Renal Replacement Therapy Preferences Survey: Is Allo-Hemodialysis an Acceptable Option for Patient Caregivers and Health Care Professionals?

Abstract

End-stage kidney disease (ESKD) is a worldwide unsolved problem. Access to renal replacement therapies (RRT) is still a challenge in some developed countries and even more so in developing countries. Allo-hemodialysis (alloHD) is a recently proposed, still hypothetical, alternative RRT where the blood of a healthy subject (“buddy”) flows countercurrent to the patient’s blood through the dialyzer. Solutes and fluid are transferred to the buddy and then cleared by his/her healthy kidneys, making alloHD essentially a procedure where the buddy “donates” kidney function intermittently to the patient. Its drastically reduced complexity makes ­alloHD particularly attractive for low-resource settings. The acceptance of alloHD by patients, caregivers, and health care professionals (HCP) is unknown. In this cross-sectional study, we surveyed the preferences and acceptance of alloHD in 3 groups: caregivers related to ESKD patients, nonrelated caregivers (nrCG), and HCP. Four areas were explored: RRT preferences, kidney organ donation for transplant acceptance, ­alloHD acceptance as a potential RRT, and alloHD technique acceptance. Hemodialysis was the preferred form of RRT. Kidney donation acceptance was similar in all groups. Intermittent kidney function donation (i.e., alloHD) was mainly accepted by related and nrCG but less accepted by HCP (87, 90, and 60% respectively, p < 0.01). New RRT alternatives such as alloHD are expected to be better received and accepted once animal, and clinical studies have demonstrated their feasibility, safety, and benefits. New RRT strategies are required primarily in most vulnerable populations and should be explored.