Home Dialysis and Incremental Haemodialysis
Authors: Roblero Maria F. Slon , Vilar Enric , Shuaib Rishana , Duncan Neill , Kotanko Peter , Schmitt Roland 
Published: May 2024

The who's and how's of these therapy options explained through patient stories

Schedule:
1. 11:30-12:00 My Place - Case 1 - Maria F Slon Roblero
2. 12:00-12:30 My Time - Case 2 - Enric Vilar
3. 12:30-13:00 Panel discussion

"My Place" - Home Dialysis

Title: Home Dialysis: My Place
Patients with chronic kidney disease have different treatment options available to them throughout their lifetime. The choice of treatment not only impacts their immediate well-being but also has significant implications for their long-term outcomes, shaping their overall experience and perception of their condition throughout their journey.
Healthcare professionals advocate for a shared decision-making process to assist patients in selecting the most suitable treatment option. This process places the patient's individual goals, needs, and priorities at the forefront, emphasizing the importance of comprehensive information and education provided by healthcare providers to empower patients in making informed choices.
Among the various kidney replacement therapy options, home dialysis stands out as an exceptional choice. It offers more than just treatment delivery; it promotes autonomy, flexible scheduling, and reduced visits to healthcare centers, allowing patients more time for activities and improving their quality of life. Evidence suggests that these benefits not only enhance perceived well-being but also foster a more active participation in their own lives; enabling them to tailor treatment to their personal needs and circumstances.
While it may sometimes seem that a patient is unsuitable for home treatment, in the majority of cases, they are indeed suitable. Therefore, it's crucial not to limit information provided to patients and to respect individual priorities. Supporting patients' decisions and fostering a proactive attitude towards both the disease and its treatment is essential. This personalized and respectful approach guides patients toward the achievement of their goals and the optimization of their well-being—an integral aspect of what home dialysis accomplishes.
Home dialysis therefore, reveals itself to be more than a treatment: it is a lifestyle. By encouraging autonomy, flexibility, and active participation in daily life, this approach aims not only to restore physical health but also seeks to empower patients to lead rich and meaningful lives.

"My Time" - Incremental Dialysis

Most patients in the UK dialyse for 3.5 to 4 hours thrice weekly without individualisation of dialysis frequency or time. Incremental haemodialysis is a different individualised approach to dialysis whereby dialysis frequency is permitted to be reduced in patients who retain significant residual renal function and dialysis intensity is increase as natural kidney function is lost. Incremental dialysis may involve less frequent dialysis (typically twice weekly) but can extend to increased dialysis intensity above thrice weekly in patients who have little to no natural kidney function.
There is growing evidence that incremental haemodialysis is at least as safe as a conventional non-individualised thrice weekly approach based on two published feasibility trials and retrospective data. These studies indicate that there may be benefits such as reduced hospitalisation compared to a conventional approach. It is also possible that vascular access events may be less common since in less frequent dialysis dialysis catheters and fistulas/grafts are used less often. Incremental dialysis appears to be substantially cost saving.
However, there are significant barriers to implementation: staff education, patient education, measurement of natural kidney function and also the challenge of adding together dialysis clearance and residual renal clearance to ensure safety.
In this session I will discuss the evidence for benefit of this approach, drawbacks and the challenges of implementation.