Delivering Home Hemodialysis: Is There Still a Role for Real‐Time Treatment Monitoring?

Abstract

Remote real-time treatment monitoring for home hemodialysis (HHD) was driven by concerns over patient safety in the early era of HHD. However, decades of clinical experience supported by objective data suggest that HHD is very safe and that remote monitoring is unlikely to avert serious adverse events. As a result, such remote monitoring is not routinely offered in the current era and is generally considered an unnecessary expense. However, a one-size-fits-all approach to abandon remote monitoring may overlook potential opportunities: to improve the clinical care of patients dialyzing at home; and to give patients the confidence to perform HHD in an unsupervised setting.

Prospective monitoring of after‐hours nursing and technologist support calls to a regional Canadian home hemodialysis program

“…The cost of on‐call technologists is likely lower due to fewer calls. The presence of on‐call services also provides some reassurance to patients and providers in the absence of real time remote treatment monitoring, which itself, is extremely costly and would not negate the need for live person‐to‐person support . Obviously, the costs of any on‐call system are highly influenced by local pay grades, overtime policies and on‐call premiums, so that these expenses cannot easily be generalized.…”

“…The presence of on-call services also provides some reassurance to patients and providers in the absence of real time remote treatment monitoring, which itself, is extremely costly and would not negate the need for live person-toperson support. 18 Obviously, the costs of any on-call system are highly influenced by local pay grades, overtime policies and on-call premiums, so that these expenses cannot easily be generalized. However, considering the cost of 1 year of center-based hemodialysis in Canada is approximately $100,000 per person, 8 the provision of on-call support services to our entire home HD unit seems to represent very good value for money.…”

The home hemodialysis hub: Physical infrastructure and integrated governance structure

“…There are different options for remote monitoring available to home HD units and their patients, although they all have the similarity of providing a means of communication between home HD staff (physicians, nurses, and clinical dialysis technicians) and patients. 21 Remote monitoring allows staff to review and assess patient's treatment, observations, recordings, and general health status remotely, allowing the patient to live as independently as possible on home HD away from the hospital setting while still receiving a high level of care and support. In addition to providing staff with up-to-date information on patients at home, remote monitoring can also assist in easing some of the fears and anxieties of patients and their families about performing HD away from the hub.…”

“…Finally, it is unlikely that remote monitoring prevents serious adverse events; however, it is plausible that more timely access to patient observations (e.g., weight and blood pressure) may improve routine patient care. 21,23 In general, more research is needed to clarify the role of remote monitoring, and many programs do not routinely offer it in the modern era.…”

“…21 Remote monitoring allows staff to review and assess patient's treatment, observations, recordings, and general health status …”