Nephrologists' perspectives on the barriers and facilitators of transitioning patients from in-clinic hemodialysis to home hemodialysis

Home hemodialysis (HHD) is a sustainable option for patients undergoing dialysis as it reduces medication intake, hospitalizations, and improves quality of life (QoL). Despite these benefits, nephrologists are still more inclined to prescribe in-clinic hemodialysis (ICH) to majority of their patients. This study was conducted to understand the barriers and facilitators of transitioning patients from ICH to HHD from the nephrologists' perspective. This cross-sectional survey utilized a previously validated Nephrology Dialysis Transplantation Education (NDT-E) instrument that was administered to nephrologists working in urban and suburban settings throughout Essex County. To evaluate outcomes, descriptive statistics were calculated for continuous variables. Frequencies and percentages were calculated for categorical variables. The Mann-Whitney U test was used to test the null hypothesis: There is not a significant difference in the facilitators/barriers of HHD between the urban and suburban physicians. Thirty-Two nephrologists completed the survey. Nearly 70% of nephrologists stated Frequent Nocturnal Hemodialysis as the best overall option for patients. Overall, 23 respondents stated patient's own home was the most suitable location to deliver more frequent/extended hemodialysis. Twenty nephrologists reported that barriers to HHD included: patient complexity and comorbidity, fear of self-cannulation, fear of isolation and lack of support, lack of space within patients' homes. This study demonstrated that majority of the nephrologists believed the best place to provide intensive hemodialysis is at patient's home. Patients that are provided HHD can benefit from improved QoL and clinical outcomes. Hence, there needs to be routine discussions of transitioning to HHD during patient-provider interaction for qualified patients.DNPIncludes bibliographical reference