While not called self-management, daily home hemodialysis (DHD), 5 to 7 short-duration hemodialysis treatments per week, promotes a patient’s ability to manage his or her condition. As a result, there are beneficial effects with a number of clinical outcomes including blood pressure and volume control, electrolyte balance, uremic symptoms and consequences, and quality of life. Kumar and colleagues reported on their attempt to demonstrate that DHD is feasible and results in clinical benefits that permit savings in overall healthcare costs despite expenditures on program infrastructure and supplies. The researchers examined the following outcomes each month for all patients: laboratory values, dialysis adequacy, hospital admission records, surgical and interventional radiology records, and prescription medication usage.

Twelve patients completed training in the home hemodialysis unit between April 2003 and April 2006. The mean age at the time of training was 58 years and mean vintage was 62 months. The mean treatment time was 147 min, and the mean number of treatments performed was 5.3 per week. When one patient with morbid obesity was excluded due to intentional weight loss, the mean dry weight at initiation of training increased by the end of the study. The mean albumin and phosphate binder usage also increased. During the 234 months the patents were studied, there were 11 hospital admissions, with a mean length of stay of 3.7 days.

Comments: The authors concluded that DHD improved nutritional status and decreases hospital admissions for dialysis-dependent patients. This, in turn, resulted in cost savings for the patients. The program used for home hemodialysis is straight forward in the actions required of patients. This would provide little wiggle room in the patient’s performance. Nevertheless and despite the present results, training in self-management could be expected to refine patient skills not only for more effective performance, but to help patients acquire the self-efficacy that they were making a contribution to their own health.

Do you have any comments?

V.A. Kumar et al. Daily home hemodialysis at a health maintenance organization: Three-year experience. Hemodialysis International, 2007;11:225-230.