#892 Hemodialysis close to home: lessons from 9 years dialysis hubs
Authors: Logtenberg Susan , Koemeester Jose 
Published: May 2024

Abstract

Background and Aims
In the Netherlands, more than 18.000 patients are treated with renal replacement therapy (RRT) (end of 2022), of which 5.216 patients with hemodialysis (HD). Only 5% (255 patients) are treated with HD outside a dialysis center, at home. Home HD can be either performed by the patient alone, or with assistance from spouse or other informal caregiver or from a health care professional. When applicable, patients and there (dialysis)partners are trained to perform their treatment independently. Home HD can give more flexibility and independence which could improve quality of life.
To make HD close to home available for patients even if their own house is not suitable and to deal with limited resources, such as nursing support, we have started in 2015 to set up small dialysis facilities in collaboration with other healthcare providers, such as nursing homes or general practitioners, and have called them Hubs. By setting up Hubs, we ensure that dialysis remains available close to home for patients who cannot carry out the treatment completely independently or with their own partner, but need help from a care worker.

Method
We provide an overview of the logistical and technical matters involved in setting up a successful Hub and will discuss the experience so far with 11 Dianet Hubs in the Netherlands.

Results
Preparatory phase: In the run-up to a new dialysis hub a standard check list is used. The Quality and Safety department supervises the process and translates control measures into cooperation agreements. For a hub to be successful, partnership with local dialysis centers and hospitals is key. Together the best location can be pinpointed. Annual audits are carried out.
Patient characteristics and medical back up: Because a Hub is a home HD setting, good stable vascular access is mandatory, together with hemodynamic stability during sessions. However, because the HD population has multiple comorbidities, in case of instability, acute consultation with the referral center is necessary. Protocols guide the health care professional at the Hub in those circumstances. Furthermore, every hub presents new challenges that are embedded in the work processes.
Current situation: Eleven dialysis hubs, each accommodating up to 8 patients are in operation in collaboration with a partnering dialysis center. Since 2015, processes have been refined, risks identified and hubs almost continuously occupied. Due to patient factors, sometimes incenter dialysis is necessary, for example in case of access problems. We learned during the pandemic, that accessibility of the dialysis hubs located in (primary) care homes is an important factor to consider when choosing a Hub location. Both patients and partnering dialysis centers feel that our Hubs meet a need for close to home assisted HD.

Conclusion
With 11 dialysis hubs we have built up a wealth of experience. From employer perspective, deployment of dialysis nurses in hubs is profitable. HD close to home offers patients an alternative for home HD. There is great support within healthcare facilities; they experience the impact of dialysis on patients’ lives. Annual audits guarantee quality and safety.