POS-647 COMBINED HOME-HEMODIALYSIS PLUS IN-CENTER HEMODIALYSIS HYBRID REGIMEN AS A FAMILY-FRIENDLY WORK-FRIENDLY OPTION - THE FIRST OF ITS KIND

ABSTRACT

Introduction: Hybrid dialysis is traditionally identified as the combined utilization of peritoneal dialysis (PD) and hemodialysis (HD) in patients with end-stage renal disease. From current literature, its reported use is quite limited outside of Japan. We in the past year encountered major family-related and work-related constraints that prevented a 41-yo man with ESRD on home HD from completing the prescribed four-times weekly HD treatments. The resulting HD inadequacy led to worsening of the patient’s physiology and a possible risk of being de-listed from a kidney transplant list. He was successfully transitioned to a new hybrid dialysis regimen of twice-weekly Home HD + twice weekly in-center HD. HD adequacy was re-established and the patient’s physiology improved to acceptable status. This is the first such report. Methods: Case Report. Results: A 41-yo man with ESRD secondary to SLE and hypertension who had successfully been on home HD, 4 x weekly, for 32 months, with the wife as a caregiver, had in the second half of 2020 experienced new family-related stressors with the non-availability of day-care for two young children, ages 3 and 5 years, respectively, due to the COVID-19 pandemic, and concurrent spousal illness. In addition, the patient who is a product delivery driver, had new demands from his employment. As a result of these obstacles, he missed several of his Home HD sessions. The result was inadequate HD delivery and worsening laboratory indices and he was potentially going to be de-listed from the kidney transplant list. In February 2021, he was switched to new hybrid dialysis regimen of twice-weekly Home HD + twice weekly in-center HD - 2 in-center HD treatments on Tuesdays and Thursdays, and 2 Home HD treatments, one during the weekend and one during the week. Each HD session lasts 3.5 hours, 2000 units Heparin bolus, and his left brachiocephalic AVF is accessed by the button-hole method. The Home Dialysis Staff continued to coordinate and monitor his dialysis care. HD adequacy was re-established and the patient’s physiology improved to acceptable status. Conclusions: Hybrid dialysis is traditionally identified as the combined utilization of peritoneal dialysis (PD) and hemodialysis (HD) in patients with end-stage renal disease. 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 patient to suit the new exigencies and circumstances at home on a long-term continuous basis. Overall, patient and family are happy with the new arrangement with improved HD adequacy and normalized laboratory data. We revisit any observed other advantages and problems that may be associated with this form of Hybrid HD care. No conflict of interest