Attitudes of nephrologists towards assisted home dialysis in Germany.

Background: Assisted home dialysis (AHD) is an option to combine the benefits of home dialysis therapy with the needs of dialysis patients who are unable to perform self-treatment at home. While this method is growing in many countries worldwide, no data so far are reported for Germany.
Methods: A survey was designed to identify the barriers to the implementation of AHD with the focus on attitudes and beliefs concerning AHD. The survey was sent to all 2060 members of the Germany Society of Nephrology.
Results: The response rate was 14% of nephrologists ( n  = 286), representing 24% of all German centres. AHD was regarded as a highly meaningful option (>90% of all responding nephrologists). Fifty-five percent of the centres practice AHD (preferred peritoneal dialysis). The number of treated patients on AHD was small (77% of the centres treat no more than 10 patients). The nephrologists in centres that performed AHD were of older age and the number of dialysis patients treated in these centres was greater. AHD was offered in 57% of centres at chronic kidney disease Stage 4. Inadequate conventional dialysis and patient's request were reasons for choosing AHD. Barriers for offering AHD were lack of reimbursement, shortage of staff, lack of expertise and lack of team motivation.
Conclusions: In the view of German nephrologists, AHD is a meaningful method to provide home dialysis care. Inadequate funding and a lack of qualified staff were identified as severe barriers to implementation of AHD. To overcome these barriers and to achieve a higher penetration of AHD, dedicated actions have to be considered. Further studies are needed to prove the AHD concept with regard to outcome effects and cost efficacy.