#3227 National home hemodialysis (HHD) survey about organization of care and medical practices in France

Abstract Background and Aims There is a renewed interest in HHD with mainly short daily session schedules and rarely long nocturnal sessions (LNHD). Data on medical practices and care organization of HHD programs are scarce. Benabed A et al. [Néphrologie&Thérapeutique 2017;13:18–25] described patients, practice and outcomes in low flow dialysate HD. KIHDNEY cohort study described practices at European level. In 2024, we decided to conduct a national survey to describe HDD practices and care organization: this is the objective of our “home survey” about organization of care and medical practices in HHD. Method Questionnaire sent in April 2024 to french nephrologists of all dialysis centers without selection via a secure e-platform. The questionnaire covers (1) characteristics of nephrologists and centers, (2) reasons for not offering or offering HHD, (3) patient profiles, (4) recruitment and training program and (5) organization of centers. Only doctors' claims are collected, no patient data is collected. We present here interim results (January 2025) of this survey which will be closed in May 2025. Results 70 nephrologists respondents to date (see Fig. 1). 86% of respondents have a HHD program. 14% don't have such program (economically not profitable, lack of medical evidence, lack of personal motivation, delegation to third-party center). The respondents are from public hospitals (49%), private clinics (11%) and dialysis associations (34%). HHD programs are heterogeneous: 25% dedicated to HDD, 34% to home (HD+ PD), 17% to home + in center HD, 22% without dedicated structure. Number of HHD patients per center is low : all modalities combined 92% of respondents have between 0–10 patients. HHD is offered mainly based on medical evidence (82%) and demand from patients (58%). Patient acceptance rate for HHD varies from 1% to 25% for 82% of respondents: refusals expressed due to “treatment introduced at home", fear of puncture, personal lifestyle choices, technical complexity. Conversely, HHD acceptance factors are quality of life, autonomy of care, geographic mobility. Age of HHD patients is 26–50 y. (38%), 51–75 y. (61%). Male gender = 60%. Comorbidities are type 2 diabetes (52%), obesity (37%), coronary artery disease (34%). Preferred indications are Young age, autonomous patient, heart failure, hyperphosphatemia. Exit modes from HHD modality are mainly renal transplantation (RT) and in center HD, Exceptionally PD or hybrid modality PD/ HDD. The Modality preceding HDD is often Self-dialysis / in center HD / CKD ND and rarely RT and PD. 75% of respondents have a HDD recruitment program for “dialysis initiation” (93%) and “urgent start program” (62%). Role of nephrologists in HHD programs is equally shared: All doctors follow all patients, one doctor follows all patients, Each doctor follows his patients. Only 10% of nurses are participating in HHD program in full time. 26% of respondents claim advanced nurses practitioners involved in HHD program. Conclusion These are interim data with probable return from experienced centers (selection bias?). These initial data indicate low number of HDD patients per center, absence of a barrier related to the doctor in this survey, expected causes of refusal (fear of puncture, technical and organizational complexity), expected preferential indications and a HDD mainly from AVF but the KTC is prescribed. These data encourage to continue the survey until May 2025 in order to have more information on the prescriptions and the structures/organization of HDD programs.