Technique Survival, Psychosocial Aspects, Respite Care, and Discontinuation in Home Hemodialysis

Recent policy changes have renewed the nephrology community’s interest in home hemodialysis (HHD). Most of these policies focus on increasing the uptake of HHD (Advancing American Kidney Health. https://aspe.hhs.gov/pdf-report/advancing-american-kidney-health ). More granular data is needed on best practices to achieve clinical and quality outcomes within the United States. There is an increased emphasis on patient modality education, technological advances, and physician training to escalate the incidence of HHD. Various aspects of technique survival need exploration as they contribute to morbidity and mortality (Perl J, Na Y, Tennankore KK, Chan CT, Clin J Am Soc Nephrol, 2017). The USRDS reports are increasing both the incidence and prevalence of HHD (United States Renal Data Report. https://adr.usrds.org/2021/end-stage-renal-disease/2-home-dialysis ). The rates of technique survival vary among home dialysis centers and countries (United States Renal Data Report. https://adr.usrds.org/2021/end-stage-renal-disease/2-home-dialysis ; Blake PG, Kidney360:1(2):115–8, 2020). The experience of a large dialysis organization in the United States demonstrated the average census across 323 clinics offering HHD was four patients per clinic, and the 1-year technique failure rate was 24.9% (Seshasai RK, Mitra N, Chaknos CM, Am J Kidney Dis:67(4):629–37, 2016) There is evidence of higher 90-day mortality among patients who experience technique failure than those who stay on therapy (Seshasai RK, Mitra N, Chaknos CM, Am J Kidney Dis:67(4):629–37, 2016). The journey of HHD patients begins with modality education, training, adjusting to therapy, and working toward transplant, although some may not be eligible. The patient referral and training increase for HHD is crucial to understanding factors and strategies to improve outcomes and make the journey less burdensome.