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Introduction

Home haemodialysis (HHD) can have a number of advantages for patients.

HHD allows you to carry out your dialysis treatment in the comfort of your own home. This gives patients the freedom to choose a dialysis schedule, helping them feel more in control of both their treatment and their time – with a recent survey of individuals being treated for kidney failure showing that 61% of patients on HHD say they have more time to spend with friends and family, when compared to in-centre haemodialysis.

Crucially, dialysing at home can allow you to do so more frequently. In-centre patients usually receive 12 hours of hospital haemodialysis each week spread over three or four hourly sessions, which is inadequate as a healthy kidney would dialyse around the clock. Home therapies allows for longer and slower dialysis, so can improve kidney function and life expectancy; one study showed a 13% lower risk of death in patients, and a 77% improvement in health.

Dialysing more frequently is also proven to reduce recovery times, from eight hours in-centre to one hour after HHD.

What is home haemodialysis (HHD)

HHD is a form of renal replacement therapy (RRT) where a kidney patient uses a dialysis machine, passing his or her blood through a filter and cleansing it in the process, at home. This offers you more frequent dialysis sessions at your convenience, allowing you to take control of your treatment. HD can be performed during the day or at night.

NICE Guidance

Patient choice

In October 2018, NICE announced that patients being treated with dialysis should be offered a choice over where and what type of treatment they have. The new recommendations say patients can choose which type of dialysis is right for them and where this treatment will take place.

The expansion of home dialysis services meets the objectives of the NHS today, with the development of patient centred care stated as a critical aim. NHS Chief Executive Simon Stevens has indicated that he supports patient choice ‘wherever possible’.

Furthermore, the NHS’s 10 year plan announced in January 2019 that a key focus was self-responsibility and giving control back to patients. This means a shift away from hospitals and into primary and community care, giving patients more choice on when and where they have treatment and ramping up support for people to manage their own health.

NHS resources

Home dialysis is exactly the kind of cost-effective innovation that will represent a major step forward for both patients and the NHS itself. The current centralised model of kidney care is a serious drain on resources; 2% of the NHS budget is spent on services for dialysis and transplantation patients and in the 52 hospitals in England that offer dialysis services, up to 50% of their patient transport service costs are accounted for by dialysis.

In order to ease the capacity burden on hospitals, in its 2002 Guidance, NICE (National Institute for Clinical Excellence) advocated home dialysis as a more cost-effective treatment than hospital dialysis and recommended its expansion.

Potential benefits of home dialysis:

There are a number of benefits that could be gained from dialysing at home. See below for stats on benefits of HHD compared to in-centre haemodialysis:

  • It is easier to fit your treatment around your life, which can have huge benefits for your mental health:
  • In a recent survey, 58% of patients reported increased happiness compared to in-centre dialysis
  • You have more freedom than in-centre patients in choosing your own dialysis schedule

Not needing to travel to hospital three times a week for in-centre haemodialysis gives you more time:

  • 61% of patients are able to spend more time with friends and family
  • 71% have more times for hobbies and leisure
  • 29% are able to either work more often or return to work
  • Home haemodialysis patients can save up to 52 days per year, with less dialysis recovery time, time spent travelling to the centre and waiting for appointments.

Studies have shown that more frequent treatment provides a number of clinical benefits:

  • Reduced reliance on additional medicine, with one study finding that 26% of HHD patients rely less on medication overall when compared to in-centre haemodialysis
  • An average of one hour recovery time compared to eight for in-centre
  • Due to better health levels, patients on frequent HHD have an increased chance of receiving a kidney transplant
  • Less risk from a two-day break imposed by weekend closures of centres
  • Puts you in control of your treatment
  • Portable machines which are purpose built for the home, such as NxStage System One, offer freedom to travel. This alleviates concerns over needing to make alternative arrangements with dialysis centres away from your home town.

Things to consider:

You will need to talk to your renal unit about the risks involved with home treatment and make sure that you understand exactly what it entails and whether it is suitable for you. Before deciding if this is the right decision for you and your family and carers, there are a few things that need to be taken into consideration:

  • You and your partner will need to commit to receive training and following the guidelines for operating the equipment
  • Your home will become your treatment environment and you will need the space required to store the supplies
  • Your home will need to be kept clean and safe for your treatment
  • You and your partner will need to take the responsibility for the treatment including:
  • Setting up the equipment, needling, responding to alarms and ending the treatment
  • Monitoring blood pressure and responding to emergencies that might occur including dizziness, nausea, low blood pressure and blood/fluid leaking.

Any concerns you may have should be raised with your Renal Unit and the decision should preferably be made as a family unit.

What to do next?

Not every patient will be suitable for home dialysis, however, every suitable patient should be offered this choice. If you think that home dialysis might work for you, then ask to discuss these options with your clinical team.

Text originally written by T. R. Statham,
National Kidney Federation and updated April, 2019 by
Eryl Bradley, www.nxstage.co.uk

The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.