Hemodialysis and Home Modalities – Transplantation&Donation Example

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"Hemodialysis and Home Modalities " is a controversial example of a paper on the transplantation and donation. End-stage renal disease is the last stage of chronic kidney disease (CKD). Renal transplantation, hemodialysis, and peritoneal dialysis are some of the modalities of treating end-stage renal disease (ESRD) patients. Haemodialysis is divided into the center and home dialysis. Continuous ambulatory (CAPD) and continuous cyclic PD (CCPD) are examples of forms of PD. There are different statics that shows trends in the prevalence of ESRD worldwide. Other statistics illustrate the different modalities that dialysis patients resort to for treatment.

Pre-dialysis and current dialysis patients have diverse perceptions about changing dialysis modalities. Home hemodialysis has a number of advantages and disadvantages but it is the better option for dialysis care. Statistics                       The Fresenius Medical Care released findings that 3,010,000 patients were treated for (end-stage renal disease) ESRD by the end of 2012. This was an approximate seven percent increase over 2011’ s ESRD prevalence. Out of the above ESRD patients, 2,358,000 were undergone dialysis treatment using either in-center hemodialysis or peritoneal dialysis but about 652,000 were recorded as living with kidney transplants.

Statistics indicated that there was an increase in ESRD seeking treatment. However, this report indicated that access to ESRD treatment was still limited in many countries but there was a minimal improvement (McFarlane & Komenda, 2011).                       Reports show that by the end of 2012, hemodialysis was still the most preferred ESRD treatment modality. This is because approximately 2,106,000 ESRD patients (89% of dialysis patients) were treated via hemodialysis with only 252,000 (11% of dialysis patients) being treated via peritoneal dialysis. Forty percent of dialysis centers belong to the public sector while sixty percent belong to the private sector.

However, there are evident geographical variations. For example, ninety-nine percent of U. S dialysis centers are privately owned whereas there are only 44% dialysis centers that are privately owned in the European Union. The U. S recorded a six percent growth in the use of peritoneal dialysis in 2012. Automated peritoneal dialysis (APD) use reduced relative to 2011. However, there was a nine percent increase in the use of continuous ambulatory peritoneal dialysis (CAPD) in 2012 over the use of the same in 2011 (Zhang et.

al. , 2010). Pre-dialysis and current dialysis patient’ s views about changing modalities             The majority of pre-dialysis patients demonstrate a lack of interest in home hemodialysis. They also express concerns about substandard care with home hemodialysis. Some pre-dialysis patients have a belief that only nephrologists have the knowledge of specialized renal care and that patients should not be involved in self-care. Some studies record that pre-dialysis patients have an inherent fear of isolation that can draw from the presence of dialysis equipment.

Both pre-dialysis and current dialysis patients explain that home hemodialysis interferes with home life. Current dialysis patients express fear of changing dialysis modalities (Zhang et. al., 2010).                       Dialysis patients have fears of becoming a burden to family members that help them in home hemodialysis treatment and would rather have clinical staff take care of their treatment. There are dialysis patients who express fear of self-cannulation and need a disconnect. Many dialysis patients resort to and trust nephrologists for information about the efficacy of changing modalities. Some nephrologists object to home modalities due to educational gaps regarding home therapies.

There are nephrologists who still rely on outdated dialysis treatment paradigms that paint home modalities as backward. Overall, pre-dialysis patients express pre-dialysis education and as such are not sure of what is right or wrongs about home hemodialysis (Jaber et. al., 2009). Home modalities as the better option for dialysis                       There are a number of pros with home modalities of dialysis. Home hemodialysis offers a more cost-effective solution than other modalities, especially in a cost-inhibited health economy. ESRD prevalence is projected to keep increasing with time.

As ESRD prevalence increases, the nephrology workforce is projected to remain the same. Home hemodialysis can help with the resultant excessive workload on nephrologists. Home hemodialysis allows patients to go about the activities of their normal life relatively easily (Saggi et. al., 2012). Home modalities record lower mortality rates than other dialysis modalities. Dialysis patients who resort to home dialysis modalities record lower hospitalization levels as compared to those who use other modalities. Compared to satellite and hospital-based hemodialysis patients, home hemodialysis records less intradialytic complications. Dialysis patients who use home hemodialysis enjoy a better quality of life than those who use other dialysis modalities.

After adjusting for confounding variables, home hemodialysis patients have fewer co-morbid complications than those patients who use other modalities. Home hemodialysis affords its patients with better rehabilitation and blood pressure control. Patients who use home hemodialysis enjoy better survival chances than those who use other modalities (Jaber et. al., 2009).                       Hospital-based dialysis predisposes individuals to learned helplessness that makes patients dependent on hospital staff. On the other hand, home hemodialysis fosters patient independence, responsibility, and confidence.

This allows patients to set their own schedules, increases patient comfort and convenience and reduces the risk of infection. Home hemodialysis allows patients a greater ability to travel than other dialysis modalities. This is especially so with the invention of smaller and more portable home hemodialysis equipment (Saggi et. al., 2012).                       Space is one of the cons of home hemodialysis. Home hemodialysis supplies and equipment require space for storage. This may need modification of domestic plumbing and electricity supply that may increase utility bills.

Taking dialysis treatment from home affects family members and the presence of dialysis compounds these effects. Home hemodialysis modalities pose a challenge to its users of disposing of medical and other wastes. Another disadvantage with home hemodialysis is that it requires specialized training units. Some studies show that some patients prefer socializing with other patients, something that home hemodialysis does not allow (Jaber et. al., 2009).                       In conclusion, the ESRD continues ranking high among serious kidney complications. Many dialysis patients prefer hospital-based care to home hemodialysis. Inadequate patient education, lack of interest, lack of self-confidence, and concerns of substandard care are examples of barriers to home hemodialysis.

Among some of the disadvantages of home, hemodialysis is increased utility bills, the need for space for storage of equipment and supplies, and waste management. However, better patient survival chances, patient independence, allowance for mobility, and better rehabilitation chances are some of the advantages of home hemodialysis. Home hemodialysis is a better option than other dialysis modalities.


Jaber, B. L., Finkelstein, F. O., Glickman, J. D., Hull, A. R., Kraus, M. A., Leypoldt, J. K., Liu, J.m Gilbertson, D., McCarthy, J., Miller, B. W., Moran, J., Collins, A. J. (2009). Freedom Study Group: Scope and Design of the Following Rehabilitation, Economics and Everyday-Dialysis Outcomes Measurements (Freedom) Study. Am J Kidney Dis 53: 310 – 320.

McFarlane, P., Komenda, P. (2011). Economic considerations infrequent home hemodialysis. Semin Dial 24: 678 – 683.

Saggi, S. J., Allon, M., Bernardini, J., Kalantar-Zadeh, K., Shaffer, R., Mehrotra, R. (2012). Considerations in the optimal preparation of patients for dialysis. Nat Rev Nephrol 8: 381 – 389.

Zhang, A. H., Bargman, J. M., Lok, C. E., Porter, E., Mendez, M., Oreopoulos, D. G., Chan, C. T. (2010). Dialysis modality choices among chronic kidney disease patients: identifying the gaps to support patients on home-based therapies. Int Urol Nephrol. 42(3): 759 – 764.

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