Implementing a home haemodialysis programme without adversely affecting a peritoneal dialysis programme

As the population with stage 5 CKD grows, the associated costs of providing dialysis care increase. Due to the high costs of these therapies, home haemodialysis is enjoying a renaissance in many jurisdictions. However, concerns persist as to whether home haemodialysis programmes grow at the expense of other home therapies such as peritoneal dialysis. This study attempts to look at the impact of a new home haemodialysis programme on an existing peritoneal dialysis programme in the province of British Columbia.

Using the provincial renal database in British Columbia (PROMIS), all patients receiving dialysis were tracked over the years preceding the implementation of a home haemodialysis programme and following its implementation. Rate of growth by specific dialysis modality (hospital haemodialysis, community haemodialysis, home haemodialysis, and peritoneal dialysis) were tracked.

When comparing the provincial growth rates in the peritoneal dialysis programme, using the 4 years before and following the introduction of the home haemodialysis programme, they were unchanged both annually (7.84% versus 7.34%) and overall (25.27% versus 23.62%). The growth within the home haemodialysis programme appears to have come from the community haemodialysis programme (annual growth rate 12.28% versus 5.87%) and in-hospital haemodialysis (annual growth rate 4.61% versus 1.3%). Incident rates of dialysis were similar both prior to and following the introduction of the home haemodialysis programme.Finally, only 6.4% of the total patients entering the home haemodialysis programme had discontinued peritoneal dialysis within the 6 months preceding home haemodialysis training, indicating a low frequency of movement from peritoneal dialysis to home haemodialysis.

Successful implementation of a home haemodialysis programme can be done at a provincial level without having an adverse impact on the growth rate of existing peritoneal dialysis programmes.