Proposed Topic (Most preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Authors (including presenting author) :
Wong YH(1), Chan CY(1), Chan PL(1), Chan WH(1), Chow YM(1), Chu YC(1), Chung SW(1), Ho WY(1), Hui CF(1), Ip NT(1), Lin WT(1), Wong PK(1), Wong SHS(1)
Affiliation :
(1) Renal Unit, Department of Medicine & Geriatrics, United Christian Hospital
Introduction :
Major obstacles to the wider use of home haemodialysis (HHD) as the preferred dialysis modality in end-stage kidney disease patients are the steep learning curve and considerable space requirement. Nxstage® System One is a new HHD system designed to be more user-friendly and requires less space. Since 2021, the United Christian Hospital (UCH) had trained nine patients with this system using short daily prescription (SDHD). This study sought to compare the performance of this new HHD program with the existing alternate nightly home haemodialysis (NHHD) program.
Objectives :
To compare: 1. Training time 2. Requirement for home space and modification 3. Running cost for electricity and water supply for patients recruited to perform SDHD and NHHD.
Methodology :
This is a retrospective analysis of patients being trained to perform SDHD with Nxstage® System One in UCH between 1/11/2021 and 30/11/2023. Data on patient demographics and duration of training were prospectively collected. The extent of home modification, space requirement, and running cost of HHD, were surveyed using questionnaire. These data were compared with our historical cohort of patients performing NHHD using high dialysate flow machine.
Result & Outcome :
Both SDHD and NHHD patients achieved adequate dialysis (mean standard Kt/V 2.04±0.48 & 3.37±0.52 respectively; p< 0.001). The training time for SDHD patients was significantly shorter than NHHD patients (12±1.4 vs. 47±11.9 session; p< 0.001). SDHD patients also enjoyed shorter machine priming time (30±0 vs. 49±15 minutes per HD session; p< 0.001), less annual maintenance time (35±0 vs. 1420±1455 minutes per year; p=0.001), less requirement for machine’s comprehensive maintenance (0.02 ± 0.043 vs. 0.14 ± 0.09 episode per month; p=0.04), less room renovation requirement (0 vs. 9 rooms; p=0.022) and less HD machine storage space requirement (0.68±0.04m^3vs. 1.03±0.27m^3). The cost of electricity (HKD$226 ± 0 vs. $369.4 ± 0 per two months) and water supply (HKD$6±0 vs. 518.1±0 per three months) was lower for SDHD patients. Compared to NHHD, SDHD using Nxstage® System One requires less training time while still providing adequate dialysis. The increased user-friendliness has resulted in less time spent on system maintenance, less home renovation and space requirement, and lower running cost. These advantages can potentially increase the adoption of HHD in Hong Kong.
