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Hemodial Int. 2019 Feb 11. doi: 10.1111/hdi.12713. [Epub ahead of print]

The home hemodialysis patient experience: A qualitative assessment of modality use and discontinuation.

Author information

1
Department of Medicine, Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
2
Department of Medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
3
Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Abstract

INTRODUCTION:

Home hemodialysis (HHD) is an under-utilized renal replacement modality in the United States in part because of high rates of discontinuation and transfer to in-center hemodialysis. Understanding, from the perspective of patients, facilitators, and barriers to sustained use of HHD is important for increasing successful use of this modality.

METHODS:

We conducted 25 semistructured interviews with 15 current and 10 former adult patients treated with home hemodialysis (23 short daily HHD and 2 nocturnal HHD). Interview transcripts were audiotaped, transcribed verbatim, and thematically analyzed.

FINDINGS:

Five themes related to continuation or discontinuation of HHD emerged: (1) degree of independence (increased flexibility, burden of therapy), (2) availability of support (emotional and physical support and caregiver burden), (3) technical aspects (familiarity with machine), (4) home environment (ability to organize supplies, space in home), and (5) attitude and expectations (positive or negative outlook about performing HHD). For each theme, positive aspects facilitated continuation of HHD and negative aspects contributed to discontinuation of HHD.

DISCUSSION:

HHD can be burdensome to patients and family members, and some discontinuations may be preventable. Helping patients with scheduling and organization, improving communication about expectations and trouble-shooting, supporting patients as well as family members, adapting the dialysis prescription to the patient's lifestyle when possible, and providing respite when needed may make HHD more sustainable for patients.

KEYWORDS:

Hemodialysis; discontinuation; home dialysis; technique failure

PMID:
30742357
DOI:
10.1111/hdi.12713

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