Abstract: PUB123
National Home Hemodialysis (HHD) Survey in France
Session Information
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Fessi, Hafedh, AURA Paris, Paris, Île-de-France, France
- Attaf, David, Fresenius Medical Care France SAS, Fresnes, Île-de-France, France
- Ficheux, Maxence, Centre Hospitalier Universitaire de Caen Normandie, Caen, Normandy, France
Group or Team Name
- French Home Survey.
Background
Interest for HHD with short daily HD is ↑. Medical practices and care organization of HHD programs are poorly known despite KIHDNEY cohort study in 2027. In 2024, we conduct a national french survey to describe HDD practices and care organization (HOME survey) at a time where a new bundle is discussed in France.
Methods
Questionnaire sent to nephrologists without selection (e-platform). Questionnaire covers (1) nephrologists / centers profils, (2) opinion about HHD, (3) patient profiles, (4) HDD program and (5) center organization. No data collection. We present results at may 2025.
Results
129 nephrologists respondents. 86% have a HHD program AND 14% don’t have program (↓ profitability, low medical evidence, ↓ personal motivation, delegation to third-part center). HHD done in public hospitals (49%), private clinics (11%) or kuratorium (34%). HHD programs are dedicated to HDD (25%), HD+PD (34%), home + in center HD (17%), no dedicated structure (22%). Low number of HHD patients/center : 0-10 patients (92%). HHD offered based on medical evidence (82%), patients willing (58%). Patient acceptance rate for HHD varies from 1 to 25% (82%). Refusals are due to “HDD introduction at home", "fear of puncture", "technical complexity". Acceptance factors are : QOL, autonomy of care, geographic mobility. Age of HHD patients is 26-50 y. (38%), 51-75 y. (61%). Central venous catheter for 20-40% of patients (15%). Male gender = 60%. Comorbidities = T2D (52%), obesity (37%), coronary artery disease (34%). Preferred indications = Young age, autonomy, heart failure, ↑ phosphatemia. Exit modes = Renal transplantation (RT), in-center HD, Exceptionally PD. Modality before HDD = Self-dialysis, in-center HD, CKD ND and rarely RT and PD. HDD recruitment program = 75% of respondents (for “dialysis initiation” (93%) and “urgent start program” (62%)). Role of nephrologists equally shared: All doctors follow all patients, One doctor follows all patients, Each doctor follows his patients. Low full-time nurses rate (10%). Advanced nurses practitioners involved for 26% of respondents.
Conclusion
HOME survey indicate low number of patients / center. The barriers related to doctors and causes of patient refusal are confirmed (profitability, fear of puncture, technical complexity). Indications of HDD are expected but central venous catheter seemes to ↑. These data need to be used to adpat training of nephrologists and patient education.