title: Starting a home hemodialysis program: single center experiences.
abstract: OBJECTIVE
  Home hemodialysis (HHD) has been used only in a minority of patients over past years although it may offer significant advantages over the other renal replacement therapies. This study describes the systems for and the initial results of starting a HHD program.
  
  
  METHODS
  A program for HHD was instituted at a university hospital having more than 20 years of experience in training patients for self-care hemodialysis. A working group designed the patient and partner education program, installations, water quality assurance, logistics, and control systems.
  
  
  RESULTS
  Between May 1998 and May 2001, 37 patients with a mean age of 48.3 +/- 12.5 (24-71) years were trained for HHD (1.0 patient/month) the mean training time being 2.0 +/- 0.6 (1-3) months. Four patients had no helper at home. The dialysis schedules (timing, frequency, duration) were individualized at home 41% of the patients having more frequent and/or longer treatments (including long-slow night and daily short HHD). The weekly dialysis time increased from 13.9 +/- 1.5 (CI 13.4-14.4) initially to 15.5 +/- 3.7 (CI 14.2-16.7) h (p = 0.008) at the end of follow-up. Significantly (p < 0.05) increased serum creatinine concentration was observed during the follow-up suggesting for an increased muscle mass. Initially 32% and at the end of follow-up 60% of the patients required no antihypertensive drugs (p < 0.05). Seventeen of the 21 drop-outs were caused by renal transplantation and the most common causes necessitating hospital back-up were related to vascular access.
  
  
  CONCLUSIONS
  In conclusion the HHD program started in a unit having experience on and commitment for training self-care hemodialysis enabled individualization of the dialysis schedules resulting in the institution of long-slow (night) and alternate day as well as daily HHD therapies. It improved the control of hypertension renal transplantation being the single most common cause of drop-out.
authors.affiliation: Department of Medicine, Division of Nephrology, Helsinki University Cerntral Hospital, Kasarmikatu 11-13, FI-00130 Helsinki, Finland. eero.honkanen@hus.fi
authors.forename: Eero
authors.initials: E
authors.lastname: Honkanen
authors.forename: R
authors.initials: R
authors.lastname: Muroma-Karttunen
authors.forename: R-M
authors.initials: RM
authors.lastname: Taponen
authors.forename: C
authors.initials: C
authors.lastname: Grönhagen-Riska
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006437:Hemodialysis, Home / Q000592:standards* / Q000706:statistics & numerical data; D018575:Home Care Services, Hospital-Based; D006785:Hospitals, University; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010530:Peritoneal Dialysis; D012648:Self Care