Any ESRD patient in the age group 20-70 are eligible to receive the training if they are motivated enough to opt for this training. All of the eligible patients would have been receiving Hemodialysis in a hospital affiliated Hemodialysis Centre. HHD (Home Hemodialysis) is not suitable for every one. Careful selection will have to be made as well as the consent of the treating Nephrologist has to be obtained, prior to acceptance to the HHD training program. If Self-Home-Hemodialysis is not opted, training will have to be given to the patient as well as the family relative, who is willing to provide the requisite help and support and prepared to undergo the training at the same time. Another alternative is to arrange or employ a ‘dialysis Nnurse or Technician, who will undertake all the requisites for performing hemodialysis at home. ‘HD’ can be done at home only after installation of all the requisite hardware such as Hemodialysis Machine, ‘Reverse Osmosis (RO)’ Plant etc. and kept ready for use, by the time the patient/partner have completed the training and are ready to come home.
The suitability can be based on the clinical parameters and the needs of the patient. When patients come for Hemodialysis, many of them would have already tried Peritoneal Dialysis. Some would have been chosen for Hemodialysis without ever having had Peritoneal Dialysis. There is heavy demand on the existing maintenance Hemeodialysis Centres all over India. Most centres do two shifts daily and some do three shifts, so that the demand can be met. Some centres work for 7 days a week, as well as in nights. Recruitment to Home Hemodialysis can be made only after adequate discussions and counselling of the patient and the family has been done, and all the facts have to be understood prior to the initiation of training. Strong family support helps and thus the role of the Partner or Carer is important. Patients should be motivated enough to seek Home Hemodialysis due to the advantages it bestows. There is definite resurgence of Home Hemodialysis globally due to the distinct benefits that have been documented in several studies, which are still continuing.
An excellent compilation of articles by well known Nephrologists in different Countries, has been published in the ‘Hemodialysis International Journal’ in July 2008. Any ‘ESRD’ patient on maintenance Hemodialysis in a hospital centre, is encouraged to discuss the contents of these articles with their Nephrologist who would have been aware of this publication.