Barriers to implementation of successful home hemodialysis include lack of patient and physician education, according to a study published online in the Clinical Journal of the American Society of Nephrology.

Noting that home hemodialysis is an underused dialysis modality in the United States, Bessie A. Young, MD, from the Puget Sound Health Care System at the University of Washington in Seattle, and colleagues examined the barriers to home hemodialysis, focusing on patients, individual physicians and practices, and dialysis facilities. Suggestions to overcome these barriers were made.

The researchers found that the benefits of home hemodialysis included potential for greater dialysis delivery; improvements in patient independence, rehabilitation, and employment potential; and greater ability to travel. The main patient barriers to home hemodialysis were lack of patient education and patient perceptions. For physicians, evidence suggested that education gaps exist regarding home therapy. Additional barriers included mechanical complexity of conventional hemodialysis systems; large requirement for water; and the cost of setting up the home for hemodialysis. The organization and structure of a home hemodialysis program should include adequate patient education, physician and nurse training, adequate staffing, and appropriate continual quality improvement programs.

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“Home hemodialysis has the potential to allow patients to enjoy increased freedom, quality of life, greater ability to travel, and tangible improvements in several domains of medical outcomes,” the authors concluded. “Increased physician and patient education can eliminate barriers to home hemodialysis and increase its use.”