Analysis of Discrepancy between Home Dialysis and Hospital Dialysis

Running Head: Dialysis
Dialysis
Institution
Name
Date

Dialysis
Introduction
Dialysis is defined as the process of getting rid of waste products together with excess fluid from
the body (Khanna & Krediet, 2009). It becomes a necessary process when the kidneys are not
able to filter blood adequately (Ronco, 2008). The dialysis therefore allows patients suffering
from kidney failure the opportunity to live productive lives (Nolph, 2013). It is important to note
that there are two types of dialysis; peritoneal and hemodialysis with each bearing advantages
and disadvantages (Auer, 2005). Therefore, patients are able to choose the type of long term
dialysis perceived to best match their needs.
Analysis of discrepancy between home dialysis and hospital dialysis
This essay will focus on analyzing the discrepancy arising from having dialysis at home and in
hospital and satellite centers. It will also analyse the long term advantages of a closer alignment
between reality and preference, for individual health care and the health system. The process of
choosing dialysis modality for patients is perceived as a complex exercise hence requires
expertise input from a renal team (Henrich, 2012). There has been a reduction in the uptake of
home dialysis in the recent past according to reports (Morfín, et al., 2017). This is because
majority of dialysis clients prefer hospital dialysis to home therapies for several reasons. There
are some advocates for home dialysis and the reasons cited for such a point of view frequently
bear a mixture of utilitarian principle of maximal usage of limited resources and individual
clinical indications. However, there are guidelines which broadly recommend that the selection
between home dialysis and hospital dialysis should be based on a shared-decision making
process mainly between the health -professional and informed patient (Kim & Kawanishi, 2018).
The shared-decision making factors in the viable clinical evidence that is available and the values
and preferences of the patient. It therefore requires the professionals and patients to understand
2

Dialysis
what is essential to the other party when choosing a treatment plan. A structured pre-dialysis
program aimed at increasing the adoption of home dialysis termed as ‘GUIDE’ describes a
retrospective analysis of outcomes in patients suffering from advanced chronic kidney disease. In
this regard, having home dialysis has been identified as an essential aspect for Australian and
New Zealand dialysis clients. This is because based on the GUIDE approach, the programme
provides a home focused approach that if it is impossible to have transplantation in a timely
fashion, home dialysis is advised over hospital- based treatment particularly by a team who seek
to increase the adoption of home therapies. The other difference between home dialysis and
center based treatment is that for home dialysis, patients are visited at home conveniently by a
case manager who is tasked with the responsibility of reviewing the circumstances of the patient
and completes a questionnaire indicating their view of suitability of the patient for home dialysis.
The dialysis done at home provides a better position that allows the patient to fit their treatment
into their daily schedules (Hörl, 2004) . This is because studies show that the more a patients
knows regarding their treatment and the more they to do on their own, the better they are likely
to do on dialysis.
This aspect has resulted to the discrepancy being witnessed between the uptake of home dialysis
and hospital and satellite dialysis. However, on the other hand in center treatment is preferred by
the majority of patients because of the technological complexity of conventional dialysis systems
(Kallenbach, 2012). This notion has challenged the prevalence of home dialysis. For instance, in
the hospitals, the patients have access to high quality treatment owing to advanced medical
facilities put in place (Himmelfarb & Sayegh, 2010). Nevertheless, home dialysis programmes
with observational studies have demonstrated greater patient satisfaction, superior control of
circulating volume and blood pressure, better patient survival and reduced running costs
3