Selecting Patients for Home Haemodialysis Modality

Home haemodialysis offers many advantages in that patients take active control of their own health care and have the ability to determine when and how they dialyse. However, in order to develop and maintain a viable home haemodialysis program there has to be a balance between overenthusiastic evangelism and being too conservative in offering patients home haemodialysis. Ideally, preparation for home haemodialysis takes place prior to the need to start dialysis, with educational sessions, discussion with current home haemodialysis patients, and creation of an established vascular access. Preferably, training should take place in a small dedicated centre rather than a main in-centre dialysis unit on a 1:1 basis with a motivated educator. Although there are many potential barriers to home haemodialysis, it is not just an option for younger, physically healthy, well-educated patients, and a surprising number of patients with significant comorbidity can become successful home haemodialysis patients with appropriate support from partners or carers where required. Often the main barrier to home haemodialysis remains suitable accommodation, particularly in inner cities. Once established at home, it is important to ensure that patient expectations and the reality of home haemodialysis do not differ substantially. The amount of support required will vary between patients in terms of psychological support, trouble-shooting access, and technical problems. As with all dialysis practice, quality assurance systems are required with patient feedback as appropriate.