Extracorporeal Home Hemodialysis: Evaluation of a New Approach to Kidney Disease Treatment

The prevalence of chronic kidney disease (CKD) is estimated to be 8-16% worldwide. With an aging population, and rising levels of hypertension, diabetes and obesity, renal diseases pose an increasing burden on public healthcare. In Italy, the annual direct treatment cost of a patient on dialysis was estimated to be around € 40000 specifically € 29 800 for peritoneal dialysis and €43 800 for hemodialysis. The economic impact of dialysis on the Italian National Health Service (NHS) was estimated to be € 2.1 billion per year. Home dialysis treatments constitute an optimal form of therapy due to the same purifying efficacy with respect to the hospital one, better patients rehabilitation, better integration in the socio-cultural context in which they live and the possibility of maintaining work and social activities. In the context of home dialysis, different technologies and equipment are available in the market. Among them, DIMI offers several advantages for the patient and represents an innovation for home hemodialysis treatment due to its great flexibility in the choice of treatment needed by the patient. The new DIMI device was used in December 2019 in fourteen prevalent patients with kidney failure aged (68 ± 11) years, attending the dialysis unit of the university hospital of Chieti. Eleven patients underwent a session of hemodialysis with a lactate-based dialysate volume of 20 liters, using a high-flux polyethersulfone hemodialyzer (Dimysis 017, Infomed). Two patients underwent a session of 4 hours and another one on a session of 3 hour. Only one patient underwent a hemodiafiltration session of 2.5 hours. The aim of this study is to carry out an evaluation of extracorporeal home hemodialysis analyzing blood chemistry tests of population described above. Parameter taken into account and analyzed in this work are: Blood urea nitrogen (BUN; mg/dl), Creatinine (mg/dl), Potassium (mEq/l), Sodium (mEq/l), Calcium (mg/dl), Lactate (mmol/l), pH, Kt/V and Urea Reduction Ratio (URR; %). All of these parameters are considered a marker of dialysis adequacy and were compared with the literature. In the results the same variation of the blood-related parameters as present in the literature has been evidenced. The results found, evidencing the potential benefit associated to the use of the DIMI device, seem encouraging in filling the gap in the market for a machine that can allow different home blood purification treatment.