Home Hemodialysis Skills Assessment Predicts Treatment Survival in Patients on Home Hemodialysis

Background: During home hemodialysis (HHD), patients require adequate skills and self-care abilities. At HHD initiation, patients are instructed in standard procedures and emergency protocols. However, adherence to these instructions may decrease as dialysis duration increases. Additionally, the required skills and self-care abilities may decline with age and changes in physical abilities, which may interfere with the proper execution of instructions. Our hospital administered the Home Hemodialysis Skills Assessment (HHSA) to patients on HHD to assess their adherence to standard procedures and emergency protocols. This study aimed to examine whether HHSA results can predict the subsequent HHD continuation rates. Methods: This was a retrospective cohort study of patients who underwent HHSA at our hospital between January 1, 2015, and December 31, 2016. The HHSA consists of six items (45 total points): 1. Dialysis machine setup, 2. needle cannulation and initiation, 3. procedures during treatment, 4. alarm response, 5. termination procedures, and 6. Post-treatment clean-up. Patients were divided into two groups based on the median total score and followed up until failure of the HHD technique, death, or the end of the study (December 2021). The primary outcome was the treatment survival rate, while the secondary outcomes were the death-censored technique and overall survival rates. Results: Fifty-four patients with a mean age of 56.8 years and a median HHD treatment duration of 67 months were included. The median HHSA total score was 35. There were no significant differences between the high-score group (score >35) and the low-score group (score ≤35) in terms of age, comorbidities, HHD treatment history, or training duration at HHD initiation. However, over the total follow-up period of 300 patient-years, the low-score group had higher rates of HHD discontinuation (15.3% vs. 46.4%, p = 0.023) and technique failure (35.7% vs. 11.5%, p = 0.046) than the high-score group. Multivariate analysis identified age, heart disease, and HHSA total score as predictors of survival after HHD treatment. Conclusion: HHSA is a predictor of treatment continuation rate in patients undergoing HHD. It may predict individual capability to continue HHD and determine the appropriate timing for transitioning from HHD to in-center dialysis.