Rather, we encourage readers to consider the options that are available to them, taking into account factors that are unique to their anticipated program structure and size, staffing sources, budget constraints, available equipment, local environment, and cultural practices.In some cases, we have clarified the question with additional considerations that are listed as bullet points.
It is important to clearly identify internal and external stakeholders in relation to a proposed home HD program.
These specific people or groups are those who will be required to support the program, either through mitigating clinical and financial risks or through promoting and/or directly contributing to it.
An important consideration is modality mix, in terms of extended-hours or frequent HD.
Longer treatments have very low marginal costs per dialysis hour, as the only additional costs are for extra utilities (ie, power and water) and dialysate.
Figure 1 compares the size of home HD programs between Japan and Australia/New Zealand.
Expanding a home HD program therefore requires substantial resources, and typically this requires a sound business case for financial investment.Dialysis Centers play an essential role in planning for and responding to a citywide public health emergency.Here you will find information, tools and resources to improve mitigation, response, and recovery during emergencies.This resource provides guidance on the processes that are involved, including: a thorough situational analysis of the dialysis landscape, emphasizing the opportunity for a home HD program; careful consideration of the clinical and operational characteristics of a proposed home HD program at your institution; the development of a compelling business case, highlighting the clinical and organizational benefits of a home HD program; and careful construction and evaluation of a request for proposal.Making the correct fiscal case for change is a crucial step in developing a home hemodialysis (HD) program.The clinical and administrative leads of the project should be comfortable that the majority of these questions have been answered to their satisfaction.In most cases, however, there is no “correct” answer.The questions in the next section should be considered in detail before starting or expanding a home HD program, or writing a business case.For each set of questions, we have indicated specific resources that are available to the reader for further information.Smaller programs or pilot projects can often be started and managed within existing hospital HD infrastructure with costs being absorbed into existing funding.Once programs grow to beyond 5-10 patients, there is often requirement for separate and specialized home HD infrastructure and staffing.