Situación actual de la hemodiálisis domiciliaria

Abstract

Home hemodialysis (HDD) is the form of extracorporeal kidney cleansing treatment in which the patient performs the technique himself at home. The requirements for including a patient in HDD, in addition to being considered the best option, are that he or she remains reasonably stable during the treatment session, has good vascular access and, as far as possible, has an exclusive space for the monitor and equipment, as well as the presence of a companion during the treatment. The advantages are numerous: avoiding contact with a hospital environment and giving it greater autonomy seem sufficient reasons to consider HDD as a first choice¹. This form of treatment has been practised since the beginning of hospital dialysis programmes, where the lack of infrastructure led the pioneers of nephrology to create strategies to respond to the growing demand for dialysis stations. In the United States and England thousands of patients were included in HDD and it seemed that this would be the best way to reduce costs and give these people the best treatment option². Many circumstances justify the fact that HDD has not developed as expected, among them the success of transplants, the rise of peritoneal dialysis, a much simpler technique that is also practiced at home, but above all the characteristics of many patients who start treatment and who are increasingly older and more morbid2. However, in recent years new ways of prescribing haemodialysis in terms of time and frequency are obtaining excellent results and evidence shows that with more frequent and/or longer sessions greater clinical control and better quality of life is achieved³. These new forms of treatment are much more tolerable for the patient and allow more efficient administration of the available resources if they can be performed at home, avoiding trips to a centre and facilitating the choice of schedules³. These reasons mean that HDD is growing substantially in developed countries although, the prevalence in Spain is still very low and barely reaches 0.2% of the dialysis population⁴. Numerous initiatives are attempting to reverse this situation, among others I would highlight the support of the SEN which has a working group on this technique⁴. This situation of the rise of HDD makes it advisable to review the latest publications on the subject in which the unquestionable advantages offered by HDD but also the difficulties of its implementation are noted. The follow-up of patients after an event requiring hospital admission, the complications suffered by patients, especially those arising from problems in vascular access and the experiences of patients and their families are covered in the articles selected below.