A New Paradigm: Home Therapy for Patients Who Start Dialysis in an Unplanned Way

Abstract

SUMMARY Background Starting dialysis in a non‐planned manner or in a ‘suboptimal’ manner is a frequent situation in dialysis centres, even for patients with a regular nephrology follow‐up. Unplanned dialysis initiation can be defined as a patient beginning dialysis with no functional vascular access or peritoneal dialysis catheter. These patients start haemodialysis with a temporary catheter, frequently converted to a tunnelled catheter pending native fistula creation or whilst waiting for fistula maturation. In this case, conventional in‐centre haemodialysis (ICH) is more frequently used than peritoneal dialysis (PD) or home haemodialysis (HHD). Review findings This review found that patients who start dialysis in an unplanned way are significantly older and have more heart and peripheral vascular diseases. Home‐based dialysis therapies showed better outcomes than ICH (PD for the first two to three years and HHD for the long‐term). Recommendations This review proposes a paradigm shift in the initial form of dialysis offered to new patients starting dialysis in an unplanned way. Even if they require a temporary catheter, it is possible for them to receive a pre‐dialysis education programme (PDEP). The PDEP should be based on both individualised information session(s) given by an experienced nurse to the patient and family and therapeutic education (educative diagnosis, individualised and group session(s)) in order to relieve anxiety and promote home modalities.

Dialysis education and options for late presenters—An ongoing dilemma

“…Home therapies such as PD and home HD are safe in acute start dialysis patients 26,27 . The European Renal Best Practice Expert Group suggests all centers should include both PD and HD in their programs and that the patient's preference should be the leading criterion for modality selection 28 .…”

“…21 Home therapies such as PD and home HD are safe in acute start dialysis patients. 26,27 The European Renal Best Practice Expert Group suggests all centers should include both PD and HD in their programs and that the patient's preference should be the leading criterion for modality selection. 28 Machowska et al 16 state that there are no known patient demographic factors within the acute start population that allow prediction of their ability to make a decision regarding dialysis modality choice.…”

Developing Life Skills in Haemodialysis Using the Guided Self‐determination Method: A Qualitative Study

“…Lecouf (), in his review study, proposed that patients starting HD treatment in an unplanned way should receive an education programme to promote home‐based dialysis treatment. GSD‐HD might be consistent with such an education programme, as five patients changed dialysis mode after the GSD‐HD intervention and one patient recommended the programme for all new patients on HD treatment.…”

“…In contrast, it was an advantage both for patients and professionals that our GSD-HD intervention was mostly shorter (about four months), and often took place during the early part of dialysis sessions. Lecouf (2013), in his review study, proposed that patients starting HD treatment in an unplanned way should receive an education programme to promote home-based dialysis treatment. GSD-HD might be consistent with such an education programme, as five patients changed dialysis mode after the GSD-HD intervention and one patient recommended the programme for all new patients on HD treatment.…”