 2002) ISSN: 0036-5599 [Print] England
• PMID: 12056407 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Female
• Hemodialysis, Home (standards, statistics & numerical data)
• Home Care Services, Hospital-Based
• Hospitals, University
• Humans
• Hypertension (prevention & control)
• Kidney Failure, Chronic (therapy)
• Male
• Middle Aged
• Nutritional Status
• Peritoneal Dialysis
• Self Care