MO898NEW ORGANISATIONAL MODEL OF HOME HEMODIALYSIS: THE EXPERIENCE OF THE PROVINCE OF BELLUNO
Authors: Carlassara Lucrezia , Pastori Giordano , Savi Umberto , Pasqualetto Marco , Giozzet Morena , Bandera Andrea 
Published: May 2021

Abstract

Background and Aims
Belluno is a mountainous province of 3610 Km2, with a low population density (56 people/Km2), and an high ISTAT old age index of 228. Four HemoDialysis (HD) Centers assist 112 patients, who spend up to 8 hours/week by ambulance to arrive at the HD Center, with a CO2 estimated emission (EE) up to 6.6 ton/year patient. The cost of in-Center HD may reach up to 61.000 €/year patient. Giving these premisis, we consider as first choice either Peritoneal Dialysis or Home HD (HDD), otherwise than in-Center HD. HHD can be Not assited HHD (NHHD), performed by the patient himself, or Assisted HHD (AHHD), the new HHD service which involves a nurse assistance at home. Both HHDs enables patients to stay at home, may improve patient’s quality of life, reduce the HD costs (32.000-34000 €/year patient), and may reduce the environmental burden of the healthcare procedures (CO2 EE of 0-2.3 ton/year patient).

Method
One patient have undertaken NHHD and other two the AHHD. Patient 1, on NHHD, is a 50 year old (y.o.) male, on HD since 9/2013. His Past Medical History (PMH) encompasses End Stage Renal Disease (ESRD) due to IgA Nephropathy, a previous kidney transplant, and hypertensive cardiopathy. Patient 2, on AHHD, is a 88y.o. woman, on HD since 01/2020. Her PMH includes ESRD due to multiple myeloma, and hypertension. Patient 3, on AHHD, is a 95y.o. male on HD since 09/2009. His PMH includes ESRD due to hypertensive nephropathy, atrioventricular block with pacemaker, hepatopathy.
HHD is performed utilising: the NxStage System (Fresenius®) for NHHD, and the Dialog iQ® System (B.BRAUN®) for AHHD. The HD prescription plans 2 hours treatment for 6 times/week for NHHD, and 4 hours treatment for 3 times/week for AHHD.
The total amount of the economical resoureces employed for HD comprise: HD equipment, healthcare-worker, and ambulance transportation (Figure).
The EE of CO2 have been determined using a calculator (www.myclimate.org). The EE of CO2 for in-Centre HD comprise both those caused by patients and nurses (Figure). We assumed the same fuel consumption of a diesel Van for the ambulances one. We assumed that nurses use a diesel compact car to commute.

Results
All patients reported a significantly improved quality of life because they were able to avoid many hours of travel to reach the HD Center. Moreover, the patient on NHHD, appreciated an increased subjective wellness, a greater independence in setting the daily work and personal appointments, and a wider freedom in the eating and drinking habits.
The economical resources that may be riallocated by the Healthcare System are up to 30.000 €/year patient.
Finally, the environmental burden of the HD procedures may be significantly reduced, with a CO2 EE saved up to 6.6 ton/year patient (equal to 3 round-trip flights Venice-NY).

Conclusion
Home HD enable patients and their families to substantially improve their quality of life, provide a safe and effective dialysis treatment for the patients, contribute to operational efficiency of the healthcare system, and reduce both the economical impact and the environmental burden of hemodialysis. In conclusion, we believe both HHDs are exellent solution, in particular NHHD for active young patients, and AHHD for fragile patients without a caregiver, resulting in a better management and outcome.