This house believes that 15% of HD patients on Home HD is a realistic target Martin Raftery
RRT at BLT
RRT at BLT 1978 -97
Key questions re Home HD n n n 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 n n 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 n n n 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 n n 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 n n n 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 n n n 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 n n n 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 n n n 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
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