Dr MADDISON TAYLOR1, Associate Professor YEOUNGJEE CHO1, Ms SHEREE SODEMAN1, Mr RODNEY BRICKLE1, Ms LISA DITTERICH1, Ms DIANA LEARY1, Dr CAROLYN VAN EPS1
1Princess Alexandra Hospital, , Australia
Biography:
Dr Maddison Taylor is completing her final year of Advanced Training in Nephrology at the Princess Alexandra Hospital and completing her fellowship at the Queensland Kidney Transplant Service. Dr Taylor has a passion for delivering personalised, patient centred care and improving their health care journey. She completed her medical training at Griffith University and formative years at Townsville University Hospital. Prior to this completing her Bachelor of Biomedical Science with Honours with a focus on migraine genetics.
Aim:
To describe the process and outcomes for patients trained to receive haemodiafiltration at home.
Background:
Home haemodialysis offers advantages over facility-based haemodialysis including better outcomes, quality of life, and flexibility at a lower cost. In recent years, haemodiafiltration (HDF) has become the mainstay of facility-based haemodialysis, with demonstrated benefit in reducing cardiovascular mortality. Implementation of HDF at home has been limited by technical barriers (e.g., need for ultra-pure substitution fluid) and concerns for training requirements, which may be disadvantaging patients dialysing at home.
Methods: Patients who underwent HDF training between 2014-2024 at the Princess Alexandra Hospital were included. Data including demographics, training, water, dialysis-related characteristics and outcomes were analysed descriptively.
Results:
In total, 42 patients successfully trained to perform HDF at home (67% male, mean age 51.1 years; 19 patients (45%) converted from HD). Median training duration was 61 days, with longer median duration for patients undergoing new start dialysis (median 126 days), compared to those who re-trained from HD to HDF (median 14.5 days, p<0.05). HDF prescriptions were highly variable to support flexibility, with average treatment duration of 15.7 hours/week (range 7-30 hours/week). The most common regimen was 5 hours/session, thrice weekly (38%). In the first six months after commencing home HDF, there were no admissions to hospital due to dialysis-related technical issues. Main water source for HDF was reticulated water (95%), with two patients using tank water. There were 23 flagged infringements to ultrapure dialysis fluid throughout the 68.5 total patient years on home HDF; without any adverse events to patients.
Conclusions:
Haemodiafiltration at home is a safe, effective, and preferable therapy for many patients offering increased flexibility and personalised prescriptions.
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