Attitude of Healthcare Professionals and Patients With End-Stage Kidney Disease Towards Home Hemodialysis: A Survey in China

Abstract

Introduction

Home hemodialysis is still in its early stages in mainland China. This survey aimed to assess the perceptions of healthcare professionals and patients towards home hemodialysis and to identify the barriers hindering its uptake.

Methods

A cross-sectional observational survey was conducted using convenience sampling. Healthcare professionals specializing in nephrology and patients with end-stage kidney disease (ESKD) across mainland China were included. A self-reported questionnaire was administered to gather data on participants' demographics, attitudes, perceived barriers, and facilitating factors related to home hemodialysis. Chi-square tests were used to analyze the association between categorical variables.

Findings

A significant majority (80.1%) of healthcare professionals recognized the need for home hemodialysis. However, there was a statistically significant difference in willingness to undertake or receive home hemodialysis between healthcare professionals (53.6%) and patients (63.2%), respectively. Healthcare professionals identified the following as top facilitating factors: patients' needs (6.9 points), higher patient benefits (5.7 points), and shortage of dialysis resources (5.1 points). The primary barriers cited were the absence of relevant policies and regulations (7.5 points), lack of guidelines and management standards (7.0 points), and inadequate treatment technology and knowledge (6.6 points). Patients' willingness to accept home hemodialysis was primarily driven by the potential to save time and travel expenses (70.7%) and reduce infection risk (49.0%). The main barriers identified by patients were the inability to manage acute complications (77.8%), increased risk of vascular access infection (66.1%), and uncertainty about self-cannulation (60.7%).

Conclusion

There is a clear demand for home hemodialysis in China among both healthcare professionals and patients with ESKD. However, the lack of a supportive system, including policies, standards, and management frameworks, remains a significant obstacle to its widespread adoption.