A home hemodialysis (HHD) is the hemodialysis , performed by the patient at home on their own responsibility, often with the support of a partner.
The development of HHD goes back to the American doctor Belding Scribner . It was also he who developed a new type of shunt in 1960 . The immense cost of dialysis at the time, as well as the number of patients and the associated rising costs, forced doctors and health systems around the world to implement cost-saving measures. In 1964, Belding Scribner began training patients on dialysis to give them the option of HHD. Further technical advances led to simpler and less complex machines. The HHD spread. It was not until 1980 that the number of HHD patients began to decline worldwide. The KfH Board of Trustees for Dialysis and Kidney Transplantation is still abbreviated to KfH today because it was founded in 1969 as the Board of Trustees for Home Dialysis .
Advantages of the HHD
- The first and most important advantage is the longer life expectancy . It can be explained by the more regular and frequent dialysis and the much greater knowledge of the patients.
- A second advantage that should not be underestimated is the self-determination of the patient.
- The flexible times are also a huge advantage. This relates to both the times and the duration of dialysis (e.g. night dialysis ) and their combinations.
- Familiar and comfortable environment with everything a patient would like (TV, reading, sleeping, visiting friends ...).
- Independence from nursing staff and other patients.
- Time savings, depending on the distance between your home and the dialysis center.
- Cost savings for the healthcare system , since no space and no staff have to be reserved (in the event of complications, of course, the dialysis center must be visited again).
- A better feeling with holiday dialysis, as the patient can puncture himself, knows the settings and can argue with the nursing staff at eye level.
Disadvantages of the HHD
- Relatively high stress on the partner and the partnership, which is usually accepted with pleasure.
- Certain structural requirements (water inlet and water outlet) or space for machine, osmosis and material (approx. 1 m³).
- In the event of complications (termination of dialysis, shunt closure, etc.), the options are limited. A dialysis center may be able to respond more professionally here.
A phone should always be at hand and emergency lighting (functional flashlight) available for emergencies.
The other requirements are divided into two groups.
Technology / storage space
A suitable dialysis machine is required for hemodialysis . Despite the technical progress, this machine is still of considerable size (e.g. Gambro AK200).
Both machines require an inlet and outlet. Most patients have the dialysis machine in the bedroom and the reverse osmosis in the bathroom.
A water inlet is connected to the reverse osmosis in the bathroom. A hose goes from her to the dialysis machine for the supply of pure water. Another hose goes into the sewage system as a drain (e.g. as a hose in the bathtub).
This is used to dispose of excess water during dialysis as well as during regular cleaning and decalcification.
The dialysis machine also needs a drain to dispose of excess and used dialysate.
It is also recommended that dialysis supplies are stored for two to three months. This means that there must be space the size of a wardrobe.
The patient and his dialysis partner
The patient should of course have a good understanding of their illness. He must be able to classify changes in his body and, if necessary, inform his nephrologist about them at an early stage.
In other words, it needs to be trained well. This usually happens in his dialysis center . In any case, he has been on dialysis for some time and knows the sequence of a dialysis session. Many patients want to have home dialysis with their partner, but this is not absolutely necessary.
This partner is also trained in the center. The puncture of the shunt is often the first major hurdle. It takes a lot of effort to puncture yourself or your partner .
The assembly and dismantling of the machine, troubleshooting and maintenance ( disinfection , decalcifying the reverse osmosis ) must be well mastered by both. This is achieved by the fact that both of them carry out the assembly and dismantling in the dialysis center first under guidance and later independently with control. As soon as the dialysis center is of the opinion that the patient has been adequately trained, the devices are delivered to the patient's home and connected.
The material can usually be brought in or the patient picks it up independently.
Reasons for the falling prevalence in Germany
Although it is very beneficial for patients to have hemodialysis at home, the number of home dialysis patients in Germany is falling and has recently reached 0.6% of those requiring dialysis.
There does not seem to be any interest on the part of the patients or they are no longer informed about this possibility.
This can have different causes:
- The dialysis centers are widespread across Germany. This means there are relatively short travel times.
- There are enough dialysis places in Germany, there are no bottlenecks.
- The dialysis patients are older on average and often suffer from other illnesses. This limits the suitability for HHD in the majority of patients.
- The living situation, especially with older patients, is often such that the space required for HHD is not available.
- The cost pressure is no longer as strong as it used to be. More than less is invested in the health system .
- The willingness of the patient to take responsibility decreases or self-determination is no longer demanded as much (experience of the author).
- The increasingly successful organ transplants .
As alternatives to home hemodialysis, there are other competing procedures for kidney dialysis ( kidney replacement procedures ), which can also be carried out in the patient's apartment or in the nursing home . These are the different home dialysis methods . The focus is on peritoneal dialysis . If assistants are required here, one speaks of assisted peritoneal dialysis as opposed to independent peritoneal dialysis .
Hospital dialysis is an alternative to center dialysis and home dialysis .
An alternative to the usual home hemodialysis (around three times a week) is daily intermittent hemodialysis (iHD) for around four hours a day. Further options are continuous kidney replacement procedures over 18 to 24 hours a day. A distinction is made here between continuous veno-venous hemodialysis (CVVHD), continuous veno-venous hemofiltration (CVVH) and continuous veno-venous hemodiafiltration (CVVHDF). These three procedures are also available for home treatment.
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