Family-friendly, work-friendly, home-hemodialysis and in-center hemodialysis hybrid: the first of its kind

Introduction: Hybrid dialysis is traditionally defined as the combination of peritoneal and hemodialysis (HD) in patients with end-stage renal disease. Its reported use is quite limited outside of Japan. We recently encountered major family-related and employmentrelated constraints that prevented a 39-yo man with ESRD on home HD from completing the four-times weekly HD treatments with HD inadequacy and worsening of patient's physiology. We successfully switched him to a new hybrid of twice-weekly Home HD + twice weekly In-Center HD. This is the first such report. Case Description: A 41-yo male with ESRD secondary to SLE and hypertension on home HD, 4 x weekly, for some years experienced family-related constraints including non-availability of day-care for two young children due to COVID-19 pandemic, spousal illness and new work-related challenges with more travel and was missing his HD sessions. The result was inadequate HD delivery and worsening laboratory indices. He now receives 2 in-center HD treatments on Tuesdays and Thursdays, and 2 home HD treatments, one during the weekend and one during the week. This was started in February 2021. Each HD session lasts for 3.5 hours, 2000 units Heparin bolus, and his left brachiocephalic AVF is accessed by the button-hole method. The Home Dialysis Staff coordinates his dialysis care. Standardized Kt/V for May 2021 was 2.6. Discussion: Hybrid dialysis is traditionally defined as the combination of peritoneal and HD in patients with ESRD. A 2020 Italian report described another type of hybrid dialysis that consisted of once-weekly in-hospital HD and home peritoneal dialysis to limit patient exposure to the hospital environment during the COVID-19 pandemic. We have described the successful application of a new Hybrid HD system that combined Home HD + In-center HD. To our knowledge, our report is the first of its kind and was designed and implemented primarily for the purpose of overcoming increasing family and employment demands on the patient. This new hybrid dialysis option was designed to facilitate a family-friendly work-friendly HD on a long-term continuous basis. The patient, the family with two young children and his employers are happy and very satisfied. Simultaneously, the patient has continued to do well with adequate dialysis and meeting all the required goals of management in the past 3 months.