Self care haemodialysis re-emerges as a viable option....
“The time has come for the NHS to make a decisive shift in providing more care out of hospitals and into the patient's community and home."
Andy Burnham, UK Government Health Minister 18 Feb 2010 |
The vast majority of haemodialysis patients around the globe undergo a standard, 4 hour 3 times per week, treatment regime in their hospital dialysis unit.
Countries like Australia and New Zealand have embraced home haemodialysis and there are other successful programs around the world. These experiences are clearly showing that home and self care haemodialysis are beneficial for the patient and save cost.
In the UK the Department of Health published in 2009 "Delivering the National Service Framework for Renal Services" and as early as 2002 NICE issued guidance encouraging more home haemodialysis. Thanks to these and other policies more than 550 patients are receiving haemodialysis at home in the UK, and the numbers are growing.
As well as being disruptive to patients' lives, this standard regime is increasingly being recognised as a poor replacement of kidney function and costly compared to home-based or self-care treatments.
Clinical benefits of home-based or self-care haemodialysis
- Ready and flexible access to increased dialysis dose rates
- Increased frequency (> 3 times weekly) and duration (>4 hours per session) of dialysis
- improves outcomes
- reduces co-morbidities
- dramatically reduces mortality rates
Barriers to home and self-care treatment
With so many indicators seemingly in favour of home or self-care haemodialysis just what is holding nephrologists back from expanding their home haemodialysis service and what is halting patients from choosing it?
A recent report from NHS Kidney Care has identified many of the potential barriers:
- Patients do not know it is an option
- No incentives for dialysis centres to offer home dialysis
- Lack of infrastructure- training, equipment, supplies
- Local centre does not offer it
- Equipment too complicated and cumbersome
- Lack of inertia and/ or resource to introduce change
Further recommendations and initiatives are being put in place to help the renal dialysis service across the UK meet these challenges.
The UK like many other countries now look set to encourage self care dialysis both as a means of improving patient outcomes as well as managing the anticipated increase in demand for dialysis in the future, with constrained budgets and resources. |
