Home haemodialysis, a beacon of hope for vulnerable patients

Assisted Home Haemodialysis (AHHD), a national programme in Qatar is a pathbreaker in many ways, according to an article in Qatar Medical Journal and featured on QScience.com recently."The programme stands as a testament to Hamad Medical Corporation’s unwavering commitment to excellence," says the article ‘Qatar’s assisted home haemodialysis programme: A beacon of hope for the vulnerable patient.”"This innovative care model is tailored to address the distinct challenges of haemodialysis patients, particularly the elderly, who require ambulance transport.”AHHD initiative, sponsored by the Ministry of Public Health and Hamad Medical Corporation (HMC), is specifically designed to address the quality-of-life needs and pressing concerns of the elderly dialysis population in Qatar, who rely primarily on ambulance transportation. This approach aims to reduce hospitalisations, medical costs, strain on ambulance services and dialysis capacity, and improve overall care.According to the authors of the article, AHHD provides the haemodialysis patients, especially the elderly with the convenience of at-home dialysis with the full support of dedicated nursing care. AHHD included 76 patients from July 2021 to December 2022. It has significantly improved patients’ quality of life, achieving an exceptional 99% satisfaction rate with an extremely low complication rate.Home haemodialysis is usually done as self-care by the patients themselves through a portable haemodialysis machine under training and monitoring by a dialysis team. It offers greater patient autonomy, cost benefits, and treatment-related flexibility, and its outcomes showed improved quality of life and patient survival compared to traditional in-centre haemodialysis.End-stage kidney disease prevalence has increased significantly in the last few decades and its prevalence is increasing in Qatar and is expected to go up by 30% by the end of 2030, say the writers of the article.Dialysis services in Qatar are solely provided by HMC and there are seven haemodialysis centres across Qatar. However, the long-distance travel and the three-weekly dialysis regimen may lead to burnout and missed treatment sessions.The frequent transportation of elderly dialysis patients with restricted mobility with constant movement between beds and stretchers or wheelchairs increase the risk of falls and fractures due to their mineral and bone disease related to age, risk factors.Moreover, strict regulations limit family members’ presence, further isolating them especially during Covid-19 times.The changes from in-centre dialysis to home haemodialysis met with some resistance and fear from patients and family members initially. This resistance was overcome by providing awareness, along with proof from evidence-based practices across the globe, illuminating the safety and efficacy of HHD.AHHD has also delivered tangible improvements in health outcomes, marked by a reduction in hospitalisations, decreased transmission of Covid-19, cost-effectiveness, alleviating strain on ambulance services, and reducing demand for dialysis slots and manpower.The article suggests that initiating an AHHD programme emerges as a potential solution to enhance the overall well-being and care quality of the vulnerable elderly population. Addressing specialised transportation, cost-efficiency, personnel training, reduced wait times, improved patient comfort, and alternative care options can significantly improve the care experience by providing dialysis treatment in the comfort of their homes, vastly enhancing the care experience for elderly dialysis patients.The article concludes that the clinical and financial success of the AHHD programme positions it as a superior alternative to traditional in-centre dialysis, particularly in its capacity to cater to the needs of the most complex and challenging patient populations.