Dialysis modality choices among chronic kidney disease patients: identifying the gaps to support patients on home-based therapies

Abstract

Sixty-one percent of patients requiring dialysis chose a home dialysis modality. Patients' and their families' disinterest in home dialysis and lack of support (either perceived or actual) represented the major overall barriers to adoption of home dialysis.

Effect of an In-Hospital Chronic Kidney Disease Education Program among Patients with Unplanned Urgent-Start Dialysis

“…Our results are consistent with previous studies comparing patients on in-center HD and PD showing that PD patients are more likely to be younger and have less comorbidities and a different distribution of ESRD etiologies (12,13). Few studies have compared patients adopting in-center HD versus home HD (14). It is interesting to note that additional support was required for patients choosing in-center HD, which may be a marker of frailty rather than a direct reflection of choice of renal replacement modality.…”

Socioeconomic Differences in the Uptake of Home Dialysis

“…PD use was not associated with area SES in Canada (11), which has a mix of government and private health care providers that is similar to the mix in Australia. Gradients in health literacy (9), comorbidities (34), and out-of-pocket expenses related to PD (35) would be expected to result in higher rates of PD among advantaged patients. Government rebates for water and electricity vary between states, and many rebates are only available to concession card holders (36), who are typically on low incomes.…”

Clinical, patient-related, and economic outcomes of home-based high-dose hemodialysis versus conventional in-center hemodialysis

“…72 Other known barriers to home HD are lack of motivation/ interest, unwillingness to change, learned helplessness, fear of isolation, perceived burden on caregivers, and fear of cannulation. [73][74][75] However, these barriers can often be overcome by adequate predialysis education, motivational training of patient and caregiver, nurse-assisted cannulation, nurse-led home visits, a well-defined nursing/technical support system for patients, and provision of respite care. [76][77][78] Target populations for high-dose home HD All patients going through predialysis education clinic who are capable and willing could be offered the choice of home HD as a form of a home-based therapy (Figure 1).…”