Regionalized self-care hemodialysis. A solution to the increasing cost

To cope with an ever-increasing number of patients with end-stage renal disease, a regionalized self-care hemodialysis program was set up and combined with the existing home and center hemodialysis, peritoneal dialysis, and renal transplantation. Five years later, of a total of 105 patients treated by hemodialysis, 66 were dialyzing themselves--31 at home and 35 in seven local self-care facilities. This proportion of patients engaging in autonomous treatment (69%) was obtained without restrictive selection criteria, since we treat 210 patients per million population with hemodialysis. The annual intake of new patients could be managed without increasing the number of center dialysis beds and by only slightly increasing the specialized staff. The cost reduction obtained with this program when compared with all center dialysis treatment represents 37%, or approximately 1,200,000 US dollars per year. These results were obtained without compromising the quality of treatment.