Burden of Daily Home Hemodialysis Prompts Some Patients to Stop Treatment

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SEATTLE—The burden of daily home hemodialysis (HD) is among the major reasons patients discontinue the modality, researchers reported at the 30th Annual Dialysis Conference here.

At Barnes-Jewish Dialysis Center at Washington University in St. Louis, Missouri, 60 patients were trained for daily home HD since 2001. The group consisted of 29 female and 31 male patients ranging in age from 10 to 86 years.

Of these, 40 discontinued therapy after an average time on daily home HD of 18.5 months (range 2-47 months).

Notably, 13 patients discontinued home HD because of the burden of therapy. Another eight patients died, five had a renal transplant, three relocated to another state, one had an illness that made difficult to continue treatment, one had recovery of renal function, and one transferred to a nearby dialysis unit. The other eight patients stopped for various other reasons.

Of the 13 patients who discontinued therapy due to burden of therapy, 11 did so after six months of successful treatment. The only difference between the patients who discontinued therapy and those who continued therapy was a higher incidence of lack of support, according to study investigator Cheryl Cress, RN, who presented study findings. She is a home modality coordinator at Washington University School of Medicine, St. Louis, Mo.

“We thought that depression or sleep deprivation was involved,” said study co-investigator Robyn Re, RN, who is home modality coordinator at Washington University.

“So we thought questionnaires would help. Then we found that it wasn't sleep deprivation or depression, but rather it came down to [whether] they have a support person or a person with a vested interest in the patients' success on home therapy. It is not that it is too difficult. It is that it is time consuming and you have to work it into a time schedule, and it is a lifelong commitment. So people get burned out.”

To improve compliance and adherence to daily home HD, the clinicians put new processes into place. These include a 12-question patient-screening tool, review of the prior psychosocial evaluation, and review of the dialysis machines and patient expectations.

The clinicians also had the patients complete a face-to-face interview with a social worker, home dialysis nurse, and a nephrologist. Under the current protocol, patients are now given a questionnaire routinely to address the impact of dialysis treatment schedules, hours of treatment, partners, life stressors, sleep patterns and sleep deprivation.  At Barnes-Jewish, the program also allows for “respite care” where the patient may return to the in-center HD for a short period of time.

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