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Home hemodialysis (HHD) can be an ideal modality choice for patients with End Stage Kidney Disease (ESKD) as it may offer several clinical and quality of life benefits. HHD patients undergo training before starting the therapy at home. However, like any other training program, it requires adequate resources and investments. The success of training depends on the quality and quantity of the training, as well as many other factors such as health literacy and the patient’s unique situation. There is a need to balance the amount of training provided to optimize the successful initiation of HHD. The goal of our analysis was to identify the optimal number of days for training HHD patients.
We used HHD patients from a large dialysis provider who had HHD training orders completed during Jan 2021 and March 2023. For each patient, we calculated the overall sum of training days or the total count of HHD training treatments completed. If a patient had any home treatment after a completed HHD training order, we considered it as training success. For each possible number of training days, we gathered all patients who completed that many training days and calculated the rate of training success rate. We calculated the correlation between the rate of training success and number of trainings days.
During the analysis period there were 11,620 patients who received HHD training. 77% (8980) of the patients had at least one successful home treatment after the first completed training treatment. The correlation between training days and success rate was strong (0.73) and statistically significant (P value <0.0001). Figure 1 shows the plot of success rate and the number of training days. The optimal number of training days was around 20-25 days. Although the success rate does not peak at this interval, one additional day of training day does not increase the success rate.
The number of training days is highly correlated to the success of patients receiving HHD in their home. For the cohort analyzed, the optimal number of days is in the interval of 20-25 days. Providing additional training beyond this period may not yield additional benefits for most patients. It is also important to note that HHD training of 20-25 days does not ensure success with graduation from training or retention on HHD modality. Further studies are required to confirm this association.