Home hemodialysis a la carte:: A tailormade program (1998-2003)

Background: There are good epidemiological (increased numbers of dialysis patients), economical (renal replacement therapy (RRT) costs) and clinical reasons (new highly efficient schedules) to reconsider the choice of home hemodialysis (HD). Study aim: Analysis of the results and costs of a flexible, tailormade home dialysis program (1998-2003). Setting: Home HD facility of the University of Turin - Italy. Methods: Results were analyzed in terms of feasibility (enrolment rate, logistical problems - the two usual caregivers performed a retrospective analysis of the clinical records; production costs, assessed with a logic bottom-up technique). Since the main program feature was the tailoring of dialysis to the patient, kinetic data were analyzed to control the efficiency of the chosen schedules. Results: In 1998-2003 (54 months), 31 patients joined the home HD program (six patients were already being treated), while another 12 patients were treated in the training area and trained for an ongoing self-care program; mean age was 47.1 +/- 12.8 yrs; 35/49 patients had clinical comorbidities. During the study, four patients died, 10 were grafted, and six patients dropped out or were transferred. In March 2003, 23 patients were at home/in training and six were being treated in the training area: 11 patients were on a conventional schedule, four on daily dialysis, 12 on other schedules (two patients non-resident in the Piedmont region were not considered). Dialysis efficiency reached the target (EKRc >11 mL/min) in all but four patients (schedules with more frequent sessions were planned for these patients). Costs were comparable to limited care HD (daily: 96.5 Euro/session at home, 98.76 Euro/session in the center; conventional: 133.48 Euro/session at home, 131.25 Euro/session in the center). Conclusion: A tailored, flexible policy can help to revive a home HD program.