This house believes that 15% of HD patients on Home HD is a realistic target

Martin Raftery

RRT at BLT

RRT by Modality

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1975 1980 1985 1990 1995 2000 2005 2010

Year

Nu

mb

er

Unit HD

Home HD

CAPD

Total dial

Txp

Total RRT

RRT at BLT 1978-97

Renal Replacement Therapy 1978-97*

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1978 1980 1982 1984 1986 1988 1990 1992 1994 1996

Unit HD

Home HD

CAPD

Txp

Total RRT

Key questions re Home HD

Is home HD an effective RRT modality?

Should major renal units offer it to patients?

Is it cost effective? Is it applicable in all parts of UK? What proportion of patients should

be on it?

Effective RRT Modality

210 patients on home HD at peak at Barts and the London

Longest survivor was 31 years of which 29 on home HD

Best BP control and best control of inter-dialytic fluid gains

Best managed AV fistulae

Part of Patient Choice Major tertiary renal units should offer it

to suitable patients Especially suitable in areas of low

population density Some patients reject transplantation on

ethical grounds, home HD is an option Gives patient flexibility re dialysis regime Not a realistic option for smaller units.

Cost effective Treatment

Not cost effective for smaller renal units

Takes approx 3 years to recover upfront costs

Unlikely to be cost effective if patient is good candidate for transplantation

Is only cost effective if carer comes free

Applicable in all regions Most suitable in areas of low population

density Least likely to be suitable in inner cities Dependant on condition of housing

stock Not possible where overcrowding exists Not possible when patient/family do not

speak English

Survey of housing for home based RRT in East London

200 consecutive home visits by pre-dialysis team

Size of accommodation Number of occupants Condition of accommodation Accessibility for deliveries Public health factors Patient choice

Results of Survey

Suitable for CAPD 68 (34%) Statutory overcrowding 104 (52%) Below decent housing standards

60(30%) Temporary accommodation 24 (12%) Unfit for human habitation 26 (13%) Suitable for home HD 0 (0%)

Criteria for Home HD Fit patient who is technically or

immunologically untransplantable Failed PD, no live donor, poor MPI and no

close HD centre Required to have house, spouse & mouse Older patient with younger fit

partner/carer If that adds up to 15% I will eat my hat

The current NICE target of 15% of HD patients on home HD is unrealistic, unachievable and was clearly arrived at by Martians