Key elements in selection of pre-dialysis patients for home dialysis

Abstract

Background: Most pre-dialysis patients are medically eligible for home dialysis, and home dialysis has several advantages over incentre dialysis. However, accurately selecting patients for home dialysis appears to be difficult, since uptake of home dialysis remains low. The aim of this study was to investigate which medical or psychosocial elements contribute most to the selection of patients eligible for home dialysis. Methods: All patients from a Dutch teaching hospital, who received treatment modality education and subsequently started dialysis treatment, were included. The pre-dialysis programme consisted of questionnaires for the patient, nephrologist and social worker, followed by an assessment of eligibility for home dialysis by a multidisciplinary team. Clinimetric assessment and logistic regression were used to identify domains and questions associated with home dialysis treatment. Results: A total of 135 patients were included, of whom 40 were treated with home dialysis and 95 with incentre haemodialysis. The key elements associated with long-term home dialysis treatment were part of the domains ‘suitability of the housing’, ‘self-care’, ‘social support’ and ‘patient capacity’, with adjusted odds ratios ranging from 0.13 for negative to 18.3 for positive associations. Conclusion: The assessment of contraindications by a nephrologist followed by the assessment of possibilities by a social worker or dialysis nurse who investigates four key elements, ideally during a home visit, and subsequent detailed education offered by specialized nurses is an optimal way to select patients for home dialysis.

Exploring experiences and health-related quality of life of caregivers of patients who start home dialysis: study protocol for a prospective, multicentre cohort study

“…They play an important role in providing information about the different treatment options and during the trajectory after starting dialysis. 31 They can teach patients and caregivers how to cope with their disease and the comprehensive dialysis treatment. Their involvement in this study will allow them to have more in-depth conversations about the needs of caregivers.…”

“…Medical social workers have specific expertise to help and support kidney patients and their families. They play an important role in providing information about the different treatment options and during the trajectory after starting dialysis 31. They can teach patients and caregivers how to cope with their disease and the comprehensive dialysis treatment.…”

Assisted peritoneal dialysis in Europe: a strategy to increase and maintain home dialysis

“…Many of these tests were developed for the elderly, but they can also be used in younger patients [ 7 , 38 ]. A home visit by a dialysis nurse and/or a social worker may be useful to determine whether the home is suitable for PD [ 39 ]. Based on this comprehensive multifactorial assessment, the healthcare professionals can determine whether the patient is capable of self-care PD or requires partial or full assistance.…”

Value of patient decision aids for shared decision‐making in kidney failure

“…In the Netherlands, education usually starts when the patient's estimated glomerular filtration rate (eGFR) falls below 20 mL/min/ 1.73 m 2 . Kidney failure treatment modality education is provided by a team of kidney HCPs consisting of nephrologists (in training), nurses, social workers and dietitians, and in some hospitals physician assistants or nurse practitioners are also involved (Bonenkamp et al, 2021). The questionnaire was distributed to all these kidney HCPs.…”