Patient Training and Patient Safety in Home Hemodialysis

Abstract

The success of a home hemodialysis program depends largely on a patient safety framework and the risk tolerance of a home dialysis program. Dialysis treatments require operators to perform dozens of steps repeatedly and reliably in a complex procedure. For home hemodialysis, those operators are patients themselves or their care partners, so attention to safety and risk mitigation is front of mind. While newer, smaller, and more user-friendly dialysis machines designed explicitly for home use are slowly entering the marketplace, teaching patients to perform their own treatments in an unsupervised setting hundreds of times remains a foundational programmatic obligation regardless of machine. Just how safe is home hemodialysis? How does patient training affect this safety? There is a surprising lack of literature surrounding these questions. No consensus exists among home hemodialysis programs regarding optimized training schedules or methods, with each program adopting its own approach on the basis of local experience. Furthermore, there are little available data on the safety of home hemodialysis as compared with conventional in-center hemodialysis. This review will outline considerations for training patients on home hemodialysis, discuss the safety of home hemodialysis with an emphasis on the risk of serious and life-threatening adverse effects, and address the methods by which adverse events are monitored and prevented.

Figure 1

Sample training schedule highlighting learning objectives introduced in successive weeks of training with the goal of independently conducting all aspects of the home HD procedure by graduation (adapted from the training manual of the home HD program in Alberta Kidney Care North, Edmonton, Canada). HD, hemodialysis MD, medical doctor; NHD, nocturnal hemodialysis; SDHD, short daily hemodialysis; RO, reverse osmosis; RN, registered nurse.