Barriers to Home Haemodialysis

Introduction: Significant variation exists in the prevalence of home haemodialysis (HHD) among UK renal centres. Our centre has a HHD prevalence of 2%, and we aimed to study how many patients who chose HHD as their preferred mode of renal replacement therapy (RRT) went on to receive this treatment and the barriers to starting this treatment. Methods: A retrospective single-centre analysis of electronic medical records for all patients who chose HHD at the time of RRT education was performed, and data were collected on patient demographics, comorbidity, frailty, RRT events, and barriers to HHD. Results: 116 patients chose HHD as their preferred mode of RRT between 2006 and 2018. Of these patients, 93 required RRT, but only 28 patients ever received HHD. No statistical difference was identified between those patients who only received unit haemodialysis (UHD) and those who went onto receive HHD with respect to age, gender, comorbidity, frailty, and socioeconomic deprivation. Patient choice, change in clinical condition, transplantation, home environment, vascular access problems, and training delays were identified as reasons patients did not start HHD. No documented reason could be found in 9 patients with a breakdown of communication between clinics and peripheral dialysis units attributed as a significant contributor in some of these patients. Of the 26 patients who started HHD after UHD, 19 did so within 1 year of starting UHD. Conclusion: Most patients who choose HHD do not receive HHD. Many patients never start HHD because of potentially reversible barriers including inadequate communication among clinicians about patient choices, patients changing their minds once in a dialysis unit, and inadequate timely training support.

Automated summary

There is significant variation in the prevalence of home haemodialysis (HHD) among UK renal centers. Most patients who choose HHD do not receive it, mainly due to inadequate communication among clinicians, patients changing their minds once in a dialysis unit, and lack of timely training support.