Abstract: SA-PO488
Home Hemodialysis (HHD) Practice and Curriculum Recommendations among Graduates of a Training Program without a HHD Clinic Experience
Session Information
- Home Dialysis - 2
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Howard, Andrew J., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
- Gupta, Nupur, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Yuan, Christina M., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
Background
The 2019 Advancing American Kidney Health initiative set a goal for ≥ 80% of new ESRD patients to receive home dialysis or kidney transplant by 2025. Home hemodialysis (HHD) rates have remained low (about 15K patients in the U.S.) and not evenly distributed between states. One barrier to increasing HHD prevalence may be a lack of familiarity among nephrologists, and lack of sufficient training during nephrology fellowship.
Methods
We performed an anonymous survey of 92/94 graduates of the Walter Reed program (1984-2023) regarding their HHD practice and training. The program’s home dialysis program is limited to peritoneal dialysis patients, and HHD training is limited to didactics and training with machines used for low-flow home dialysis. The survey was conducted from 12/4/2023-2/4/2024.
Results
52/92 (57%) responded with 50/52 (96%) completing the survey. All were in clinical practice. 75% (38/51) had been in practice ≦20 years. 43% (22/51) had (or had at one time) an HHD practice, and 54% (12/22) had been HHD directors/co-directors. Of those who practiced HHD, 73% (16/22) had started within the last 10 years. The majority of HHD practitioners were in the southern (50%) or western (23%) U.S., and 32% had rural practices. 54% (12/22) followed 6-10 patients. “On the job” training (68%) was the predominant way they reported learning HHD skills. Barriers most commonly cited by HHD practitioners were lack of patient interest (41%), lack of patient partners (27%), and lack of nursing staff to train patients (27%). Respondents indicated that the minimum effective curriculum to achieve HHD competence should include block/longitudinal HHD clinic (84%), familiarization with HHD machines (82%), didactic lectures (80%), and training in effective counselling for HHD (80%).<br type="_moz" />
Conclusion
Among graduates of a training program without an HHD clinical experience, 43% reported subsequently practicing HHD. The majority learned their skills “on the job”. Overall, graduates felt that a block/longitudinal HHD clinic was the most effective way for fellows to learn HHD skills during training.
Disclaimer: The views expressed in this abstract are those of the authors and do not necessarily reflect the official policy of the Department of Defense or the U.S. government.