Home hemodialysis: a comprehensive review of patient-centered and economic considerations

Figures & data

Table 1 Home HD barriers and potential solutions

Barriers	Potential solutions
Lack of exposure, visibility, and education regarding home HD	Units adopt formal predialysis education with nonbias information regarding all treatment options
Preconception that home HD is “too difficult and complex”	Training for clinical staff to increase confidence in home HD Utilization and further development of simpler home HD training machines
Lack of patient confidence to perform home HD	Peer support from established home HD patients
Fears of vulnerability and isolation from medical support	Strong clinical recommendation for home HD
Unexpected problems at early stage of home HD	Increased support when patient transitioning home
Fear of self-cannulation	Technological support for patient at home Community house models of care
Caregiver burden	Encouraging home HD independence with enhanced support Paid models of support – family members or support staff Inclusion of family members in education and training
Increased cost of home HD to patient	Transparent information regarding expected costs Reimbursement for out-of-pocket costs Community houses
Increased travel expenses	Units provide flexible and individualized training programs (after hours/5 day week/training in home)
Extended training duration	Exploration of return and training work policy
Housing problems (storage and water quality)	Developments in technology and home HD machines Independent community houses
Socioeconomic disadvantage	Reimbursement for out-of-pocket, transport, and setup costs Independent community houses Increased support and peer education for minority and indigenous groups Government policy and incentive programs

Abbreviation: HD, hemodialysis.

Figure 1 PRISMA flow chart of included studies.

Abbreviation: CKD, chronic kidney disease.

Table S1 Included studies

Author	Year	Title	Journal	Subtopic
Agar et al^Citation1	2005	Nocturnal haemodialysis: an Australian cost comparison with conventional satellite haemodialysis	Nephrology	Economic perspective
Barneih et al^Citation2	2014	Views of Canadian patients on or nearing dialysis and their caregivers: a thematic analysis	Candaian Journal of Kidney Health and Disease	Patient perspective
Berns et al^Citation3	2015	Honoring patient preferences: the 2016 National Kidney Foundation Presidential Address	AJKD	Patient perspective
Blogg et al^Citation4	2008	The experience of spouses caring for a person on home haemodialysis: an ethnography	RSAJ	Patient perspective
Brill et al^Citation5	2014	Economic benefits of increased home dialysis utilization and innovation	Report	Economic perspective
Cafazzo et al^Citation6	2009	Patient-perceived barriers to the adoption of nocturnal home hemodialysis	CJASN	Patient perspective
Cases et al^Citation7	2011	The experience of individuals with renal failure participating in home haemodialysis: an interpretative phenomenological analysis.	Journal of Health Psychology	Patient perspective
Cass et al^Citation8	2010	The economic impact of end-stage kidney disease in Australia: projections to 2020	Report	Economic perspective
Cina et al^Citation9	2013	Use of home hemodialysis after peritoneal dialysis technique failure	PDI	Patient perspective
Combes et al^Citation10	2015	Taking hospital treatments home: a mixed methods case study looking at the barriers and success factors for home dialysis treatment and the influence of a target on uptake rates	Implementation Science	Patient perspective
Cornelis et al^Citation11	2014	An international feasibility study of home haemodialysis in older patients	NDT	Patient perspective
Courts et al^Citation12	2000	Psychosocial adjustment of patients on home hemodialysis and their dialysis partners	Clinical Nursing Research	Patient perspective
Giles et al^Citation13	2003	A phenomenological investigation into the life- world of home haemodialysis	Social Work in Health Care	Patient perspective
Giles et al^Citation14	2005	The paradox of living with a home haemodialysis machine	Social Work in Health Care	Patient perspective
Gonzalez-Perez et al^Citation15	2005	Hemodialysis for end-stage renal disease: a cost- effectiveness analysis of treatment-options	Int J Technol Assess Health Care	Economic perspective
Hanson et al^Citation16	2016	Patient experiences of training and transition to home haemodialysis: a mixed methods study	Nephrology	Patient perspective
Helentera et al^Citation17	2012	Employment of patients receiving maintenance dialysis and after kidney transplant: a cross- sectional study from Finland	AJKD	Patient perspective
Howard et al^Citation18	2009	The cost-effectiveness of increasing kidney transplantation and home-based dialysis	Nephrology	Economic perspective
Howard et al^Citation19	2015	Funding and planning: what you need to know for starting or expanding a home hemodialysis program	Hemodialysis International	Economic perspective
Klarenbach et al^Citation20	2014	Economic evaluation of frequent home nocturnal hemodialysis based on a randomized controlled trial	JASN	Economic perspective
Komenda et al^Citation21	2012	An economic assessment model for in-center, conventional home, and more frequent home hemodialysis	Kidney International	Economic perspective
Komenda et al^Citation22	2010	The cost of starting and maintaining a large home hemodialysis program	Kidney International	Economic perspective
Kroeker et al^Citation23	2003	An operating cost comparison between conventional and home quotidian hemodialysis	AJKD	Economic perspective
Lim et al^Citation24	2010	How public and private reforms dramatically improved access to dialysis therapy in Malaysia	Health Affairs	Equity perspective
Liu et al^Citation25	2015	High-dose hemodialysis versus conventional in- center hemodialysis: a cost-utility analysis from a UK payer perspective	Value in Health	Economic perspective
Liyanage et al^Citation26	2015	Worldwide access to treatment for end-stage kidney disease: a systematic review	The Lancet	Equity perspective
Ludlow et al^Citation27	2012	Australian consumer perspectives on dialysis: first national census	Nephrology	Patient perspective
Malmstrom et al^Citation28	2008	Cost analysis and health-related quality of life of home and self-care satellite haemodialysis	NDT	Economic and patient perspective
Manns et al^Citation29	2007	The economics of end-stage renal disease care in Canada: incentives and impact on delivery of care	Int J Health Care Finance Econ	Economic perspective
Marshall et al^Citation30	2013	Independent community house hemodialysis as a novel dialysis setting: an observational cohort study	AJKD	Patient perspective
McFarlane et al^Citation31	2003	The quality of life and cost utility of home nocturnal and conventional in-center hemodialysis	Kidney International	Economic perspective
McFarlane et al^Citation32	2011	Economic considerations in frequent home hemodialysis	Seminars in Dialysis	Economic perspective
McLaughlin et al^Citation33	2003	Why patients with ESRD do not select self-care dialysis as a treatment option	AJKD	Patient perspective
Mehrotra et al^Citation34	2005	Patient education and access of ESRD patients to renal replacement therapies beyond in-center hemodialysis	Kidney Int	Patient perspective
Mohr et al^Citation35	2001	The case for daily dialysis: its impact on costs and quality of life	AJKD	Economic perspective
Morton et al^Citation36	2010	Patient views about treatment of stage 5 CKD: a qualitative analysis of semistructured interviews	AJKD	Patient perspective
Morton et al^Citation37	2010	The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies	BMJ	Patient perspective
Morton et al^Citation38	2011	Characteristics of dialysis important to patients and family caregivers: a mixed methods approach	NDT	Patient perspective
Morton et al^Citation39	2012	Dialysis modality preference of patients with CKD and family caregivers: a discrete-choice study	AJKD	Patient perspective
Morton et al^Citation40	2015	The impact of social disadvantage in moderate-to- severe chronic kidney disease: an equity-focused systematic review	NDT	Equity perspective
Muehrer et al^Citation41	2011	Factors affecting employment at initiation of dialysis	CJASN	Patient perspective
Muehrer et al^Citation29	2011	Factors affecting employment at initiation of dialysis	CJASN	Patient perspective
Namiki et al^Citation42	2010	Living with home-based haemodialysis: insights from older people	Journal of Clinical Nursing	Patient perspective
Navva et al^Citation43	2015	Present status of renal replacement therapy in Asian countries	Blood Purification	Economic perspective
Osterlund et al^Citation44	2014	Identification of facilitators and barriers to home dialysis selectin by Canadian adults with ESRD	Seminars in Dialysis	Patient perspective
Pierratos et al^Citation45	2016	Personal Support Worker (PSW)-supported home hemodialysis: a paradigm shift	Hemodialysis International	Patient perspective
Polaschek et al^Citation46	2003	Living on dialysis: concerns of clients in a renal setting	Journal of Advanced Nursing	Patient perspective
Polaschek et al^Citation47	2003	Haemodialysing at home: the client experience of self-treatment	Journal of Renal Care	Patient perspective
Rivara et al^Citation48	2014	The changing landscape of home dialysis in the United States	Current Opinion in Nephrology and Hypertension	Economic perspective
Robinson et al^Citation49	2016	Factors affecting outcomes in patients reaching end-stage kidney disease worldwide: differences in access to renal replacement therapy, modality use, and haemodialysis practices	The Lancet	Patient perspective
Teerawattananon et al^Citation50	2015	How to meet the demand for good quality renal dialysis as part of universal health coverage in resource-limited settings?	Health Research Policy and Systems	Economic perspective
Tong et al^Citation51	2013	The beliefs and expectations of patients and caregivers about home haemodialysis: an interview study	BMJ Open	Patient perspective
Tong et al^Citation52	2015	Research Priorities in CKD: Report of a National Workshop Conducted in Australia	AJKD	Patient perspective
Vanholder et al^Citation53	2012	Reimbursement of dialysis: a comparison of seven countries	Nephrology	Economic perspective
Vestman et al^Citation54	2014	Freedom and confinement: Patients’ experiences of life with home haemodialysis	Nursing Research and Practice	Patient perspective
Walker et al^Citation55	2015	Patient and caregiver perspectives on home hemodialysis: A systematic review	AJKD	Patient perspective
Walker et al^Citation56	2014	The cost effectiveness of contemporary home haemodialysis modalities compared to facility haemodialysis: A systematic review of full economic evaluations	Nephrology	Economic perspective
Walker et al^Citation57	2016	The economic considerations of patients and caregivers in choice of dialysis modality	Hemodialysis International	Patient perspective
Wong et al^Citation58	2009	Patients' experiences with learning a complex medical device for the self-administration of nocturnal home hemodialysis	Nephrology Nursing Journal	Patient perspective
Wyld et al^Citation59	2012	A systematic review and meta-analysis of utility- based quality of life in chronic kidney disease treatments	Plos One	Patient perspective
Xi et al^Citation60	2013	Patient experiences and preferences on short daily and nocturnal home hemodialysis	Hemodialysis International	Patient perspective
Young et al^Citation61	2012	How to overcome barriers and establish a successful home HD program	Clin J Am Soc Nephrol	Patient perspective

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