title: Self-cannulation for haemodialysis: patient attributes, clinical correlates and self-cannulation predilection models.
abstract: OBJECTIVE
  With emerging evidence in support of home haemodialysis (HHD), patient factors which determine uptake of the modality need to be better understood. Self-cannulation (SC) is a major step towards enabling self-care 'in-centre' and at home and remains the foremost barrier to its uptake. Human factors governing this aspect of HD practice are poorly understood. The aim of this study is to better understand self-cannulation preferences and factors which define them in end stage renal disease (ESRD).
  
  
  METHODS
  In this multicentre study, 508 of 535 patients from predialysis (Group A: n = 222), in-centre (Group B: n = 213), and home HD (Group C: n = 100) responded to a questionnaire with 3 self-cannulation questions. Simultaneously, data on clinical, cognitive and psychosocial variables were ascertained. The primary outcome measure was 'perceived ability to self-cannulate AV access'. Predictive models were developed using logistic regression analysis.
  
  
  RESULTS
  36.6% of predialysis patients (A) and 29.1% of the 'in-centre' haemodialysis patients (B) felt able to consider SC for HD. Technical-skills related apprehension was highest in Group B (14.4%) patients. Response to routine venepuncture and the types of SC concerns were significant predictors of perceived ability to self-cannulate. There was no significant difference in concern for pain across the groups. In multivariable regression analysis, age, education level, 3 MS score, hypoalbuminemia in Groups B & C and additionally, attitude to routine phlebotomy and the nature of specific concern for self-cannulation in Groups A, B and C, are significant predictors of SC preference. The unadjusted c-statistics of models 1 (derived from Group A and validated on A) and 2 (derived from B+C and validated on B), are 0.76(95% CI 0.69, 0.83) and 0.80 (95% CI 0.74, 0.87) respectively.
  
  
  CONCLUSIONS
  There is high prevalence of perceived ability to self-cannulate. Modifiable SC concerns exist in ESRD. The use of predictive models to objectively define and target education and training strategies could potentially impact on HD self-management and future uptake of home HD.
authors.affiliation: Department of Nephrology, Central Manchester Hospitals NHS Trust, Manchester, United Kingdom.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Jayanti
authors.affiliation: Department of Biostatistics, University of Manchester, Manchester, United Kingdom.
authors.forename: Philip
authors.initials: P
authors.lastname: Foden
authors.affiliation: Department of Psychology, University of Manchester, Manchester, United Kingdom Investigators in the BASIC-HHD study group is provided in the Acknowledgments.
authors.forename: Alison
authors.initials: A
authors.lastname: Wearden
authors.affiliation: Department of Biostatistics, University of Manchester, Manchester, United Kingdom.
authors.forename: Julie
authors.initials: J
authors.lastname: Morris
authors.affiliation: Department of Nephrology, Central Manchester Hospitals NHS Trust, Manchester, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Brenchley
authors.affiliation: Department of Nephrology, Central Manchester Hospitals NHS Trust, Manchester, United Kingdom.
authors.forename: Sandip
authors.initials: S
authors.lastname: Mitra
mesh_terms: D002404:Catheterization / Q000379:methods*; D006801:Humans; D006435:Renal Dialysis / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000628:therapy*