Evaluation of the Current Status of Home Hemodialysis in the Middle East Then Perspectives and Possibilities of Home Hemodialysis in Egypt

Abstract

Abstract Background Chronic kidney disease (CKD) is a growing worldwide epidemic. The incidence and prevalence of end-stage renal disease (ESRD) are expected to continue to increase. The most recent United States Renal Data System (USRDS) reports indicate that the incident dialysis population has grown older, has more comorbid conditions than previous years, and is starting dialysis with higher levels of residual kidney function (RKF). Aim of the Work This study was done to evaluate the current status of home hemodialysis in the Middle East, then to study the perspectives and future possibilities of home hemodialysis in Egypt. It was carried out during the last 2 years; 2019 and 2020. It included 2 parts: Patients and Methods A retrospective and prospective study on 100 patients that was randomly selection and was adult ESRD patients (age > 18 years) either were treated and maintained on home hemodialysis during the last 5 years or will be treated and maintained on home hemodialysis during the period from march 2019 to march 2020. Results HD patients with volume overload or those with cardio-renal syndrome were found to better tolerate excessive UF with the use of home HD machines than that with the usual in-center machines. SLED and SCUF modes were very effectively managed with the use of these simple HD machines. It was noticed that the loss of residual renal functions in new HD patients, was significantly less with the use of home HD than with the usual in-center HD. This was related to less dialysate exposure other than the use of ultrapure dialysate. Conclusion The psychological status was significantly improved in those patients with having their sessions at their homes without any added stressors related to in-center HD. Even new ESRD patients who are too reluctant to start HD, were better convinced to start home HD. Home HD is a gentle and benign mode of HD with less reported intra-dialytic complications; attributed to the use of ultrapure dialysate solutions other than the treated tap/well water used in center HD.