Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 30855
The Current Home Hemodialysis Practices and Patients’ Safety Related Factors: A Case Study from Germany

Authors: Ilyas Khan. Liliane Pintelon, Harry Martin, Michael Shömig


The increasing costs of healthcare on one hand, and the rise in aging population and associated chronic disease, on the other hand, are putting increasing burden on the current health care system in many Western countries. For instance, chronic kidney disease (CKD) is a common disease and in Europe, the cost of renal replacement therapy (RRT) is very significant to the total health care cost. However, the recent advancement in healthcare technology, provide the opportunity to treat patients at home in their own comfort. It is evident that home healthcare offers numerous advantages apparently, low costs and high patients’ quality of life. Despite these advantages, the intake of home hemodialysis (HHD) therapy is still low in particular in Germany. Many factors are accounted for the low number of HHD intake. However, this paper is focusing on patients’ safety-related factors of current HHD practices in Germany. The aim of this paper is to analyze the current HHD practices in Germany and to identify risks related factors if any exist. A case study has been conducted in a dialysis center which consists of four dialysis centers in the south of Germany. In total, these dialysis centers have 350 chronic dialysis patients, of which, four patients are on HHD. The centers have 126 staff which includes six nephrologists and 120 other staff i.e. nurses and administration. The results of the study revealed several risk-related factors. Most importantly, these centers do not offer allied health services at the pre-dialysis stage, the HHD training did not have an established curriculum; however, they have just recently developed the first version. Only a soft copy of the machine manual is offered to patients. Surprisingly, the management was not aware of any standard available for home assessment and installation. The home assessment is done by a third party (i.e. the machines and equipment provider) and they may not consider the hygienic quality of the patient’s home. The type of machine provided to patients at home is similar to the one in the center. The model may not be suitable at home because of its size and complexity. Even though portable hemodialysis machines, which are specially designed for home use, are available in the market such as the NxStage series. Besides the type of machine, no assistance is offered for space management at home in particular for placing the machine. Moreover, the centers do not offer remote assistance to patients and their carer at home. However, telephonic assistance is available. Furthermore, no alternative is offered if a carer is not available. In addition, the centers are lacking medical staff including nephrologists and renal nurses.

Keywords: home hemodialysis, home hemodialysis practices, patients’ related risks in the current home hemodialysis practices, patient safety in home hemodialysis

Digital Object Identifier (DOI):

Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 277


[1] M. Girndt, P. Trocchi, C. Scheidt-Nave, S. Markau und A. Stang, „The Prevalence of Renal Failure. Results from the German Health Interview and Examination Survey for Adults, 2008–2011 (DEGS1),“ Deutsches Arzteblatt International, Bd. 113, Nr. 6, pp. 85-91, 2016.
[2] Medical Netcare GmbH, „Jahresbericht 2017 zur Qualität in der Dialyse,“ 2018.
[3] C. Barth, „Quality assurance in dialysis in Germany,“ Dialysis & Transplantation, Bd. 39, Nr. 9, pp. 404-405, 2010.
[4] Kuratorium für Dialyse und Nierentransplantation e.V., „Jahres Bericht 2017,“ KfH, 2017.
[5] J. W. Agar, R. J. Knight, R. E. Simmonds, J. M. Boddington, C. M. Waldron und C. A. Somerville, „Nocturnal haemodialysis: An Australian cost comparison with conventional satellite haemodialysis (Review Article),“ Nephrology, Bd. 10, Nr. 6, pp. 557-570.
[6] R. Walker, M. R. Marshall, R. L. Morton, P. McFarlane und K. Howard, „The cost‐effectiveness of contemporary home haemodialysis modalities compared with facility haemodialysis: A systematic review of full economic evaluations.,“ Nephrology, Bd. 19, Nr. 8, pp. 459-470, 2014.
[7] R. M. Fagugli, P. Pasini, F. Pasticci, G. Ciao, B. Cicconi und U. Buoncristiani, „Effects of short daily hemodialysis and extended standard hemodialysis on blood pressure and cardiac hypertrophy: a comparative study.,“ Journal of nephrology, Bd. 19, Nr. 1, pp. 77-83, 2006.
[8] K. C. H. Manley, D. Grabe, S. M. S, C. Hoy und G. Bailie, „Quantifying home medication regimen changes and quality of life in patients receiving nocturnal home hemodialysis,“ Hemodialysis International, Bd. 15, Nr. 2, pp. 234-242, 2011.
[9] B. F. Culleton, M. Walsh, S. W. Klarenbach, G. Mortis, N. Scott-Douglas und H. M. R. R Quinn, „Effect of frequent nocturnal hemodialysis vs conventional hemodialysis on left ventricular mass and quality of life: a randomized controlled trial,“ Jama, Bd. 298, Nr. 11, pp. 1291-1299, 2007.
[10] B. Miller, R. Himmele, D. Sawin, J. Kim und R. Kossmann, „Choosing Home Hemodialysis: A Critical Review of Patient Outcomes,“ Blood purification, Bd. 45, Nr. 1-3, pp. 224-229, 2018.
[11] A. X. Garg, R. S. Suri, P. Eggers, F. O. Finkelstein, T. Greene und M. U. P. L Kimmel, „Patients receiving frequent hemodialysis have better health-related quality of life compared to patients receiving conventional hemodialysis,“ Kidney international, Bd. 91, Nr. 3, pp. 746-754, 2017.
[12] M. R. Marshall, C. M. Hawley, P. G. Kerr, K. R. Polkinghorne, r. J. Marshall, J. W. Agar und S. P. McDonald, „Home hemodialysis and mortality risk in Australian and New Zealand populations,“ American Journal of Kidney Diseases, Bd. 58, Nr. 5, pp. 782-793, 2011.
[13] K. L. Johansen, R. Zhang, Y. Huang, S. C. Chen, C. R. Blagg und A. S. G.-R. N. G. Kutner, „Survival and hospitalization among patients using nocturnal and short daily compared to conventional hemodialysis: a USRDS study,“ Kidney international,, Bd. 76, Nr. 9, pp. 984-990, 2009.
[14] W. Pommer, S. Wagner, D. Müller und J. Thumfart, „Attitudes of nephrologists towards assisted home dialysis in Germany,“ Clinical Kidney Journal, Bd. 11, Nr. 3, pp. 400-405, 2017.
[15] S. Kvale und S. Brinkmann, Interviews: Learning the craft of qualitative research interviewing, Sage, 2015.
[16] A. P. Alba, F. S. Roblero, S. C. Gasch und M. A. B. Rubio, „Barreras para el desarrollo de la hemodiálisis domiciliaria en España. Encuesta a nefrólogos españoles,“ Nefrología, Bd. 37, Nr. 6, pp. 665-668, 2017.
[17] K. Osterlund, D. Mendelssohn, C. Clase, G. Guyatt und G. Nesrallah, „Identification of facilitators and barriers to home dialysis selection by Canadian adults with ESRD,“ In Seminars in dialysis, Bd. 27, Nr. 2, pp. 160-172, 2014.
[18] A. Jayanti, P. Foden, S. Mitra und B.-H. s. group, „Multidisciplinary staff attitudes to home haemodialysis therapy,“ Clinical kidney journal, Bd. 10, Nr. 2, pp. 269-275, 2017.
[19] J. l. Welch, C. Thomas-Hawkins, T. Bakas, s. M. McLennon, D. Byers, C. J. Monetti und B. S. Decker, „Needs, concerns, strategies, and advice of daily home hemodialysis caregivers,“ Clinical nursing research, Bd. 23, Nr. 6, pp. 644-663, 2014.
[20] J. Perl, Y. Na, K. K. Tennankore und C. T. Chan, „Temporal trends and factors associated with home hemodialysis technique survival in Canada,“ Clinical Journal of the American Society of Nephrology, Bd. 12, Nr. 8, pp. 1248-1258, 2017.
[21] K. Allcock, B. Jagannathan, C. J. Hood und M. R. Marshall, „Exsanguination of a home hemodialysis patient as a result of misconnected blood-lines during the wash back procedure: a case report,“ BMC nephrology, Bd. 13, Nr. 1, p. 28, 2012.
[22] C. C. f. O. H. a. Safety, „,“ 2016. (Online). Available: (Zugriff am 15 12 2018).
[23] L. A. Spry, J. M. Burkart, C. H. C, L. Mortier und J. D. Glickman, „Survey of home hemodialysis patients and nursing staff regarding vascular access use and care,“ Hemodialysis International, Bd. 19, Nr. 2, pp. 225-234, 2015.
[24] R. S. Suri, L. Li und G. E. Nesrallah, „The risk of hospitalization and modality failure with home dialysis,“ Kidney international, Bd. 88, Nr. 2, pp. 360-368, 2015.
[25] E. D. Weinhandl, J. Liu, D. T. Gilbertson, T. J. Arneson und A. J. Collins, „Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients,“ Journal of the American Society of Nephrology, Bd. 23, Nr. 5, pp. 895-904, 2012.
[26] E. S. Hilbers, C. G. d. Vries und R. E. Geertsma, „Medical technology at home: safety-related items in technical documentation,“ International journal of technology assessment in health care, Bd. 29, Nr. 1, pp. 20-26, 2013.
[27] D. T. Chan, R. Faratro und C. T. Chan, „The impact of simulation-based teaching on home hemodialysis patient training,“ Clinical kidney journal, Bd. 8, Nr. 5, pp. 594-598, 2015.
[28] S. Appleby, „Shared care, home haemodialysis and the expert patient.,“ Journal of renal care, Bd. 39, Nr. S1, pp. 16-21, 2013.
[29] M. Mollaoğlu, M. Kayataş und B. Yürügen, „Effects on caregiver burden of education related to home care in patients undergoing hemodialysis,“ Hemodialysis International, Bd. 17, Nr. 3, pp. 413-420, 2013.
[30] S. Mehrabian, D. Morgan, C. Schlaeper, C. Kortas und R. M. Lindsay, „Equipment and water treatment considerations for the provision of quotidian home hemodialysis,“ American journal of kidney diseases, Bd. 42, pp. 66-70, 2003.
[31] A. Rajkomar, K. Farrington, A. Mayer, D. Walker und A. Blandford, „Patients’ and carers’ experiences of interacting with home haemodialysis technology: implications for quality and safety,“ BMC nephrology, Bd. 15, Nr. 1, p. 195, 2014.
[32] B. Wong, D. Zimmerman, F. Reintjes, M. Courtney, S. Klarenbach, G. Dowling und R. P. Pauly, „Procedure-related serious adverse events among home hemodialysis patients: a quality assurance perspective,“ American Journal of Kidney Diseases, Bd. 63, Nr. 2, pp. 251-258, 2014.
[33] K. K. Tennankore, C. d’Gama, R. Faratro, S. Fung, E. Wong und C. T. Chan, „Adverse technical events in home hemodialysis,“ American Journal of Kidney Diseases, Bd. 65, Nr. 1, pp. 116-121, 2015.
[34] D. M. Connaughton, A. Jamal, J. McWilliams, P. O’Kelly, J. Ormond und A. B. C. Magee, „Home haemodialysis in Ireland,“ Irish journal of medical science, Bd. 182, Nr. 1, pp. 91-96, 2013.
[35] M. H. Rosner, S. Q. Lew, P. Conway, J. Ehrlich, R. Jarrin und U. D. P. P. Brophy, „Perspectives from the Kidney Health Initiative on advancing technologies to facilitate remote monitoring of patient self-care in RRT,“ Clinical Journal of the American Society of Nephrology, Bd. 12, Nr. 11, pp. 1900-1909, 2017.
[36] N. Liu, J. Kim, Y. Jung, A. Arisy, M. A. Nicdao und M. M. K. Sud, „Remote monitoring systems for chronic patients on home hemodialysis: field test of a copresence-enhanced design,“ JMIR human factors, Bd. 4, Nr. 3, 2017.
[37] J. A. Cafazzo, K. Leonard, A. C. Easty, P. G. Rossos und C. T. Chan, „Patient perceptions of remote monitoring for nocturnal home hemodialysis,“ Hemodialysis International, Bd. 14, Nr. 4, pp. 471-477, 2010.
[38] J. L. Ditchburn und A. Marshall, „Renal telemedicine through video‐as‐a‐service delivered to patients on home dialysis: A qualitative study on the renal care team members’ experience,“ Journal of renal care, Bd. 43, Nr. 3, pp. 175-182, 2017.
[39] A. Rajkomar, A. Mayer und A. Blandford, „Understanding safety–critical interactions with a home medical device through Distributed Cognition,“ Journal of biomedical informatics, Bd. 56, pp. 179-194., 2015.
[40] J. Hope, „A patient perspective on the barriers to home dialysis,“ Journal of renal care, Bd. 39, Nr. S1, pp. 3-8, 2013.
[41] N. F. Courts, „Psychosocial adjustment of patients on home hemodialysis and their dialysis partners,“ Clinical Nursing Research, Bd. 9, Nr. 2, pp. 177-190, 2000.
[42] J. Nearhos, C. V. Eps und J. Connor, „Psychological factors associated with successful outcomes in home haemodialysis,“ Nephrology, Bd. 18, Nr. 7, pp. 505-509, 2013.
[43] C. Vestman, M. Hasselroth und M. Berglund, „Freedom and confinement: Patients’ experiences of life with home haemodialysis,“ Nursing research and practice, 2014.
[44] R. Shaw, „Being-in-dialysis: The experience of the machine–body for home dialysis users,“ Health, Bd. 19, Nr. 3, pp. 229-244, 2015.
[45] A. Jayanti, J. Morris, P. Stenvinkel und S. Mitra, „Home hemodialysis: beliefs, attitudes, and practice patterns,“ Hemodialysis International, Bd. 18, Nr. 4, pp. 767-776, 2014.
[46] I. Ledebo, „What limits the expansion of self‐care dialysis at home?.,“ Hemodialysis International, Bd. 12, Nr. S55-S60, 2008.
[47] E. F. Rix, L. Barclay, S. Wilson, J. Stirling und A. Tong, „Service providers’ perspectives, attitudes and beliefs on health services delivery for Aboriginal people receiving haemodialysis in rural Australia: a qualitative study,“ BMJ open, Bd. 3, Nr. 10, 2013.