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Home Dialysis: A Majority Chooses It, a Minority Gets It
Osama El Shamy1, Tamara Muller2, Joji Tokita2
1Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA, omelshamy@gmail.com.
Blood Purification
|January 27, 2021
Summary
Dialysis education significantly increased home dialysis uptake, with most patients choosing peritoneal dialysis (PD) or home hemodialysis (HHD). Key barriers to home dialysis include lack of a care partner and insufficient home space.
Area of Science:
- Nephrology
- Renal Replacement Therapy
- Chronic Kidney Disease (CKD) Management
Background:
- Outpatient renal replacement therapy options include in-center hemodialysis (HD), home HD (HHD), and peritoneal dialysis (PD).
- In 2017, less than 11% of incident end-stage kidney disease (ESKD) patients utilized home dialysis modalities.
- Dialysis modality education is crucial for informed patient decision-making.
Purpose of the Study:
- To evaluate the impact of dialysis modality education on patient choices for renal replacement therapy.
- To identify barriers preventing patients from selecting home dialysis (PD or HHD).
Main Methods:
- A retrospective, single-center study analyzed patients referred for dialysis modality education from January 2019 to March 2020.
- Data collected included patient demographics, CKD stage, and reasons for refusing home dialysis.
- Household income and proximity to the home dialysis unit were also assessed.
Main Results:
- Out of 167 referred patients, 74% chose a home dialysis modality (59% PD, 15% HHD), compared to 23% choosing in-center HD.
- Among patients initially choosing in-center HD, 56% later opted for a home modality after education.
- Primary barriers to home dialysis were identified as lack of a care partner, insufficient home space, and patient preference.
Conclusions:
- Dialysis modality education effectively shifts patient preference towards home-based therapies like PD and HHD.
- Addressing barriers such as care partner availability and living space is essential to increase home dialysis adoption.
- Patient choice and suitability for surgical candidacy significantly influence the decision against home dialysis modalities.
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