Hemodiafiltration at Home: A Single Centre Experience Reviewing Safety, Efficacy, and Implementation

Patients with kidney failure receiving dialysis are at an increased risk of cardiovascular events. Hemodiafiltration (HDF) has been shown to decrease cardiovascular mortality. Due to concerns around technical challenges and the need to achieve ultra-pure water standards, HDF is not readily available for those receiving hemodialysis at home. This study was conducted to describe the process and outcomes in implementing a home HDF program.

Patients who received home HDF training between 2014 and 2024 at the Princess Alexandra Hospital, Australia were included. The primary outcome was the proportion of patients who successfully completed training for HDF at home. Outcomes related to training duration, water, and clinical outcomes including hospitalizations, transfer to facility-based hemodialysis were analyzed descriptively.

In total, 42 patients (67% male, mean age 51.1 ± 12.8 years) undertook HDF therapy at home. About 39 patients commenced HDF training with a 100% training success rate, and 3 patients were supported by nursing-assisted HDF therapy at home. Median training duration was 61 days, which was longer for patients who were new to starting home dialysis (126 days), compared to those who converted from home hemodialysis to HDF (14.5 days, p < 0.05). HDF prescriptions were highly variable (mean treatment hours 15.7 ± 4.9 h/week). The median time of home HDF treatment was 17.5 months (interquartile range IQR 9.9-31). In the first 6 months after starting HDF at home, there were no hospitalizations due to dialysis-related technical issues including water-related problems. Three patients (7%) transitioned to facility-based hemodialysis.

HDF at home is a safe therapy for patients who are considered to receive hemodialysis at home, offering increased flexibility and personalized prescriptions.