About the Toolkit

Home hemodialysis (HD) is associated with numerous clinical advantages over facility-based hemodialysis. These advantages include improvements in survival,1-3 cardiovascular endpoints,4,5 mineral metabolism,5,6 quality of life, and patient autonomy.7,8

Perhaps most importantly, treatment in the home environment liberates patients from strict dialysis schedules and provides flexibility for them to receive enhanced HD regimens, allowing them to meet their clinical and patient-centered goals. In recent years, there has been significant growth in the number of home HD patients worldwide; however, most experts feel that home HD remains underutilized.9

Despite recognizing the potential benefits of home therapy, oftentimes clinicians without direct experience in home HD may be uneasy about recommending this modality for their patients, and some may be uncertain where or how to begin offering home HD therapy. One of the identified gaps in recognizing home HD as a viable modality is a lack of practical resources available to facilitate adoption of home HD through the initiation or expansion of a program.10-12

To address this need, we initiated The Global Forum for Home Hemodialysis, comprised of internationally recognized nephrologists, home HD nurses, administrators, and patient advocates, and a patient who has undergone home HD for more than 10 years. This collaborative has worked to develop a comprehensive, open-source, web-enabled, practical manual for healthcare teams and providers to create and/or expand a home HD program.

The manual contains a wealth of information gleaned from the panel members’ cumulative clinical experience, and is presented in the form of modules that have been reviewed internally by forum members and by an external peer-review process. In it, you will find a suite of practical tools (eg, checklists for vascular access audits, business case templates, psychosocial support guides, etc), accessible through both web-based and downloadable PDF formats.

There is no doubt that home HD has repositioned itself as a valid, safe, and effective form of renal replacement therapy, with the potential to deliver better care for our patients in the future. It is our hope that this website will act as a catalyst to enhance the momentum of change!

References

Marshall MR, Hawley CM, Kerr PG, Polkinghorne KR, Marshall RJ, McDonald SP. Home hemodialysis and mortality risk in Australian and New Zealand populations. Am J Kidney Dis. 2011;58:782-793.

Nesrallah GE, Lindsay RM, Cuerden MS, et al. Intensive hemodialysis associates with improved survival compared with conventional hemodialysis. J Am Soc Nephrol. 2012;23:696-705.

Tennankore KK, Kim SJ, Baer HJ, Chan CT. Survival and hospitalization for intensive home hemodialysis compared with kidney transplantation. J Am Soc Nephrol. 2014;252113-20.

Chan CT, Greene T, Chertow GM, et al. Effects of frequent hemodialysis on ventricular volumes and left ventricular remodeling. Clin J Am Soc Nephrol. 2013;8:2106-2116.

Culleton BF, Walsh M, Klarenbach SW, et al. Effect of frequent nocturnal hemodialysis vs conventional hemodialysis on left ventricular mass and quality of life: A randomized controlled trial. JAMA. 2007;298:1291-1299.

Daugirdas JT, Chertow GM, Larive B, et al. Effects of frequent hemodialysis on measures of CKD mineral and bone disorder. J Am Soc Nephrol. 2012;23:727-738.

Chertow GM, Levin NW, et al; for the FHN Trial Group. In-center hemodialysis six times per week versus three times per week. N Engl J Med. 2010;363:2287-2300.

Tennankore K, Nadeau-Fredette AC, Chan CT. Intensified home hemodialysis: Clinical benefits, risks and target populations. Nephrol Dial Transplant. 2014;29:1342-1349.

MacGregor MS, Agar JW, Blagg CR. Home haemodialysis—international trends and variation. Nephrol Dial Transplant. 2006;21:1934-1945.

Muroma-Karttunen R. Almost anyone can have home therapy but can we overcome the barriers? J Ren Care. 2013;39(Suppl 1):22-27.

Ludlow MJ, George CRP, Hawley CM, et al. How Australian nephrologists view home dialysis: Results of a national survey. Nephrology (Carlton). 2011;16:446-452.

Berns JS. A survey-based evaluation of self-perceived competency after nephrology fellowship training. Clin J Am Soc Nephrol. 2010;5:490-496.