Abstract
Home dialysis, which includes Peritoneal Dialysis and Home Hemodialysis, provides lots of profit to patients suffering of Chronic Kidney Disease, especially in terms of comfort, life quality and autonomy. However, its use is marginal in France, with an inhomogenous distributaion according to geographical regions. We conducted a French national survey of nephrologists to assess the barriers to the development of home dialysis. After analyzing the responses of the 230 participating nephrologists, the main obstacles to the development of the two techniques were identified and classified according to their reporting rate. The major obstacles that emerge from the survey are : the lack of information among the general public, a lack of acknowledgement of nurses specializing in these techniques, the limited number of structures that practice dialysis at home, and information difficulties among patient about dialysis techniques. The specific peritoneal dialysis-related difficulties reported are : difficulties in management of follow-up care and rehabilitation, the fear of insufficient purification and the difficulties related to the dialysis catheter. Concerning home hemodialysis, the barriers concern fear of autopunction and the need for a third party. This study helps to identify the representations of nephrologists on the major obstacles to the development of home dialysis to develop lines of thought for its promotion, both in terms of training, institutional acknowledgement, and the necessary regulatory evolution.
Highlights
En France, le traitement de la maladie rénale chronique terminale repose sur une offre diversifiée dont le pivot central est la transplantation rénale
The main obstacles that emerged from the survey were: the lack of information of the general public, the lack of acknowledgement of the nurses specialized in these techniques, the limited number of structures practicing home dialysis and the difficulties about dialysis techniques information process
Specific difficulties reported with peritoneal dialysis include: difficulties for patients to access to rehabilitation care units, fear of inadequate dialysis dose and difficulties related to the dialysis catheter
Summary
Home dialysis : where are the barriers ? a national survey of French nephrologists. journal officiel du Registre de Dialyse Péritonéale de Langue Française RDPLF www.rdplf.org. Nous avons réalisé une enquête nationale française auprès des néphrologues pour évaluer les freins au développement de la dialyse à domicile. Les freins majeurs qui ressortent de l’enquête sont : le manque de médiatisation auprès du grand public, un défaut de reconnaissance des infirmières spécialisées dans ces techniques, le nombre limité de structures pratiquant la dialyse à domicile, et les difficultés relatives à l’information pré-dialyse. Concernant l’hémodialyse à domicile (HDD), les freins portent sur la peur de l’autoponction et la nécessité d’une tierce personne. Cette étude permet d’identifier les représentations des néphrologues sur les freins majeurs au développement de la dialyse à domicile pour développer des pistes de réflexion pour sa promotion, tant sur le plan de la formation, de la reconnaissance institutionnelle, que de la nécessaire évolution règlementaire
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