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This house believes that 15% of HD patients on Home HD is a realistic target Martin Raftery

Explore the feasibility of having 15% of HD patients on home HD. The discussions cover effectiveness, cost, applicability in different regions, patient choice, and housing factors. Insights from surveys and criteria for home HD are provided.

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This house believes that 15% of HD patients on Home HD is a realistic target Martin Raftery

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  1. This house believes that 15% of HD patients on Home HD is a realistic targetMartin Raftery

  2. RRT at BLT

  3. RRT at BLT 1978-97

  4. Key questions re Home HD • Is home HD an effective RRT modality? • Should major renal units offer it to patients? • Is it cost effective? • Is it applicable in all parts of UK? • What proportion of patients should be on it?

  5. Effective RRT Modality • 210 patients on home HD at peak at Barts and the London • Longest survivor was 31 years of which 29 on home HD • Best BP control and best control of inter-dialytic fluid gains • Best managed AV fistulae

  6. Part of Patient Choice • Major tertiary renal units should offer it to suitable patients • Especially suitable in areas of low population density • Some patients reject transplantation on ethical grounds, home HD is an option • Gives patient flexibility re dialysis regime • Not a realistic option for smaller units.

  7. Cost effective Treatment • Not cost effective for smaller renal units • Takes approx 3 years to recover upfront costs • Unlikely to be cost effective if patient is good candidate for transplantation • Is only cost effective if carer comes free

  8. Applicable in all regions • Most suitable in areas of low population density • Least likely to be suitable in inner cities • Dependant on condition of housing stock • Not possible where overcrowding exists • Not possible when patient/family do not speak English

  9. Survey of housing for home based RRT in East London • 200 consecutive home visits by pre-dialysis team • Size of accommodation • Number of occupants • Condition of accommodation • Accessibility for deliveries • Public health factors • Patient choice

  10. Results of Survey • Suitable for CAPD 68 (34%) • Statutory overcrowding 104 (52%) • Below decent housing standards 60(30%) • Temporary accommodation 24 (12%) • Unfit for human habitation 26 (13%) • Suitable for home HD 0 (0%)

  11. Criteria for Home HD • Fit patient who is technically or immunologically untransplantable • Failed PD, no live donor, poor MPI and no close HD centre • Required to have house, spouse & mouse • Older patient with younger fit partner/carer • If that adds up to 15% I will eat my hat

  12. The current NICE target of 15% of HD patients on home HD is unrealistic, unachievable and was clearly arrived at by Martians

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