Study finds home dialysis patients fare better than satellite patients

A man sitting on a chair with tubes hooked up from a dialysis machine to his left arm.

A recent study has found that home dialysis patients saw a reduction in mortality rates compared to patients in satellite units, which are facility or hospital-based haemodialysis units. 

Director of Nephrology Professor Peter Kerr led a study to look at the dataset of Monash Health’s dialysis population over several years and saw home dialysis patients’ mortality rate was markedly better than the satellite patients’. 

“We analysed the home dialysis patients over several years and matched them two to one with satellite dialysis patients. So, for every home patient, we compared them to two satellite dialysis patients. The matching meant they had similar clinical characteristics such as age and medical condition.  

“The main difference between them being one was at home, and one was in the satellite, and the home patients did a lot better,” he said. 

Professor Kerr who is also a professor at Monash University says in general, patients who do home dialysis are younger and have fewer medical complications. But even among them, the mortality rate for matched satellite patients was still about 8% while the home dialysis patients were at 3.6%.  

What contributed to the better outcomes? 

Professor Kerr says there are several reasons. Firstly, home dialysis patients can dialyse more frequently and for longer periods. . They usually dialyse 6 to 8 hours at a time, and strictly every other day, including weekends. Whereas when patients do dialysis at the centre, it’s usually 5 hours and 3 times a week. 

“One of the other reasons that home dialysis patients do well is the empowerment of the patient. You empower them to look after themselves. And so, they don’t push the boundaries because they’ve got to fix it,” Professor Kerr explains. 

He adds that one of the big problems for dialysis patients is fluid management. If the patient drinks too much, they will need to remove the fluid through dialysis.  

And if there is a lot to remove, the patient’s blood pressure could drop making dialysis unmanageable. 

Monash Health leading the way globally  

Professor Kerr says that there has been a growing interest in revitalising home dialysis around the world, largely led by the Australian experience.  

“As a result of our work, Turkey, for example, has recently commenced a home haemodialysis program and is showing similar improvements in outcome for their patients,” he says.  

Back home, he says Monash Health has always tried to push home dialysis as a model of care not only because of better outcomes for patients but also for resourcing and financial reasons.  

“One of the problems that the hospital has is space for dialysis. Now we have a new dialysis unit opening at Kingston soon. It will be full on day one. Then you have to start thinking about building another one and they cost a lot of money. It also costs a lot to have nurses looking after them,” he says.  

In Australia, he adds that the cost of labour is more expensive than the machines. So, it’s far cheaper to have someone dialyse at home, both in terms of the actual day-by-day costs, but also the infrastructure costs as well as the more positive results for the patient.  

He says it costs up to $75,000 per year for a satellite dialysis patient, while a home dialysis patient costs $50,000 a year. 

Convenience for home dialysis patients 

It’s also a lot more convenient and comfortable for the patient, as 50-year-old home dialysis patient Adam Brayshaw shares. 

He started doing home dialysis in July this year and says he likes that he has the freedom to do things he would normally do at home when he spends hours doing dialysis. 

“I dialyse 7 days a fortnight, and I dialyse for 8 hours each session. What do I do? It depends; from reading a book, surfing the internet, watching a movie, Netflix, doing my own study on dialysis – done that a few times – rereading the manual just so I get the info in my head right and going through the notes I’ve taken from the information the staff at the dialysis centre gave me as well,” Adam says. 

He says it was only 28 years ago that he found out that he was born with one kidney, which he later found out wasn’t functioning well. It was scarred because of an undetected Urinary Tract Infection (UTI).  

The discovery came about after it was detected he had an extremely high blood pressure reading.  

But he’s managed through medication and a healthy diet for more than 20 years and only needed to start dialysis this year.  

He started in May and went through about 7 weeks of training and dialysis at our home training hemodialysis facility in Dandenong. 

“We discussed that at the renal clinic with different physicians and they said for a young guy, this is the best option, due to the fact that it gives you autonomy to work at home, look after yourself, you get to dialyse for longer hours, which means you tend to feel better and have a better clearance rate of all the toxins in your body,” Adam says.  

A typical dialysis day 

Adam usually starts at 6:30 am and ends at about 4:30 pm as it takes about 30 mins to set up and end the day.  

He starts by organising his snacks, drinks, and food for the day. And then he goes to his dialysis room and turns on the machine, tests the water to make sure it is free of contaminants and that it’s safe to use. 

He will then weigh himself and start setting up the machine, setting up all the lines for dialysis and then calculate how much fluid he needs to remove for the day and put the number into the machine.  

Once all the lines have been set up, he will need to insert two needles to make an arteriovenous fistula, which is a connection that’s made by joining an artery and a vein to the dialysis machine. 

One needle is to take the blood out and the other is to return the blood and go through the lines in the machine and back out again – on the same arm. 

While it can be a daunting idea to do home dialysis on your own, Adam says the training provided at the dialysis centre made him feel comfortable with the idea and well-prepared before he started his first treatment at home, on his own. 

He has some advice for new patients who may be hesitant to dialyse at home. 

“If they are nervous or scared, that’s all right, because the staff who do the training do a fantastic job. They’ll guide you through the process and help you in any way you need. Even if there are issues, they don’t berate you at all. They’ll ask what you did wrong and what you think you have to do to fix the problem. 

“It’s a very happy teaching environment. They are very encouraging, and they let you know what you did well even if you made a couple of mistakes on that day. It is a happy and positive environment where the staff really assist you and make sure you’re comfortable before you go home, which I found excellent,” Adam says. 

 

 

Approved by: Angus Henderson, General Manager, Research Strategy and Anjali Dhulia, Chief Medical Officer 



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