An 82-year-old man presented with hypertension and type 2 diabetes treated in the Nephrology Department since January 2007 due to renal failure secondary to nephroangioedema.
A left radiocefic fistula was performed unsuccessfully, so it was decided to place a tunnelled catheter in the right jugular vein and start dialysis programmedly.
Subsequently, another sigmoid fistula was performed, which did not work either.
1.
The patient, despite his age, remained in his clinical analysis company, to which he came daily, so that the active hours spent in the hospital making dialysis meant a great impediment to his work.
In the room the patient was very nervous so we informed him of the existence of the HDDD program, he seemed to like it because the next day he came to ask for information and we decided to start training.
Initially, we followed the same procedure as with the previous patient, but we saw that this patient would not be able to follow it, so it was proposed that a family member learn.
They decided that your child and a nurse will be trained.
We began to program the educational sessions, and found that for each patient there is a rhythm of learning, so we had to adapt the previous protocols.
These served as guide or reminder and the training period was a little longer in this case, since the two people who came to learn did not come together, but on alternate days.
There were no problems with the adequacy of the household or with the installation of the water plant.
The duration of both training sessions was 2 months and 2.5 months, respectively.
For training, we took advantage of the three weekly dialysis sessions scheduled with a duration of four hours.
The material we used for the training was the same that the patients would take at home: the filter used in the two cases polypharmacy 1.7 (Xenium 170®), dialysis fluid with calcium 30 and potassium 2.
A monitor model Aurora Baxter® was installed at home, equipped with a tensiometer, tactile screen and adjustable height.
The pump velocity was programmed at 350 ml/min and the bathing fluid velocity at 800 ml/min. A treatment frequency of 6 days per week and 2 hours of the session duration was set at home.
In both cases, when the training was completed, we went home to give a good view of the installation, and make the first dialysis with the company and support of our team (nephrologist, nurse and technician).
No major difficulties were raised, except for the moment of catheter connection, because they were not familiar with the placement of gloves and what involved a sterile technique.
To avoid problems at home, the patients were provided with the unit's telephone and we advised them to have their treatment schedule between 8 and 22 hours, if any problem appeared, we could solve it.
Both patients went home with a permanent catheter and waited for a new fistula because, theoretically, although the connection to the catheter is easier for patients, it is necessary to try to avoid it, due to the increased risk of infections.
As in the experience of other centers, we have advised that the patient is not only at home at the time of HD and it is very important that the patient feels supported at home by both a family member and a family member.
Home hemodialysis should be considered a reversible option, and the patient and his/her family should understand that the possibility of going back to bed in the hospital or in a center is always open.
Many studies support the benefits of daily hemodialysis, but it entails great organizational difficulties in the units, so daily home hemodialysis would be a good alternative and an excellent treatment option for stable patients in the future.
Although there are numerous studies on home hemodialysis, there are few experiences with HDDD, which is a useful therapeutic modality that can be performed by any nephrology service, provided that it has adequate infrastructure.
In our case, all problems were resolved by telephone, without the need for displacement.
Due to our short experience, we do not have enough data to confirm an improvement in the analytical results of these two patients, but they claim they are much better and have the time needed to perform their activities without time restrictions.
Currently, we are training a 55-year-old woman derived from the peritoneal dialysis consultation, who lives at a distance of 100 Km from our center and works in an agricultural farm and we think that if we inform patients of active renal diseases.
