Main Barriers to the Introduction of a Home Haemodialysis Programme in Poland: A Review of the Challenges for Implementation and Criteria for a Successful Programme

Overview

Journal J Clin Med

Specialty General Medicine

Date 2022 Jul 27

PMID 35887931

Authors

Dana Kendzia

Federica Lima

Jacek Zawierucha

Ellen Busink

Christian Apel

Jacek Stanislaw Malyszko

Pawel Zebrowski

Jolanta Malyszko

Affiliations

Soon will be listed here.

Abstract

Introduction: Home dialysis in Poland is restricted to the peritoneal dialysis (PD) modality, with the majority of dialysis patients treated using in-centre haemodialysis (ICHD). Home haemodialysis (HHD) is an additional home therapy to PD and provides an attractive alternative to ICHD that combines dialysis with social distancing; eliminates transportation needs; and offers clinical, economic, and quality of life benefits. However, HHD is not currently provided in Poland. This review was performed to provide an overview of the main barriers to the introduction of a HHD programme in Poland.

Main Findings: The main high-level barrier to introducing HHD in Poland is the absence of specific health legislation required for clinician prescribing of HHD. Other barriers to overcome include clear definition of reimbursement, patient training and education (including infrastructure and experienced personnel), organisation of logistics, and management of complications. Partnering with a large care network for HHD represents an alternative option to payers for the provision of a new HHD service. This may reduce some of the barriers which need to be overcome when compared with the creation of a new HHD service and its supporting network due to the pre-existing infrastructure, processes, and staff of a large care network.

Conclusions: Provision of HHD is not solely about the provision of home treatment, but also the organisation and definition of a range of support services that are required to deliver the service. HHD should be viewed as an additional, complementary option to existing dialysis modalities which enables choice of modality best suited to a patient's needs.

References

Ludlow M, George C, Hawley C, Mathew T, Agar J, Kerr P . How Australian nephrologists view home dialysis: results of a national survey. Nephrology (Carlton). 2011; 16(4):446-52. DOI: 10.1111/j.1440-1797.2010.01403.x. View

Rydell H, Ivarsson K, Almquist M, Clyne N, Segelmark M . Fewer hospitalizations and prolonged technique survival with home hemodialysis- a matched cohort study from the Swedish Renal Registry. BMC Nephrol. 2020; 20(1):480. PMC: 6937632. DOI: 10.1186/s12882-019-1644-z. View

Marshall M, Polkinghorne K, Kerr P, Hawley C, Agar J, McDonald S . Intensive Hemodialysis and Mortality Risk in Australian and New Zealand Populations. Am J Kidney Dis. 2015; 67(4):617-28. DOI: 10.1053/j.ajkd.2015.09.025. View

Vanholder R, Davenport A, Hannedouche T, Kooman J, Kribben A, Lameire N . Reimbursement of dialysis: a comparison of seven countries. J Am Soc Nephrol. 2012; 23(8):1291-8. DOI: 10.1681/ASN.2011111094. View

Yeoh E, Wong M, Wong E, Yam C, Poon C, Chung R . Benefits and limitations of implementing Chronic Care Model (CCM) in primary care programs: A systematic review. Int J Cardiol. 2018; 258:279-288. DOI: 10.1016/j.ijcard.2017.11.057. View

Yau K, Muller M, Lin M, Siddiqui N, Neskovic S, Shokar G . COVID-19 Outbreak in an Urban Hemodialysis Unit. Am J Kidney Dis. 2020; 76(5):690-695.e1. PMC: 7362862. DOI: 10.1053/j.ajkd.2020.07.001. View

Rydell H, Ivarsson K, Almquist M, Segelmark M, Clyne N . Improved long-term survival with home hemodialysis compared with institutional hemodialysis and peritoneal dialysis: a matched cohort study. BMC Nephrol. 2019; 20(1):52. PMC: 6375181. DOI: 10.1186/s12882-019-1245-x. View

Beby A, Cornelis T, Zinck R, Liu F . Cost-Effectiveness of High Dose Hemodialysis in Comparison to Conventional In-Center Hemodialysis in the Netherlands. Adv Ther. 2016; 33(11):2032-2048. DOI: 10.1007/s12325-016-0408-4. View

Karkar A, Hegbrant J, Strippoli G . Benefits and implementation of home hemodialysis: A narrative review. Saudi J Kidney Dis Transpl. 2015; 26(6):1095-107. DOI: 10.4103/1319-2442.168556. View

10.

Schiller B, Munroe H, Neitzer A . Thinking outside the box-identifying patients for home dialysis. NDT Plus. 2015; 4(Suppl 3):iii11-iii13. PMC: 4421467. DOI: 10.1093/ndtplus/sfr123. View

11.

Corbett R, Blakey S, Nitsch D, Loucaidou M, McLean A, Duncan N . Epidemiology of COVID-19 in an Urban Dialysis Center. J Am Soc Nephrol. 2020; 31(8):1815-1823. PMC: 7460899. DOI: 10.1681/ASN.2020040534. View

12.

Humphreys J, Harvey G, Coleiro M, Butler B, Barclay A, Gwozdziewicz M . A collaborative project to improve identification and management of patients with chronic kidney disease in a primary care setting in Greater Manchester. BMJ Qual Saf. 2012; 21(8):700-8. DOI: 10.1136/bmjqs-2011-000664. View

13.

Fluck R, Fouque D, Lockridge Jr R . Nephrologists' perspectives on dialysis treatment: results of an international survey. BMC Nephrol. 2014; 15:16. PMC: 3912927. DOI: 10.1186/1471-2369-15-16. View

14.

Marshall M, van der Schrieck N, Lilley D, Supershad S, Ng A, Walker R . Independent community house hemodialysis as a novel dialysis setting: an observational cohort study. Am J Kidney Dis. 2012; 61(4):598-607. DOI: 10.1053/j.ajkd.2012.10.020. View

15.

Schachter M, Tennankore K, Chan C . Determinants of training and technique failure in home hemodialysis. Hemodial Int. 2013; 17(3):421-6. DOI: 10.1111/hdi.12036. View

16.

Taylor D, Fraser S, Bradley J, Bradley C, Draper H, Metcalfe W . A Systematic Review of the Prevalence and Associations of Limited Health Literacy in CKD. Clin J Am Soc Nephrol. 2017; 12(7):1070-1084. PMC: 5498363. DOI: 10.2215/CJN.12921216. View

17.

Whitlow M, Wallace E . Remote Patient Monitoring: An Important Tool in Advancing Home Dialysis. Kidney Med. 2020; 1(6):327-328. PMC: 7380348. DOI: 10.1016/j.xkme.2019.10.002. View

18.

Hope J . A patient perspective on the barriers to home dialysis. J Ren Care. 2013; 39 Suppl 1:3-8. DOI: 10.1111/j.1755-6686.2013.00333.x. View

19.

Morita P, Huynh K, Zakir A, Cafazzo J, McQuillan R, Bargman J . Supporting the Establishment of New Home Dialysis Programs Through the Explore Home Dialysis Program. Kidney Int Rep. 2019; 4(2):293-300. PMC: 6365366. DOI: 10.1016/j.ekir.2018.10.019. View

20.

Maguire N . Personal experiences of home haemodialysis: patients' and carers' experiences. NDT Plus. 2015; 4(Suppl 3):iii25-iii26. PMC: 4421468. DOI: 10.1093/ndtplus/sfr125. View