Home Hemodialysis Practice and Curriculum Recommendations Among Graduates of a Military Nephrology Training Program...

The Advancing American Kidney Health Initiative set a goal that ≥80% of new end-stage kidney disease patients receive home dialysis or kidney transplant by 2025. Home hemodialysis (HHD) prevalence remains low, and one barrier may be a lack of familiarity with HHD among nephrologists and insufficient training during fellowship.

We performed an anonymous survey of 92/94 graduates from the Walter Reed military nephrology program (1984-2023) regarding their HHD practice and training. The home dialysis program includes only peritoneal dialysis, and HHD training is limited to didactics and training with machines used for low-flow dialysate HHD. The survey was conducted from April 12, 2023 to April 2, 2024.

Fifty-two out of ninety-two (57%) responded; 96% completed the survey. Seventy-five percent (38/51) had been in practice for ≤20 years. Forty-three percent (22/51) practice(d) HHD. Of these, 54% (12/22) had been HHD directors/co-directors, and 73% (16/22) had started practice in the last 10 years. The majority were in the southern (50%) or western (23%) United States, and 32% had rural practices. 54% (12/22) followed 6 to 10 patients. Sixty-eight percent reported learning HHD skills "on the job." Barriers most commonly cited were lack of patient interest (41%), lack of patient partners (27%), and lack of nursing staff (27%). Overall, graduates indicated that the minimum effective curriculum for HHD competence should include block/longitudinal HHD clinic (84%), familiarization with HHD machines (82%), didactic lectures (80%), and training in effective counseling (80%).

Among graduates of a military nephrology training program without HHD clinic experience, 43% reported subsequently practicing HHD, the majority learning "on the job." Overall, graduates indicated that block/longitudinal HHD clinic was the most effective way for fellows to learn HHD skills. Nephrology programs should expect that graduates are likely to care for HHD patients, and prepare them accordingly. In addition, for military nephrologists, HHD skills can be applied to dialysis delivery in austere settings.