Experiences on Home Hemodialysis without an Assistant

Abstract

A program of home hemodialysis (HHD) was instituted at a University Hospital in 1998. In this study we evaluated experiences in training patients for HHD with and without an assistant. So far we have trained 59 patients for HHD. All patients had either AV fistula (58 cases) or arteriovenous graft (1 case). In 1998–2000 only two of 32 patients were trained to perform HHD without an assistant. However, we have changed our training policy and in 2001 6 of 14 patients and in 2002 12 of 13 patient were trained to perform HHD without an assistant. The mean age of all patients with an assistant (n = 39) was 49.8 ± 11.9 years (mean ± SD), range 24 to 71 years. The assistant was spouse or other relative (36 cases), a friend (2 cases), or nurse (1 case). The mean age of patients without an assistant (n = 20) was 42.4 ± 14.2 years, range 18 to 64 years. Fourteen of the patients with an assistant continue on HHD. Drop outs (25 cases) were caused by renal transplantation (20 cases), death ( 3 cases), social and access problems (2 cases). Sixteen of the patients without an assistant continues on HHD. All drop outs were caused by renal transplantation (4 cases). So far 570 patient months have been performed in HHD by patients with an assistant and 115 patient months by patients without an assistant. The mean training time in 2002 was 4–5 weeks. We have had no major technical or medical complications in our home hemodialysis program in either training groups. Conclusions: We have good experiences in training patients to perform home hemodialysis by themselves. Home hemodialysis without an assistant allowed tailored and flexible dialysis schedule. Patients are independent and no family member is tied to the treatment. This program enables home hemodialysis also for those patients who live alone.