Abstract: FR-PO510
Initial Experience With Home Hemodialysis Using the Tablo Hemodialysis System
Session Information
- Home Dialysis, Policy, Novel Approaches
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Weinhandl, Eric D., Satellite Healthcare, San Jose, California, United States
- Schumacher, Josh, Outset Medical, San Jose, California, United States
- Aragon, Michael A., Outset Medical, San Jose, California, United States
- Abra, Graham E., Satellite Healthcare, San Jose, California, United States
Background
Home hemodialysis (HHD) utilization in the United States is approximately 2%. The modality offers customizability of therapy, but places stress on patients and their care partners. Devices that greatly improve the user experience are needed. One such device, the Tablo Hemodialysis System, was cleared for use in the home setting in early 2020. We analyzed the evolving clinical experience of HHD with Tablo at Satellite Healthcare (SHC), a dialysis provider with >3% utilization of HHD.
Methods
We identified patients who initiated use of Tablo for HHD in SHC facilities between 1 January 2021 and 30 April 2022. We summarized patient characteristics, including modality prior to initiation of HHD with Tablo and vascular access. We tallied the number of training sessions and estimated distributions of prescribed treatment frequency and hours per week. Using digital flowsheets, we assessed treatment adherence between 1 October 2021 and 15 May 2022. We estimated the cumulative incidence of attrition due to death, conversion to in-center hemodialysis (IHD), or conversion to HHD with an alternative device.
Results
The cohort included 34 patients. Patient proportions were 27% aged 18-44 years, 32% aged 45-64 years, 41% aged ≥65 years, 71% male, and 47% with diabetes. Regarding modality history, 29% were incident end stage kidney disease (ESKD) patients, 41% on IHD, 21% on HHD with an alternative machine, and 9% on peritoneal dialysis (PD). Regarding vascular access, 26% had a catheter. Mean numbers of training sessions were 11, 11, and 9 for incident ESKD, IHD, and existing HHD patients, respectively. Prescribed treatment frequency was 4 sessions/week in 82% of patients; prescribed hours/week were 12.0-14.9 in 70% of patients, with equal shares below and above this range. Adherence to prescribed hours was 90% with ≤3.5 sessions/week and 86% with ≥4.0 sessions/week. At 12 months, the cumulative incidence of death, conversion to IHD, and conversion to HHD with alternative device was 11%, 13%, and 3%, respectively.
Conclusion
Patients performing HHD with Tablo have been diverse in age, modality history, and vascular access. On average, HHD training has been completed in 11 or fewer sessions, regrardless of prior modality, and treatment adherence at home has exceeded 85%. HHD attrition has been low, thus portending continued growth of the modality with the use of Tablo.