DISPELLING MYTHS IN THE UPTAKE OF HOME HAEMODIALYSIS: FOCUS ON SOCIO-DEMOGRAPHIC FACTORS

INTRODUCTION AND AIMS: Home haemodialysis (HHD) has been associated with improved morbidity and mortality in patients with end stage renal disease (ESDRD). However, uptake of this modality continues to be limited; in the UK, HHD only represents 2.1% of prevalent dialysis patients. Several barriers have been identified, including poor uptake by certain sections of the ESRD population. In our unit, new strategies implemented since 2005 have resulted in the increase of the proportion of HHD from 6.9% in 2004 to 12.7% in 2010. This study aimed to characterise the socio-demographic profiles of patients taking up HHD in before and during the period of expansion. METHODS: We retrospectively analysed data collected on patients trained for HHD in our unit from 2003 to 2010. We compared socio-demographic parameters like gender, age, race and marital status between the period 2003/2004 and 2005-2010.We also compared the Index of Multiple Deprivation (IMD), (which is based on access to housing, healthcare, education and employment) of the patients during these two periods. RESULTS: 136 patients successfully completed HHD from January 2003 to August 2010. The average number trained per year increased from 5 in 2003/2004 to 26 in 2005-2010. During this period, the mean time taken to successfully complete training has remained similar; 154±60 days in 2003/2004 and 153±41 days in 2005-2010 (p=0.72). The mean age has increased from 40.3±10 to 48.2 ± 8 years. In this “expansion era”, 41.2% of the patients were above 50 years when they enrolled for training. The female to male sex ratio increased from 1:3 to 1:1.8. Only 10% of unmarried patients enrolled for training in 2003/2004; this has increased to 42.6%. Also, whilst only two patients were from ethnic minority groups in the first period, this increased to 21% in 2005-2010. Although the median IMD of patients starting training is similar between the two periods (44.95% and 42.48% respectively, p=0.83) patients with much lower indexes (more deprived) were enrolled in the second period. The minimum IMD in 2003/2004 was 7.87%, whilst in 2005-2010 it was 0.01%. Also, only 10% of patients in the “first era” had an IMD of less than 10%; this increased to 19.1% in the second period. There was no correlation between the IMD rank and time taken to complete training (r=-0.05). CONCLUSIONS: Extending HHD to all socio-demographic groups seems to be crucial to increasing uptake of HHD and hence increasing the proportions patients using this therapy. Embracing these new groups does not seem to have any impact on the duration of successful training to self care.