Choosing Home Hemodialysis: A Critical Review of Patient Outcomes

Abstract

Background/Aim: Home hemodialysis (HHD) has been associated with improved clinical outcomes vs. in-center HD (ICHD). The prevalence of HHD in the United States is still very low at 1.8%. This critical review compares HHD and ICHD outcomes for survival, hospitalization, cardiovascular (CV), nutrition, and quality of life (QoL). Methods: Of 545 publications identified, 44 were not selected after applying exclusion criteria. A systematic review of the identified publications was conducted to compare HHD to ICHD outcomes for survival, hospitalization, CV outcomes, nutrition, and QoL. Results: Regarding mortality, 10 of 13 trials reported 13–52% reduction; three trials found no differences. According to 6 studies, blood pressure and left ventricular size measurements were generally lower in HHD patients compared to similar measurements in ICHD patients. Regarding nutritional status, conflicting results were reported (8 studies); some found improved muscle mass, total protein, and body mass index in HHD vs. ICHD patients, while others found no significant differences. There were no significant differences in the rate of hospitalization between HHD and ICHD in the 6 articles reviewed. Seven studies on QoL demonstrated positive trends in HHD vs. ICHD populations. Conclusions: Despite limitations in the current data, 66% of the publications reviewed (29/44) demonstrated improved clinical outcomes in patients who chose HHD. These include improved survival, CV, nutritional, and QoL parameters. Even though HHD may not be preferred in all patients, a review of the literature suggests that HHD should be provided as a modality choice for substantially more than the current 1.8% of HHD patients in the United States.

Human factors testing of the Quanta SC+ hemodialysis system: An innovative system for home and clinic use

“…Additionally, given that the overall mean age at dialysis initiation is approximately 64 years old, rates of cognitive impairment are estimated to affect a significant proportion of dialysis patients; cognitive impairment affects a person's judgment and dexterity, hindering their ability to self‐manage complicated HHD systems. Moreover, although self‐care can promote self‐empowerment, an individual's support network often needs to be involved in a patient's care; and indeed this is reflected in several studies that suggest home dialysis users tend to be younger and married or cohabitating, with fewer comorbidities …”

“…Moreover, although self-care can promote selfempowerment, an individual's support network often needs to be involved in a patient's care; and indeed this is reflected in several studies that suggest home dialysis users tend to be younger and married or cohabitating, with fewer comorbidities. 6,25,26 Given low uptake rates of HHD in developed countries, it is imperative for the design of HHD systems to address the needs of patients and caregivers of different ages and abilities to help overcome some of these barriers and successfully increase HHD uptake. SC+ was designed with the intention of being a simple HHD system that delivers adequate dialysis power when compared to traditional hemodialysis systems, while having a compact size and an approachable appearance, so that patients can integrate the system within their homes with ease, without necessarily overly "medicalizing" the home environment.…”

“…In comparison, dialysis offered in the home setting, such as home hemodialysis (HHD), is a more cost‐effective treatment option in the long term . Furthermore, HHD provides patients with the ability to dialyze more frequently and/or for longer periods of time on a flexible schedule, which is generally associated with improved outcomes over traditional thrice‐weekly in‐center dialysis regimens, and may also be associated with lower rates of dialysis‐related complications, hospitalizations, and mortality . Moreover, HHD also provides patients with greater autonomy and flexibility, allowing them to maintain a normal schedule without frequent dialysis facility or hospital visits, while also offering potential quality of life improvements …”

“…2,3 Furthermore, HHD provides patients with the ability to dialyze more frequently and/or for longer periods of time on a flexible schedule, which is generally associated with improved outcomes over traditional thrice-weekly in-center dialysis regimens, 4 and may also be associated with lower rates of dialysis-related complications, hospitalizations, and mortality. 5,6 Moreover, HHD also provides patients with greater autonomy and flexibility, allowing them to maintain a normal schedule without frequent dialysis facility or hospital visits, while also offering potential quality of life improvements. 7 Despite the benefits that HHD offers, uptake rates are the lowest among all dialysis modality types, with reported utilization rates of 4.9% of dialysis patients in Canada, 8 4.4% in the United Kingdom, 9 and 1.9% in the United States.…”

Enhancement of solute clearance using pulsatile push-pull dialysate flow for the Quanta SC+: A novel clinic-to-home haemodialysis system

“…Importantly, when patients are treated in their own home, they have lower rates of dialysis-related complications, hospitalisations and mortality [4][5][6]. Moreover, HHD also provides patients with quality-of-life improvements [7].…”