title: Staff-assisted home hemodialysis in debilitated or terminally ill patients.
abstract: End stage renal disease (ESRD) patients who are diagnosed to have a terminal illness or severe debility have limited options for their continued care. This results in a frequent decision to withdraw dialysis support. Due to their tenuous condition, continued transportation to the dialysis facility further aggravates the emotional, financial and physical burden to the patient and family. We would like to present our data on 28 patients with severe debilitating and terminal illnesses. The mean age was 69 years with a (+/-) 11.8 SD and range of 44-87 years. Nine of them were males and 19 females. All of these were considered terminally ill as most of these patients had multi-organ failure. Ten had stroke, 16 had cardiac failure, 2 had severe vascular insufficiency, one resulting in bilateral leg amputation, 5 had debilitating pulmonary disease needing oxygen therapy and 8 had cancer. These patients were dialyzed at their home by a registered nurse (RN) according to a dialysis prescription provided by an attending nephrologist. Twenty-three patients died at home, one transferred to acute care facility and 3 to hospice care after a mean staff-assisted home hemodialysis (SAHD) duration of 14.1+/-2.9 weeks. ESRD patients with severe disability can continue dialysis in a more convenient and comfortable setting at home, and yet be relatively cost-effective.
authors.affiliation: University of Texas Medical Branch at Galveston, Internal Medicine, 77555-0562, USA.
authors.forename: Mahendra
authors.initials: M
authors.lastname: Agraharkar
authors.forename: Cynthia
authors.initials: C
authors.lastname: Barclay
authors.forename: Aruna
authors.initials: A
authors.lastname: Agraharkar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D006233:Persons with Disabilities; D005260:Female; D006437:Hemodialysis, Home / Q000191:economics* / Q000379:methods / Q000451:nursing*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D018570:Risk Assessment; D016019:Survival Analysis; D013727:Terminal Care / Q000191:economics / Q000379:methods*; D019452:Terminally Ill; D013781:Texas; D016896:Treatment Outcome