Understanding barriers to home‐based and self‐care in‐center hemodialysis

Abstract

Despite superior outcomes and lower associated costs, relatively few patients with end-stage renal disease undergo self-care or home hemodialysis. Few studies have examined patient- and physician-specific barriers to self-care and home hemodialysis in the modern era. The degree to which innovative technology might facilitate the adoption of these modalities is unknown. We surveyed 250 patients receiving in-center hemodialysis and 51 board-certified nephrologists to identify key barriers to adoption of self-care and home hemodialysis. Overall, 172 (69%) patients reported that they were "likely" or "very likely" to consider self-care hemodialysis if they were properly trained on a new hemodialysis system designed for self-care or home use. Nephrologists believed that patients were capable of performing many dialysis-relevant tasks, including: weighing themselves (98%), wiping down the chair and machine (84%), clearing alarms during treatment (53%), taking vital signs (46%), and cannulating vascular access (41%), but thought that patients would be willing to do the same in only 69%, 34%, 31%, 29%, and 16%, respectively. Reasons that nephrologists believe patients are hesitant to pursue self-care or home hemodialysis do not correspond in parallel or by priority to reasons reported by patients. Self-care and home hemodialysis offer several advantages to patients and dialysis providers. Overcoming real and perceived barriers with new technology, education and coordinated care will be required for these modalities to gain traction in the coming years.

Results of human factors testing in a novel Hemodialysis system designed for ease of patient use

“…A new hemodialysis system (Tablo™ Hemodialysis System) was developed with the intention to address these issues through features such as the automation of set‐up and disconnect steps, real‐time water purification and dialysate delivery and through the use of electronic storage and transmission of treatment data. A recent survey with 50 board‐certified nephrologists suggests that the Tablo™ Hemodialysis System may expand the pool of capable patients able to perform self‐care inside and outside a clinic setting, due to the system's overall simplicity, perceived ease of use, and short training time . Patients receiving in‐center hemodialysis were also surveyed; 70% indicated that they were “likely” or “very likely” to consider self‐care if performed with the new system.…”

“…A recent survey with 50 board-certified nephrologists suggests that the Tablo TM Hemodialysis System may expand the pool of capable patients able to perform self-care inside and outside a clinic setting, due to the system's overall simplicity, perceived ease of use, and short training time. 15 Patients receiving in-center hemodialysis were also surveyed; 70% indicated that they were "likely" or "very likely" to consider self-care if performed with the new system.…”

Second Generation Nanoporous Silicon Nitride Membranes for High Toxin Clearance and Small Format Hemodialysis

“…The benefits of frequent hemodialysis are well‐documented . Yet less than 0.5% of incident ESRD patients elect home hemodialysis (in the US in 2017), where more frequent treatment is feasible, citing the need for large, complex equipment, the appointment of caretakers, and self‐cannulation as reasons to continue with the less beneficial thrice‐weekly therapies . Only a revolutionary change in therapy that improves longevity, lifestyle, and daily well‐being will disrupt the current regime of hemodialysis therapy.…”

Protein Separation and Hemocompatibility of Nitride Membranes in Microfluidic Filtration Systems

“…The top barriers to adoption of home-based HD include, space for equipment and supplies, lack of support/care partner, training/education limitations, self-cannulation, and medicalization of the home [20–23]. All of these hindrances can be ameliorated, to some extent, with the small form factor devices that our membranes can bring to market.…”