#1199 Revolutionizing dialysis care for the elderly: lessons from the AHHD program

Abstract Background and Aims The number of elderly dialysis patients in Qatar is rising, with 58% over the age of 60. Many face mobility challenges, often needing ambulance transport for treatment. To address this, the assisted home hemodialysis (AHHD) program was introduced, providing at-home dialysis to improve their quality of life. We highlight the challenges faced during its implementation and the solutions adopted. Method We documented all challenges encountered during the implementation of the AHHD program from its inception in June 2021 through December 2024. Additionally, we recorded the solutions applied to overcome these obstacles to ensure the program's success and sustainability. Results After 3.5 years of implementing the AHHD program, 169 patients were enrolled. Throughout the program's initiation and maintenance, we encountered several challenges, with the most significant being: (i) Patient or Family Anxiety About Home Dialysis: This challenge was more pronounced among patients with prior dialysis experience, with only 50% of them agreeing to join AHHD compared to over 90% of newly initiated dialysis patients. Extended patient and family training sessions, coupled with in-depth discussions, proved effective in addressing these concerns. (ii) Central Venous Catheters (CVC) Management: 69% of patients were on dialysis via CVCs, with nearly one-third requiring tissue plasminogen activator (TPA) as a maintenance catheter lock. Despite major safety concerns regarding TPA use in home settings, the issue was successfully managed with proper training to staff and patients, we had no bleeding episodes or hypersensitivity. (iii) Staff Training and Experience: The lack of experience among nurses and physicians posed a significant challenge, as home dialysis demands a unique combination of medical expertise and social adaptability. This issue was resolved by providing 6-8 weeks of specialized training before integrating staff into the AHHD program. (iv) Emergency Preparedness: To handle medical or technical emergencies, a small dialysis center was established as a backup facility, ensuring seamless patient care when needed. (v) Catheter-Related Infections: Concerns were mitigated by adhering to infection control protocols training and adherence. As a result, infection rates were reduced to be reported in only 3 cases, highlighting the efficacy of the protocol. Conclusion Despite the frequent challenges encountered during the establishment of the AHHD program, these obstacles were manageable when weighed against the significant benefits.