Establishing a Home Nocturnal Hemodialysis Program: “Starting From Scratch”

Purpose:  In April 2001, the Northern Alberta Renal Program (NARP) in Edmonton, Alberta received a government grant to start a Home Nocturnal Hemodialysis program for 17 patients. At that time NARP did not have a home program, so the challenge was to develop and operationalize the program and to stay within the requirements related to the grant. Methods:  We describe our experience with specific reference to funding, infrastructure, human resources, monitoring, and the target population. Results:  Funding from the grant allowed space for one dialysis teaching station and clinic area. A multidisciplinary team of a nurse, technician, social worker, and dietitian were recruited. New procedures were written, and new manuals were prepared for teaching. Several new machines were evaluated. The Bellco Formula machine from Genpharm was chosen. This machine had very limited use in North America and had never been used in a home program or a nocturnal program with monitoring. Initiating the monitoring proved to be one of our main challenges. We initiated monitoring with Capital Health Link, the telephone health information line for our region, to provide the observers for the monitoring. Initially the program was intended to serve people who lived in remote areas not serviced by a satellite hemodialysis unit, but in a population of 600 dialysis patients we were having difficulty recruiting. We widened the criteria and expanded our marketing strategy. Based on a survey of other programs and a patient satisfaction survey, we discontinued the monitoring after one year as it did not prove clinically beneficial and patients viewed it as restrictive. Conclusion:  Through perseverance and teamwork we were able to establish this innovative program “from scratch.” We received an award for innovation from our health authority in 2003. The program now has 15 patients at home enjoying the benefits of home nocturnal hemodialysis, and we are expecting to expand the program. The evaluation to date is encouraging with respect to this therapy being clinically more effective than conventional dialysis and an improved quality of life for the patients.