Promoting Self-Sufficiency in Home Hemodialysis: A Single Center's Journey to Improved Adoption and Therapy Retention

Background: Despite challenges posed by inadequate support, care partner burnout, self-care skill gaps, and fear of self-cannulation, a significant proportion of patients demonstrate capacity for solo HHD, as shown in a large survey where 50% admitted to have mastered it within 3 months. Additionally, 16% of patients with care partners opted for independence at least sometimes, and 15% dialyzed solo. Patients prioritize autonomy, deeming rare complications manageable, which underscores the critical role of promoting self-management skills. This approach is particularly important given the association between failed HHD therapy and poor patient outcomes. Methods: Our quality improvement program empowers patients to acquire self-care skills, including self-cannulation. We used the PATH-D tool to assess task distribution and developed a plan to promote independence through education, partnership with vascular surgeons, and tailored training to build patient confidence and autonomy. Results: Cannulation was found to be the primary task requiring assistance. Key outcomes included: 2 patients transitioning to solo HHD despite having a partner, 1 patient transitioning to solo HHD after losing their partner, nealry 50% patients (15/33) achieving independence performing >80% of tasks, 33% of patients (11/33) self-cannulating despite having a care partner, 1 starting solo HHD optimally. Conclusion: Our program has successfully shifted our approach from default assisted HHD to various degrees of unassisted HHD and demonstrates the potential for proactive promotion of self-sufficiency to improve HHD sustainability. Further follow-up will be valuable to assess long-term outcomes, identify predictors of successful autonomy, and refine our approach to maximize benefits for patients