Recruitment and training for home hemodialysis: experience and lessons from the Nocturnal Dialysis Trial

Abstract

Background and objectives: We assessed perceived barriers and incentives to home hemodialysis and evaluated potential correlates with the duration of home hemodialysis training.

Design, settings, participants, & measurements: Surveys were sent to the principal investigator and study coordinator for each clinical center in the Frequent Hemodialysis Network Nocturnal Trial. Baseline data were obtained on medical comorbidities, cognitive and physical functioning, sessions required for home hemodialysis training, and costs of home renovations.

Results: The most commonly perceived barriers included lack of patient motivation, unwillingness to change from in-center modality, and fear of self-cannulation. The most common incentives were greater scheduling flexibility and reduced travel time. The median costs for home renovations varied between $1191 and $4018. The mean number of home hemodialysis training sessions was 27.7 +/- 10.4 (11-59 days). Average training time was less for patients with experience in either self-care or both self-care and cannulation. The number of training sessions was unrelated to the score on the Modified Mini Mental Status or Trailmaking B tests or patient's education level. Training time also did not correlate with the SF-36 Physical Function subscale but did with the modified Charlson comorbidity score and older patient age.

Conclusions: Lack of patient or family motivation and fear of the dialysis process are surmountable barriers for accepting home hemodialysis as a modality for renal replacement therapy. Formal education and scores on cognitive function tests are not predictors of training time.

Figure 1.

Fate of patients enrolled in the FHN Nocturnal Trial.

Figure 2.

Associations of access type, prior training, cognition and age on training time for home hemodialysis. There was no difference in training time between those randomized to conventional versus nocturnal dialysis. (A) Patients using a tunneled catheter required marginally fewer sessions. (B) Patients having experience in self-care centers required fewer training sessions. (C) Score on the Modified Mini Mental Status Exam had no association with the number of sessions needed to complete training. (D) Age had a positive association with the number of sessions needed to complete training. See text for details. Box plots indicate 10th, 25th, 50th, 75th, and 90th percentiles. +, mean value.