Barriers to Adoption of Nocturnal Home Hemodialysis

Healthcare Human Factors


Home hemodialysis is a home-based renal treatment therapy option for patients with established chronic kidney disease. In comparison to conventional hemodialysis (CHD) at health care institutions, nocturnal home hemodialysis (NHHD) can significantly improve patient health outcomes and health care resource utilization. However, adoption of NHHD remains limited. To further understand the barriers to adoption, Healthcare Human Factors collaborated with researchers from the University Health Network and the University of Toronto.

The study included CHD, NHHD, and predialysis patients from the University Health Network. Surveys and ethnographic interviews were used to gather demographics, psychosocial attributes, anxiety levels, quality of life, and perceptions of NHHD therapy. Based on the data, a number of major themes arose. The primary barriers perceived by CHD patients were fear of self-cannulation, perceived burden on family members, fear of a catastrophic event in the absence of nursing support, and lack of self-efficacy in performing the therapy.

The findings suggest that patients may be overwhelmed by the complexity of present medical technology. In addition, the study underscores the importance of patient-centric design in home-based medical devices to accelerate adoption.