FP460
NEW TOOLS FOR A SHORT DAILY HOME DIALYSIS PROGRAM DEVELOPMENT:A FRENCH NEPHROLOGIST GROUP EXPERIENCE

INTRODUCTION AND AIMS: In France, Hemodialysis is the preferred nephrologist’s choice compared to Peritoneal Dialysis for end stage renal disease patients. The French government strongly encourage Home Dialysis to limit the cost when preemptive transplantation is not suitable. Whereas peritoneal dialysis remains stable for the past 10 years, we observed since a couple of years the development of Daily Home Dialysis Programs showing interesting results. At his time more than 350 patients in France receive this dialysis method. However in France, the number of home dialysis patients remain too low (n=350) as compared to the in-center dialysis patients’ number (n=45 000).

METHODS: From September 2012 on, and in order to expand the supply of daily home dialysis we opened a new Unit. It opened in spring 2015 and is entirely dedicated to self-care dialysis education. We screened every CKD stage IIIa to CKD stage V ND patients. Just after the nephrologist consultation patients are refered to a well-trained renal nurse to be evaluated for their dialysis technique best choice. We hereby present the tools implemented to select eligible patients to these techniques, and which require strong nurse involvement, well beyond the medical team. Following a reflection on the quality of information given to the patients, it has clearly appeared that home dialysis is not limited to the dialysis technique and the unique presentation of a dialysis machine. We opted for the French Self Convective System Physidia® S³ (SeCoHD). We have chosen to devote a workshop to the specificity of home dialysis with the desire to create our own support. In this context, we have created video material to respond to their needs. Our videos illustrate the principle of the Daily Home Dialysis and button hole technique. In our view, it is a means of communication, interactive, accessible to all patients and in tune with the times. We also developed a game of cards about questions that patients frequently ask to us. At the end of this workshop, a global report is provided to the patients and they have time with their entourage to define their best home dialysis strategy.

RESULTS: Using these tools and education’s procedure and workshops, 13 patients, ten males and three females (53.7 +/- 13.4 yo) have been included to the Short Daily Home Dialysis program from February 2015 up to now. Excepted three of them, all the patients were incident patients and all with a native radio-cephalic venous vascular access. All of them were well trained for self-puncture and none of them required any helping person for. None of them were hospitalized for side-effects or vascular access problems excepted once for a venous stenosis which did not impaired the technique. Seven patient’s received a kidney transplantation, 6 are still on the Short Daily Home Dialysis program. In order to prevent technique failure, we provide a monthly in-center dialysis session using the machine as they use at home. During this session, the training unit renal nurse check all the patient procedure, the blood tests results to permit the nephrologist decision for therapy and oral treatment.

CONCLUSIONS: Developing new tools and procedure during the CKD patient pathway, early from CKD stage IIIa, it appeared to us that many patients could be enrolled in a Self-Care Dialysis program. From now till 2019, we will evaluate the increasing number of Daily Home Dialysis patients in complete autonomy compared to the in-center patient’s number and the decreasing number of last referral patients. In addition, we will evaluate the patients’ clinical outcomes on all the patients included from 2017 to 2019, regarding technique failure, quality of life, and overall survival.