How Australian Nephrologists View Home Dialysis: Results of a National Survey
Submitted by Mr CS Soong
Nephrology - Accepted Article (Accepted, unedited articles published online for future issues) -DOI: 10.1111/j.1440-1797.2010.01403.x
Marie J Ludlow 1, Charles RP George 2, Carmel M Hawley 3, Timothy H Mathew 4, John W M Agar 5, Peter G Kerr 6, Lydia A Lauder7
1 Medical Project Manager, Kidney Health Australia
2 Department of Nephrology, Concord Hospital, Concord, New South
3 Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland
4 Medical Director, Kidney Health Australia
5 Department of Renal Medicine, Geelong Hospital, Victoria
6 Department of Nephrology, Monash Medical Centre, Clayton, Victoria
7 National Manager Strategic Health Projects & Publications, Kidney Health Australia
Abstract
Aim Australia's commitment to home dialysis therapies has been significant. However, there is marked regional variation in the uptake of home haemodialysis (HD) and peritoneal dialysis (PD) suggesting further scope for the expansion of these modalities.
Methods Between 1 April and 5 August 2009, Australian nephrologists invited to complete an online survey. Seventy-six questions were asked covering characteristics of the dialysis units, responders¡¯ experience, adequacy of facilities and support structures, attitudes to the use of home HD and PD and issues impeding the increased uptake of home dialysis.
Results Completed surveys were received and analyzed from 71 respondents; 27from Heads of Units (35% response rate) and 44 (16%) from other nephrologists. There was strong agreement that HD with long hours was advantageous and that this was most easily accomplished in the home. PD was not considered to be an inferior therapy. A ¡°PD first¡± policy existed in 34 of Renal Units. The most commonly reported impediments to expanding home dialysis services were financial disadvantage for home HD patients, and lack of physical infrastructure for training, support, and education. Areas of concern for expanding home dialysis programs included psychiatry support, access to respite care and home visits, and lack of support from administration and government. The majority of medical nephrologists would recommend home dialysis to more patients if these impediments could be overcome.
Conclusion This survey identified support from nephrologists for the expansion of home dialysis in Australia and highlighted important barriers to improving access to these therapies.
Abstract found here
1 comment:
This is an interesting article that reflects practice in Australia. In reality, long hours 6x/week Home HD has better outcomes and less morbidity than cadaveric renal transplant. However without a viable affordable system in Malaysia, Home HD will remain a dream for now and we only have PD as a home dialysis option.
It is worrying that PD is becoming increasingly the monopoly of 2 companies. With Malaysia moving to a PD first policy in MOH- it would be advantageous for a local company like Ain Medicare to develop a non spike, 2 bag PD system, in addition to tenckhoff catheters.
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