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Is home hemodialysis a practical option for older people?
Henry H L Wu1,2, Andrew C Nixon1,2,3, Ajay P Dhaygude1,2
1Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK.
Insights
Home hemodialysis (HHD) offers advantages for older adults with kidney disease, but barriers like caregiver support and frailty exist. Innovations in assisted HHD and telehealth can improve access for this growing population.
Area of Science:
- Nephrology
- Geriatrics
- Public Health
Background:
- The aging population is driving increased demand for dialysis services.
- The COVID-19 pandemic highlighted risks of in-center hemodialysis, promoting home-based alternatives.
- Home hemodialysis (HHD) presents practical and clinical benefits for patients.
Purpose of the Study:
- To review factors influencing the implementation of HHD in older adults.
- To identify barriers and unmet needs for HHD in the elderly dialysis population.
- To explore strategies for increasing HHD accessibility and inclusion for seniors.
Main Methods:
- Literature review examining current evidence on HHD for older adults.
- Analysis of practical and clinical challenges associated with HHD initiation.
- Exploration of potential solutions, including assisted HHD models and telehealth.
Main Results:
- Barriers to HHD in older adults include lack of caregiver support, cognitive/physical impairments, vascular access issues, and training needs.
- Patient frailty status is a key consideration for HHD decision-making.
- Telehealth and assisted HHD models show promise for improving HHD accessibility.
Conclusions:
- Addressing barriers through enhanced support, frailty assessment, and technological integration is crucial for expanding HHD.
- Assisted HHD care models and telehealth advancements can significantly increase HHD opportunities for older dialysis patients.
- Further research and development are needed to optimize HHD for the growing elderly population with end-stage kidney disease.
Abstract:
An increasing demand for in-center dialysis services has been largely driven by a rapid growth of the older population progressing to end-stage kidney disease. Since the onset of the COVID-19 pandemic, efforts to encourage home-based dialysis options have increased due to risks of infective transmission for patients receiving hemodialysis in center-based units. There are various practical and clinical advantages for patients receiving hemodialysis at home. However, the lack of caregiver support, cognitive and physical impairment, challenges of vascular access, and preparation and training for home hemodialysis (HHD) initiation may present as barriers to successful implementation of HHD in the older dialysis population. Assessment of an older patient's frailty status may help clinicians guide patients when making decisions about HHD. The development of an assisted HHD care delivery model and advancement of telehealth and technology in provision of HHD care may increase accessibility of HHD services for older patients. This review examines these factors and explores current unmet needs and barriers to increasing access, inclusion, and opportunities of HHD for the older dialysis population.
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