Abstract
Most pre-dialysis patients are medically eligible for home dialysis, and home dialysis has several advantages over incentre dialysis. However, accurately selecting patients for home dialysis appears to be difficult, since uptake of home dialysis remains low. The aim of this study was to investigate which medical or psychosocial elements contribute most to the selection of patients eligible for home dialysis. All patients from a Dutch teaching hospital, who received treatment modality education and subsequently started dialysis treatment, were included. The pre-dialysis programme consisted of questionnaires for the patient, nephrologist and social worker, followed by an assessment of eligibility for home dialysis by a multidisciplinary team. Clinimetric assessment and logistic regression were used to identify domains and questions associated with home dialysis treatment. A total of 135 patients were included, of whom 40 were treated with home dialysis and 95 with incentre haemodialysis. The key elements associated with long-term home dialysis treatment were part of the domains 'suitability of the housing', 'self-care', 'social support' and 'patient capacity', with adjusted odds ratios ranging from 0.13 for negative to 18.3 for positive associations. The assessment of contraindications by a nephrologist followed by the assessment of possibilities by a social worker or dialysis nurse who investigates four key elements, ideally during a home visit, and subsequent detailed education offered by specialized nurses is an optimal way to select patients for home dialysis.
Highlights
Home dialysis, that is, peritoneal dialysis (PD) or home haemodialysis (HD), offers more flexibility and independence than conventional incentre haemodialysis (CHD), whereas patient survival is comparable or better.[1,2,3] it is not surprising that extensive pre-dialysis programmes lead to a preference for home dialysis in 70% of pre-dialysis patients.[4]
In 15% of patients, the social worker did not succeed in performing a home visit due to time constraints or because the patient did not consent to a home visit
More CHD patients lived alone and had congestive heart failure compared to home dialysis patients
Summary
That is, peritoneal dialysis (PD) or home haemodialysis (HD), offers more flexibility and independence than conventional incentre haemodialysis (CHD), whereas patient survival is comparable or better.[1,2,3] it is not surprising that extensive pre-dialysis programmes lead to a preference for home dialysis in 70% of pre-dialysis patients.[4] the percentage of patients treated with home dialysis is only about 9–11% throughout the world.[5,6] An important barrier to uptake of home dialysis is limited pre-dialysis care.[7,8,9,10,11]. Conclusion: The assessment of contraindications by a nephrologist followed by the assessment of possibilities by a social worker or dialysis nurse who investigates four key elements, ideally during a home visit, and subsequent detailed education offered by specialized nurses is an optimal way to select patients for home dialysis
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