Hemodialysis Patients' Perceptions of Home Hemodialysis and Self-Care (Report‪)‬

Introduction Home hemodialysis (HHD) is a favourable option for patients requiring renal replacement therapy. It has been noted through research that this type of therapy is more cost-effective than in-centre therapies and the benefits to patients are well documented (Harwood & Leitch, 2006). HHD first started in the early 1960s, as a means of providing a more cost-effective treatment modality. Literature suggests that home dialysis is more convenient and improves quality of life for renal failure patients (Kashani & Motiwala, 2007). The other benefits to patients dialyzing at home include more flexibility in dialysis schedules, convenience, no transportation issues, more time with the family, less time in a hospital setting, increased knowledge regarding dialysis, and improvements to personal health and independence (Harwood & Leitch, 2006). Statistics demonstrate that there is an increase in numbers of patients with end stage renal disease (ESRD): there were 14,567 dialysis patients with ESRD in Canada on December 31, 2000, a number that continues to climb and that has more than doubled from 6,811 patients in 1991. Canadian Institute of Health Information's (CIHI) data also show that 4,386 new patients started treatment during 2000, 60% higher than the number who began treatment in 1991 (CIHI, 2004). CIHI indicated that a quarter of a million individuals in Canada were on dialysis in 2007. Of those, 48% remained on hemodialysis therapy, 12% remained on peritoneal dialysis (PD) and 40% had kidney transplants (CIHI, 2007). The prevalence of individuals on HHD is 0.4% to 0.6% and peritoneal dialysis is slightly higher at 8.4% to 10.4% (CIHI, 2007). The growth of home dialysis continued until the early 1980s and then started to decline, despite the evidence showing beneficial outcomes. Home dialysis (combining both PD and HHD) slowly decreased since 1981, from 23% to 11% in 2001. In-centre hemodialysis treatments went from 59% in 1993 to 74% in 2001 (CIHI, 2004). Research shows that the population of those with renal failure and those having to undergo hemodialysis treatments is vastly growing (Schatell, 2005). However, the patient population doing home dialysis is falling. Ontario's Ministry of Health and Long-Term Care (MoHLTC) has set provincial targets for dialysis modality distribution, which all dialysis programs are expected to achieve by 2010. The goal is that only 60% of patients are to dialyze in in-centre hemodialysis, 30% in home PD, and 10% in HHD (Kashani & Motiwala, 2007).