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Dialysis treatment carries a high burden for patients, families, and care givers. Elderly patient with limited mobility and multiple comorbidities specifically suffer poor quality of life on dialysis. This population unlikely to be candidate for traditional home hemodialysis (HHD) modality. Our study presenting our novel experience in the state of Qatar with providing Assisted HHD (AHHD) for elderly patients with limited mobility in their home environment.
A Retrospective nationwide study performed between July 1st 2021 - December 31st 2022. Our objectives were evaluating efficacy and safety of AHHD. We included all adult chronic HD elderly patients who are using ambulance (or eligible for it). We excluded patients who are not suitable for home therapy (psychiatric illness, aggressive behavior, etc.). National electronic medical record was used to obtain data.
We had 76 patients (57.9% females) accepted and started AHHD out of 197 eligible patients. Main reason for rejecting the program (121 patients) were feeling safer in the clinic setting or improper home environment. Mean age was 73+/-11 years. During average follow up period off 7 months, around 4500 dialysis sessions were provided, 12 patients had died, and 2 patients returned to dialysis center (retention rate of 97.4%). We had 55 patients had permcath and 21 had AV fistulas. 8 incidents of dialysis catheter malfunction reported during our study (6 required tPA installation in the house setting and only two needed catheter exchange (one had catheter related infection)). No reported significant access bleeding or hypotension episodes. We found a significant decrease of hospitalization rates (40%) compared to pre-study period with only 12% were related to dialysis (mostly due to volume overload and non-compliance with dialysis schedule). We had only 20 minor technical incidents related to electricity or water supply failures that was resolved without much interruption of treatment. The program overall was cost effective and reduced cost by over 25% (mostly related to saving of ambulance cost). Patients and families were satisfied with program, improved QOL by reducing ambulance transfer time and burden and having HD in the comfort in their home among their family. Quality measures including adequacy, anemia, and mineral and bone parameters were maintained. Patients had very low incidence of COVID-19 compared to our average in center dialysis patients.
Our distinctive AHHD program found to be successful, cost effective, and improved patients care and QOL.