Equipment and water treatment considerations for the provision of quotidian home hemodialysis.
BACKGROUND
Whereas clinical benefits of more frequent hemodialysis (HD) treatment are well documented, little information is available about technical aspects involved in setting up a patient's home for home HD. Technical considerations include the home infrastructure, as well as required plumbing modifications and electrical hook-ups.


METHODS
Twenty home HD installations were supported for the London Daily/Nocturnal Hemodialysis Study. The Fresenius 2008H (Fresenius Medical Care, North America, Lexington, MA) HD machine was used for all home HD installations in conjunction with a Service Deionization Tank (SDI) water treatment system composed of pretreatment, purification, and posttreatment components. To ensure that SDI systems provided high-quality water and dialysate, standard bacteriological testing was performed throughout the study, and patient serum C-reactive protein (CRP) levels were tracked as an indicator of nonspecific inflammation.


RESULTS
The annual number of hours of work required for each home HD installation and service/maintenance was approximately 75 and 58 hours, respectively. Water quality proved high because there were only 4 occurrences of failed endotoxin and bacterial tests; all were subsequently retested and provided satisfactory results. Serum CRP levels showed no significant difference comparing home HD patients with conventional in-center HD control patients.


CONCLUSIONS
Although support of 20 home HD installations was economically feasible within the constraints of the London Health Sciences Centre Department of Biomedical Engineering, resources were strained by the final year of the study. This suggests that any sustained growth beyond the current study design may require a review of staffing, resources, and model of service delivery needs.
Mehrabian
Shawn
S
Optimal Dialysis Research Unit, London Health Sciences Centre, London, Ontario, Canada.
Morgan
Dale
D
Schlaeper
Christian
C
Kortas
Claude
C
Lindsay
Robert M
RM
D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D002097:C-Reactive Protein / Q000032:analysis; D004866:Equipment Contamination / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006437:Hemodialysis, Home / Q000295:instrumentation / Q000379:methods*; D006798:Housing / Q000592:standards; D006801:Humans; D007239:Infections / Q000097:blood / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome; D014876:Water Pollution / Q000517:prevention & control*; D018508:Water Purification
D002097:C-Reactive Protein