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Maximising and Sustaining Home-Based Dialysis Therapies

Sydney Local Health District
Project Added:
15 August 2016
Last updated:
19 August 2016

Maximising and Sustaining Home-Based Dialysis Therapies


This project reviewed the service delivery model for patients with End-Stage Kidney Disease (ESKD) who require dialysis therapy. Solutions include a new clinical pathway, training manual and staff training, with revised patient education packages and refurbished training units at Royal Prince Alfred (RPA) Hospital.

View a poster from the Centre for Healthcare Redesign graduation, August 2016.

Maximising and Sustaining Home-Based Dialysis Therapies poster


To increase the proportion of patients in Sydney Local Health District (SLHD) on home-based dialysis therapies, from 41% to more than 50% over four years.


  • Improves health outcomes and quality of life in patients, while reducing levels of depression.
  • Reduces the cost of providing dialysis therapy to patients, as home-based therapies are far more affordable than hospital-based services.
  • Reduces pressure on acute services, increasing access for those who need it most.
  • Provides a patient-centred approach to care, with improved levels of flexibility and independence.
  • Improves skills and knowledge of dialysis patients and staff, through education.
  • Improves the environment in Renal Services to be more comfortable and homelike for patients.


ESKD is the most severe form of chronic kidney disease, with patients usually requiring dialysis therapy or a kidney transplant to survive. The number of people in Australia who have ESKD and require dialysis therapy is growing, with research showing an 11% increase between 2010 and 20131.

Despite the increase of hospital-based dialysis treatments in SLHD over the past five years, the number of patients who choose to receive dialysis at home is reducing. Home-based dialysis is flexible and can be tailored to the needs of the patient, with reported benefits including improvements to quality of life, depression levels and clinical outcomes2,3.

While hospital-based dialysis costs approximately $60,900 per patient per year, the estimated cost of home-based dialysis is significant less at $28,300. As such, increasing the number of patients who choose home-based dialysis over hospital therapies will significantly reduce the financial burden on acute services.

The NSW Health Renal Services Plan set a target for home-based dialysis at 50% of all dialysis therapies. Prior to the project, SLHD had 41% of patients receiving home-based treatment. It was anticipated that increasing this rate would improve patient outcomes and reduce costs, while providing patients with greater levels of flexibility, independence and care.


  • A clinical pathway was developed, which outlines how the patient is referred to renal services and the home dialysis training unit which teaches patients how to manage their dialysis at home.
  • Pre-dialysis education packages were reviewed with patients and feedback incorporated into an updated version that will be trialled with a small group of patients.
  • A patient training manual for peritoneal dialysis (PD) and home haemodialysis (HHD) patients will be developed which will improve patient completion rates.
  • A needs analysis of staff education is underway and competency assessments will be conducted, so staff can develop their skills as trainers.
  • The PD home dialysis training unit was refurbished with new paint and furniture, to provide a more comfortable and homelike environment for patients. Refurbishment of the HHD training unit is currently underway.
  • The structure of renal services multidisciplinary team meetings will be reviewed which will allow improved communication and closer monitoring of the patients’ progress in home dialysis training.

Project status

Implementation - the initiative is currently being implemented.

Key dates

July 2015 – December 2019

Implementation sites

  • Concord Hospital, SLHD
  • Royal Prince Alfred Hospital, SLHD



A full evaluation will be conducted in December 2019, with quarterly audits commencing in September 2016. The following outcomes will be measured, using data collected from the SLHD renal database:

  • number of patients who complete HHD training
  • number of patients who complete PD training
  • number of patients who transfer from satellite dialysis services to HHD and PD training
  • patient satisfaction with education and new training manual
  • staff satisfaction with new staff education and competency assessments
  • patient satisfaction with the new physical environment.

Lessons learnt

Engaging key stakeholders with regular face-to-face communication is essential. It’s also important to ensure all documents are circulated among stakeholders for feedback.


  1. Australia and New Zealand Dialysis and Transplant Registry.
  2. Watanabe Y, Ohno Y, Inoue T et al. Home hemodialysis and conventional in-center hemodialysis in Japan: a comparison of health-related quality of life. Hemodialysis International 2014; 18(1): S32-8.
  3. Marshall MR, Walker RC, Polkinghorne KR et al. Survival on home dialysis in New Zealand. PLoS ONE 2014; 9(5): e96847. DOI: 10.1371/journal.pone.0096847.


Sarah Whitney
A/Director Allied Health
Sydney Local Health District
Phone: 02 9515 9562

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