NUTRITION

3.0 Home Haemodialysis (HHD) – The Benefits of Frequent Dialysis

Introduction

There are many benefits of Home Haemodialysis, and many of these include improvements in health outcomes and quality of life. Reasons for this could be:

• You manage your treatment so it is easier to follow recommended restrictions.
• Your self-esteem may increase as you regain control of your health and your life.
• In the home environment, you can choose to, and you are able to do more frequent dialysis and more hours of dialysis.
• Compared to conventional, dialysis Home Haemodialysis, you have increased freedom and flexibility. The time used for travelling and waiting to receive dialysis treatment at the clinic can be used for socializing with family and friends, with spare time for activities and work. Even on dialysis you can be part of family activities¹.

In this chapter, we will talk about some benefits of Home Haemodialysis. There are of course risks and it will not suit everyone². 

3.1 Improved physical health

Patients who do Home Haemodialysis compared to conventional dialysis have reported significant improvements in their physical health which includes the following³;

3.1.1 Better control of fluid (weight gain on dialysis)^4,5,6

• More regular dialysis reduces weight gain between dialysis sessions.
• Better fluid control means less cramps and episodes of low blood pressure during dialysis.
• Better fluid control reduces the risk of your heart muscle being damaged and causing heart failure^4,5,6,7.

3.1.2 Improved blood pressure

• Blood pressure reduction is a consistent benefit of Home Haemodialysis. This can mean less blood pressure medications.

3.1.3 Improved blood biochemistry

When the kidneys stop working you lose the ability to control your phosphate, potassium, calcium and salts.

• With dialysis, these improve and with frequent dialysis further improvements are seen. This can mean less diet restrictions^4,8.

3.1.4 Improvement in nutritional status

• Less need for dietary restrictions^4,8,9.
• Improved appetite^9,10.

3.1.5 Improved fertility and pregnancy

Pregnancy in women with end stage renal disease on renal replacement therapy is uncommon.

• For those able to conceive, more frequent /or longer dialysis sessions, offers improved outcomes^11,12.

3.1.6 Survival (how long you live)

• Home Haemodialysis provides improvements in survival compared to regular haemodialysis at a clinic (mainly due to longer hours)^4,13,14.
• The long-term survival on Home Haemodialysis is good, has improved over time, and can be a good alternative to renal transplantation for some people^4,14.

3.2 Enhanced Quality of life

Most patients with end-stage kidney disease experience several physical, mental, and psychosocial problems that have a major impact on quality of life. Studies have reported the following benefits;

3.2.1 Recovery Time

• One of the most striking changes noted with frequent Haemodialysis is that recovery time or post dialysis fatigue is shortened and you can go back to normal daily activities shortly after completing your Home Haemodialysis treatment^15,16.

3.2.2 Improved vitality and energy

• Improvements in patient self-reported vitality and energy may occur¹⁷.
• There is improvement in sex-related hormones which can improve the quality of sexual relationships¹⁸.

3.2.3 Decreased medication burden

• The improved physical health often leads to less medications.

3.2.4 Improved sleep quality

• Sleep quality and sleep apnoea may improve^16,19,20.

3.2.5 Changed mental capacity

• Studies have found significant improvement in depression scores, many suggesting a positive emotional impact of treatment with more frequent Home Haemodialysis^15,16.
• Many people find their brain seems less foggy and they can think more clearly²¹.

3.2.6 Freedom

• You experience increased freedom because you control your own times for dialysis¹⁶.
• You can take responsibility for your own health and can choose how to balance dialysis with work or your daily activities.

References

1. Karkar A, Hegbrant J, Strippoli GF. Benefits and implementation of home hemodialysis: A narrative review. Saudi J Kidney Dis Transpl. 2015;26(6):1095-107.
2. Pauly RP, Eastwood DO, Marshall MR. Patient safety in home hemodialysis: quality assurance and serious adverse events in the home setting. Hemodialysis international International Symposium on Home Hemodialysis. 2015;19 Suppl 1:S59-70.
3. Colm C, Magee C, Kevin Tucker J, Ajay K. Core Concepts in Dialysis and Continuous Therapies, 2016
4. Tennankore K, Nadeau-Fredette AC, Chan CT. Intensified home hemodialysis: clinical benefits, risks and target populations. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association – European Renal Association. 2014;29(7):1342-9.
5. Chertow GM, Levin NW, Beck GJ, Depner TA, Eggers PW, Gassman JJ, et al. In-center hemodialysis six times per week versus three times per week. The New England journal of medicine. 2010;363(24):2287-300.
6. Raiman JG, Chan CT, Daurgidas JT, Depner T, Gotch FA, Greene t et al. The Effect of Increased Frequency of Haemodialysis on Volume-Related Outcomes: A Secondary Analysis of the Frequent Hemodialysis Network Trials. Blood purification. 2016; 41 (4):277-86
7. Georgianos PI, Sarafidis PA. Pro: Should we move to more frequent haemodialysis schedules? Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association – European Renal Association. 2015;30(1):18-22.
8. Borman N, Nair S, Goffin E. More Frequent Haemodialysis Improved Outcomes: The Wish Comes True at Home. European Medical Journal 2017;5(1):36-42
9. Galland R, ArkoucheW, Cleaud CH, Delawari E, Fouque D. Short Daily Hemodialysis rapidely improves nutritional status in hemodialysis patients. Journal INS. 2001. Vol 60, Issue 4, 1555-1560
10. Spanner E, et al. The Impact of Quotidian Hemodialysis on Nutrition. Am J Kidney Dis 42 (1 Suppl), 30-35. 7 2003
11. Hladunewich M, Schatell D. Intensive dialysis and pregnancy. Hemodialysis international International Symposium on Home Hemodialysis. 2016;20(3):339-48.
12. Leduc, V., Ficheux, M., Bechade, C., Dreyfus, M., Lobbedez, T. and Henri, P. Pregnancy on short-daily home hemodialysis using low dialysate flow rate: A new hope for the end-stage renal disease patients. Hemodialysis International 2017. doi:10.1111/hdi.12590
13. Tennankore KK, d’Gama C, Faratro R, Fung S, Wong E, Chan CT. Adverse technical events in home hemodialysis. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2015;65(1):116-21.
14. Rydell H, Krutzen L, Simonsen O, Clyne N, Segelmark M. Excellent long time survival for Swedish patients starting home-hemodialysis with and without subsequent renal transplantations. Hemodialysis international International Symposium on Home Hemodialysis. 2013;17(4):523-31.
15. Jaber BL, Lee Y, Collins AJ, Hull AR, Kraus MA, McCarthy J, et al. Effect of daily hemodialysis on depressive symptoms and postdialysis recovery time: interim report from the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2010;56(3):531-9.
16. Jaber BL, Finkelstein FO, Glickman JD, Hull AR, Kraus MA, Leypoldt JK, et al. Scope and design of the Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements (FREEDOM) Study. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2009;53(2):310-20.
17. Finkelstein FO, Finkelstein SH, Wuerth D, Shirani S, Troidle L. Effects of home hemodialysis on health-related quality of life measures. Seminars in dialysis. 2007;20(3):265-8.
18. Van E, et al. Changes in serum prolactine, sex hormones and thyroid function with alternate nightly nocturnal home haemodialysis. Nephrology. Vlome 17, Issue 1. 2012, 42-47
19. Finkelstein F, Schiller B, Daoui R, Gehr TW, Kraus MA, Lea Y, Miller BW, Sinsakul M, Jaber BL.
    At-home short hemodialysis improves the long-term helalth- rrelated quality of life. Kidney Int. 2012; 82(5):561-9
20. Jaber B. et al. Impact of At-home Short Daily Hemodialysis on Restless Legs Symptoms and Sleep Disturbances. CJASN 2011
21. Xi W, Singh PM, Harwood L, Lindsay R, Suri R, Brown JB, et al. Patient experiences and preferences on short daily and nocturnal home hemodialysis. Hemodialysis international International Symposium on Home Hemodialysis. 2013;17(2):201-7.