Chronic kidney disease has become a major global public health problem. Hemodialysis is the main method of renal replacement therapy, including two main modes: central dialysis and home dialysis. Central dialysis mode means that patients receive regular treatment by professional medical staff in clinical environments such as hospitals or dialysis centers. The family dialysis model means that patients undergo dialysis treatment in a family environment under the guidance of professional medical personnel. Affected by the new crown pneumonia epidemic, hemodialysis clinical resources are in short supply, and the family dialysis model has attracted public attention.

Peritoneal dialysis and family hemodialysis

In the central dialysis mode, patients generally need to go to the hospital or dialysis center for treatment three times a week or more frequently all year round, and normal life is seriously affected. The family dialysis model is relatively flexible, and the treatment plan can be reasonably arranged according to the actual needs of the patient, which can ensure the quality of life of the patient, and thus attracts increasing attention from all parties.

Home dialysis modes include peritoneal dialysis (PD) and home hemodialysis (HHD). Peritoneal dialysis requires the use of peritoneal dialysis equipment, which is relatively simple to operate and can better maintain the patient's residual renal function, but there are also some problems that cannot be ignored. For example, the adequacy of peritoneal dialysis is insufficient and the water removal is slow; long-term peritoneal dialysis may lead to peritoneal disease and functional deterioration, and continuous attention should be paid to the infection control of patients.

Home hemodialysis is based on hemodialysis equipment. Under the guidance of professional medical staff, patients can carry out treatment by themselves, or patients can carry out treatment with the assistance of family members and nursing staff. Compared with peritoneal dialysis, home hemodialysis has higher dialysis efficiency and relatively easy infection control, but it has higher requirements for patient operations, patient family conditions, medical support, and equipment.

From a global perspective, peritoneal dialysis is the main method of home dialysis. The proportion of home hemodialysis is low, and some European developed countries and regions have a higher acceptance of home hemodialysis. At present, my country's family dialysis model only uses peritoneal dialysis, and family hemodialysis has not yet been promoted.

Main factors affecting family hemodialysis

Family hemodialysis has a good development prospect, but because hemodialysis itself is more complicated, and there are many differences between the family environment and the clinical environment, it will take time for the wide application of family hemodialysis. The main influencing factors include patients and their family conditions, medical care Support, home hemodialysis equipment, etc.

Patients receiving home hemodialysis, their families, and nursing staff must pass corresponding training, have basic knowledge of hemodialysis, be proficient in the operation requirements of hemodialysis equipment and its supporting equipment, and consumables, fully understand the risks related to hemodialysis, and be able to handle blood in a timely manner Frequently asked questions about dialysis, strictly follow the guidance of professional medical staff.

Patient's family conditions Family hemodialysis requires patients to have a good economic foundation and sanitary conditions, and be able to provide a dedicated family space to place hemodialysis equipment and its supporting equipment, especially water treatment equipment that occupies a large space and requires dedicated pipelines.

Medical support Family hemodialysis must rely on the support of professional medical institutions. Medical institutions should assess whether the patient is suitable for home hemodialysis based on the patient’s own wishes; regularly carry out patient training and continuously dynamically assess the patient’s ability; designate a dedicated person to provide technical support during the patient’s treatment; establish a home hemodialysis quality control system to form The corresponding operating specifications.

Household hemodialysis equipment Household hemodialysis equipment needs to fully consider factors such as the use environment, target users, and core functions of household hemodialysis, and design products in combination with human factors engineering and usability. In terms of use environment, it is necessary to pay attention to the necessary conditions such as space, environment (temperature, humidity, etc.), electrical (power supply, electromagnetic compatibility, etc.), and water quality. In terms of target users, it is necessary to consider the population characteristics of patients, their families, and nursing staff, adopt a user-friendly interface design, and provide detailed instructions for use. The core function of home hemodialysis equipment should have the necessary hemodialysis treatment mode, and provide automatic pre-flushing, disinfection and other product functions, as well as remote monitoring and support functions.

Can take the lead in pilot projects in areas with conditions

As an important part of the family dialysis model, family hemodialysis has received increasing attention internationally. The country has issued laws to encourage patients to receive home hemodialysis, gradually replacing central dialysis.

Due to the different levels of economic development, medical resources, water quality and other aspects of China, there are still many difficulties in the development and promotion of household hemodialysis. The first to carry out the pilot work of household hemodialysis in areas with conditions will be the future development direction.