Patient Training and Patient Safety in Home Hemodialysis.

The success of a home hemodialysis (HD) program depends largely on a patient safety framework and the risk tolerance of a home dialysis program. Dialysis treatments require operators to perform dozens of steps repeatedly and reliably in a complex procedure. For home HD, those operators are patients themselves or their care partners, so attention to safety and risk mitigation is front of mind. While newer, smaller and more user-friendly dialysis machines designed explicitly for home use are slowly entering the marketplace, teaching patients to perform their own treatments in an unsupervised setting many hundreds of times remains a foundational programmatic obligation regardless of machine. Just how safe is home HD? How does patient training impact this safety? There is a surprising lack of literature surrounding these questions. No consensus exists among home HD programs in terms of optimized training schedules or methods, with each program adopting its own approach based on local experience. Furthermore, there is little available data on the safety of home HD as compared to conventional in-center hemodialysis. This review will outline considerations for training home HD patients, discuss the safety of home HD with an emphasis on the risk of serious and life-threatening adverse effects, and address the methods by which adverse events are monitored and prevented.