Joseph A, Kindos P, Lundin AP, Berlyne GM
Home hemodialysis in trained self-care ambulatory patients
limited in urban setting by availability of space and partner
NKF 6th Spring Clinical Meeting (Dallas)
Am J Kidney Dis
(Apr) 29:A9 1997
Woods and Port et al have shown that mortality in home HD patients is
lower than
their in-center counterparts.
As reviewed by HDCN, selection bias is always a possibility to
explain these
results. However, another issue is, if home HD is so good, why isn't
everyone doing
it? In this abstract, Joseph et al surveyed 24 of their self-care patients
and asked
them why they were not on home HD. The most common obstacle was lack of a
partner
(62%), and lack of adequate space (50%). Work schedules, inadequate water
supply,
and landlord refusal were other reasons given. The authors conclude that
simplification of home HD equipment and/or patient duties might increase the
percentage of patients on this therapy.
Comment: The results of this abstract may well be heartening to at
least one
company (Aksys Ltd) in the process of developing a simplified home HD machine
(other
companies may be pursuing this as well). However, it is difficult to know to
what
extent the answers to questionnaires reflect true obstacles. Also, with lack
of a
partner, even with a simplified machine, patients who are not very self-
actualized
may still not want to pursue a home treatment option. We will soon be
posting audio
files of talks given by Drs. Woods and Port on home HD at the Denver PD
meeting in
February of 1997.
(John T. Daugirdas, M.D., University of Illinois at Chicago)
The abstract is available from the AJKD site, either in
low resolution .gif format, or in
.pdf format (you need to download Acrobat reader to
read .pdf files).
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NKF 6th Spring Clinical Meeting (Dallas)
Basic hemodialysis :
Home hemodialysis