Hospital haemodialysis patients’ and nurses’ perceived barriers to home-based therapy

Dr Adam Mullan1,2, Dr Walaa Saweirs1,2, Lisa Harvey-Jack1, Jill Rengatch1, Nikki Ferris1

1Northland District Health Board, , New Zealand, 2University of Auckland, Auckland, New Zealand

Home based dialysis has been shown to improve quality of life.  Over the last ten years there has been a decline in the proportion of individuals embarking upon home based dialysis in Northland (New Zealand), such that only 28.6% were undertaking a home therapy as of August 2019.  The reasons for this decline are multi-factorial, and include an ageing and increasingly co-morbid population (Diabetes mellitus is the cause ESKD in 57.5%), resource constraints and patient specific factors.

In order to better understand the impact of these latter factors we undertook a survey of all prevalent hospital haemodialysis patients.  The aim of the survey was to assess the perceived barriers to home based therapy from the perspectives of patients currently on hospital haemodialysis and, independently, their primary haemodialysis nurse.  The survey was delivered in an independent and non-confrontational manner either utilising an electronic survey tool (Survey Monkey®) or via a paper equivalent depending upon patient choice.  The plan is to subsequently survey those on a home based therapy as well as those currently being managed by our Chronic Kidney Disease team at the time of their home visit or family meeting.

We present the results of the initial survey of those on hospital based haemodialysis.  This is part of our team’s aim to better understand the real barriers to home therapy faced by our specific population with a view to utilising consumer co-design methodology in order to increase the uptake of home-based therapy.


I graduated from the University of Edinburgh in 1994 with honours having also undertaken a one year intercalated degree in immunopathology.  I went on to complete a basic science PhD (MRC Clinical Research Fellowship) in 2005 at the University of Edinburgh.  This was primarily at a molecular level using recombinant DNA technology together with protein purification techniques to produce MHC class II-peptide tetramers using Goodpasture antigen peptide fragments.  The intention was to identify auto-antigen specific CD4 positive T cells in Goodpasture’s Disease.  I successfully developed the basic MHC class II-peptide monomers with a view to forming the tetrameric constructs.

Having completed my clinical nephrology and general medical training in Scotland, I came to New Zealand in 2007.  I have been the PD Clinical lead for the unit from an early stage, and have been the Clinical Director of Nephrology services in Northland since 2017.  I am one of the founding faculty members of the ANZ PD Academy, and have been lecturing at the annual clinical meeting since its inception in 2011.  I have been Chair of the New Zealand PD Registry since January 2017.

I was an investigator in the CARI PD implementation project to assess anti-microbial prophylaxis. I was the local clinical lead for a Ministry of Health Diabetes and CKD management project which reported in 2013 and formed the foundation of the New Zealand national Chronic Kidney Disease in Primary Care pathway.

I was a Principle Investigator for the AKTN CKD-FIX. I am currently an investigator in a national study “The genetic cause of End Stage Renal Disease in Aoteoroa, New Zealand” as well as TEACH-PD.


The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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