Home Hemodialysis Program Development

Development of a successful home hemodialysis (HHD) program requires collaboration and dedication of a strong team of healthcare providers with the primary goal of improving the lives of patients on dialysis. HHD is not in-center hemodialysis performed at home. Rather, it is a home dialysis modality that utilizes hemodialysis equipment, policies and procedures engineered for home use. Principles learned from peritoneal dialysis will enable the staff to empower patients to succeed on HHD. The similarities between HHD and peritoneal dialysis are striking, and therefore, these two modalities should be integrated in a home dialysis program. Both require a commitment to excellent patient care and safety, assessment of patient-perceived benefit as gauged by patient-reported outcome measurements, patient training methods adjusted for patient learning styles, and identify the patient as the focal point of the program. Home dialysis patients can be recruited from chronic kidney disease (CKD) clinics, in-center hemodialysis units, and acute start hospital admissions. The entire nephrology practice must promote home dialysis and should consider every patient as a potential HHD patient. Strong leadership, especially by physicians and nursing, are indispensable. The HHD team will include physicians, nurses, social workers, dieticians, biomedical engineers, administrative assistants, and facility administrator. The physician medical directors have multiple responsibilities similar to in-center HD, but they also have tasks specific to HHD. The medical director has to be an expert in HHD, educate the staff including other physicians, and monitor the safety of every patient’s personal “HHD facility.” The home dialysis facility must be designed for maximum efficiency but also has to be attractive to patients. Training rooms should be designed and set up to mimic the home environment. The staff must be organized and consistent with patient messaging to make sure they set a high standard for patients. All clinic activities should adapt to the patient’s lifestyle. Extra clinic visits that do not directly improve patient care can be an unnecessary burden for patients. HHD requires significant sacrifice by the patients and caregivers. Maximizing patient benefit and minimizing burden will prevent patient burnout and should drive all decisions regarding patient care.