The Potential Burden of Home Dialysis on Patients and Caregivers: A Narrative Review

Abstract

Purpose of review:Home dialysis modalities offer several benefits for patients with end-stage kidney disease when compared with facility-based thrice-weekly hemodialysis. To increase uptake of home dialysis, many centers are encouraging a “home-first” approach. However, it is important to appreciate that “one size may not fit all” and that dialysis modality selection is a complex decision that needs to be individualized. The purpose of this review was to explore aspects associated with home dialysis that may be associated with burden for patients and their caregivers and to discuss strategies to alleviate these concerns.Sources of information:Original research articles were identified from PubMed using search terms “peritoneal dialysis,” “home hemodialysis,” “home dialysis,” “barriers,” “quality of life” and “burden.”Methods:We performed a focused narrative review examining potential sources of burden with home dialysis therapies after conducting a critical appraisal of the literature and identifying the major recurring themes.Key findings:Home dialysis is associated with burden for certain patients. Indeed, some patients may experience ongoing concerns regarding the risks of adverse events and of inadequately performing dialysis on their own. Psychosocial issues affecting quality of life may also arise and include fear of social isolation, sleep disturbances, perceived financial burden, anxiety, and fatigue. Patients who depend on a caregiver may worry about creating a stressful home environment for their close ones. Furthermore, the demands associated with being a caregiver may lead to psychosocial distress in the caregivers themselves. All these factors may lead to burnout and consequently, therapy discontinuation necessitating an unplanned transition to in-center hemodialysis leading to adverse outcomes. However, certain strategies may help alleviate burden especially if concerns are identified early on.Limitations:As we did not apply any formal tool to assess the quality of the studies included, selection bias may have occurred. Nonetheless, we have attempted to provide a comprehensive review on the topic using numerous diverse studies and extensive review of the literature.Implications:Future studies should focus on better identifying patient priorities and strategies to facilitate dialysis modality selection and improve quality of life.

Understanding Home Hemodialysis Patient Attrition: A Cohort Study

“…These findings are consistent with patient and caregiver perspectives, 22 while social isolation and a lack of peer support have been reported as factors affecting HHD patient decisions to leave in other studies. 19,22,23 It would be important for the HHD team to assess the needs of patients who appear to be struggling in order to provide targeted interventions that meet their support needs.…”

Farklı diyaliz modalitelerinin hasta yakını yaşam kalitesi üzerindeki etkileri

“…Evde tedavi yöntemlerinden biri olan periton diyalizinin uygulanabilmesi için hasta veya yakınının belirli sosyokültürel seviyede olması, sıvı değişimlerinin uygulanabileceği uygun değişim odasının olması, işlemlerin asepsi kurallarına uygun bir şekilde doktor ve hemşire reçetelerine uygun şekilde yapılabilmesi gerekmektedir. Hastalara esneklik, özgüven, hastane ortamından uzaklaşma, daha esnek kronik böbrek yetmezliği diyeti, daha iyi sağ kalım ve yaşam kalitesi imkanı sağlayan periton diyalizi tedavisi aynı zamanda her gün uygulama gerekliliği, evde hijyenik ortamın sağlanması, tedavi sorumluluğunun üstlenilmesi, sağlık personelinden uzak olunması gibi sebeplerden hasta ve hasta yakınlarına fiziksel, duygusal ve sosyal anlamda yük oluşturabilmektedir (7)(8)(9)(10)(11). Hemodiyaliz tedavisi ise çoğunlukla diyaliz merkezinde sağlık personeli denetiminde yapılması, haftanın belirli günlerinde uygulanması, ev ortamında herhangi bir düzenleme gerektirmemesi (ev hemodiyalizi uygulanan hastalar dışında) gibi göreceli avantajlar sağlamasının yanında haftanın belirli günlerinde bir diyaliz merkezine bağlı olma, fizyolojik olmayan kan temizleme işleminin diyaliz günlerinde hastada yarattığı halsizlik, bulantı ve kusma, kas krampları gibi yan etkilere sebep olabilmesi, kanama ve osteoporoz riskini arttıran kan sulandırıcı ilaç kullanma zorunluluğu, daha sıkı diyet ve daha fazla mortalite ve morbidite riski sebeplerinden hasta ve hasta yakınlarına yük oluşturabilmektedir (12)(13)(14).…”

Narrative interviews to assess quality of life in Peritoneal Dialysis

“…Il ressentira alors une invasion de la dialyse dans sa vie quotidienne et sa qualité de vie s'en trouvera dégradée [12,13,15]. Si les facteurs psychosociaux pèsent lourdement dans le choix d'une modalité de dialyse à domicile, ils sont également des causes majeures d'abandon du traitement [17,18]. Le patient doit alors bénéficier d'un soutien optimal et continu [13 ,15,16] par une écoute, une disponibilité et une empathie de la part des équipes de DP.…”