Home and Community Care Digest

Home and Community Care Digest December 2004 : 0-0

Home hemodialysis achieves better outcomes than in other care settings

Abstract

Due to advances in technology and the significant time and disruption to patients' lives caused by hemodialysis treatment, home hemodialysis has gained increasing attention. This study compares treatment outcomes of home hemodialysis to those receiving hemodialysis in hospitals and outpatient clinics. Home hemodialysis resulted in better treatment outcomes than other care settings on the majority of outcomes considered. The major negative finding related to home hemodialysis is that family members found providing care more disruptive to their lives and more stressful. Home hemodialysis may continue to be a viable option for many patients, provided that appropriate supports and respite for family members are in place.
Background: The number of people with end-stage renal disease (ESRD) continues to rise in many developed countries, resulting in increasing numbers receiving renal therapy, usually hemodialysis. Due to advances in technology and the significant time and disruption to patients' lives caused by hemodialysis treatment, home hemodialysis has gained increasing attention. This study compares treatment outcomes of home hemodialysis to those receiving hemodialysis in hospitals and outpatient clinics.

Methods: This study was a systematic review of the literature, spanning 1985 to 2001 and including all major medical journal databases. The review included randomized control trials, comparative observational studies, and systematic reviews that compared home with hospital or outpatient clinic hemodialysis for patients with ESRD. Outcomes included quality of life, survival, technical aspects, access to care, hospitalization rates, employment status, as well as measures of health status and comorbidities. Twenty-seven studies were included in the final review. Across all studies, 1,760 patients received care at home, 8,360 in hospital, and 1,258 in outpatient clinics.

Findings: In general, home hemodialysis patients were in better health and had fewer comorbidities than those receiving care in hospital or in clinics. Home hemodialysis patients reported better quality of life and psychological well-being than other groups and were more able to participate in activities of daily living. After controlling for differences between treatment groups, home-based patients had lower mortality rates than hospital patients, but similar survival rates to outpatient clinic patients. Home-based patients were the most likely to be employed, and also performed best on a number of biomedical indicators (blood pressure, adverse events, biochemical markers). The major negative finding related to home hemodialysis is that family members found providing care more disruptive to their lives than other groups, reporting fewer social contacts and higher stress.

Conclusions: Home hemodialysis resulted in better treatment outcomes than other care settings on the majority of outcomes considered. Because the majority of home hemodialysis patients are younger and in better health than those receiving care elsewhere, these results are not conclusive. However, they do suggest that home hemodialysis may continue to be a viable option for many patients, provided that appropriate supports and respite for family members are in place. Finally, a new generation of home hemodialysis machines currently under development may improve ease of use, reduce complications and the burden to caregivers.

Reference: Mowatt, G., Vale, L., MacLeod, A. "Systematic review of the effectiveness of home versus hospital or satellite unit hemodialysis for people with end-stage renal failure". International Journal of Technology Assessment in Health Care, 2004; 20:3, 258-268.

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