How do you approach selecting a dialysis modality for a patient with advanced CKD who is interested in home therapy but has a history of medication non-adherence and poor attendance at clinic appointments?
How do you approach selecting a dialysis modality for a patient with advanced CKD interested in home therapy, who has a history of medication non-adherence and poor attendance at clinic appointments?
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Good question. I would like to give them a chance at home dialysis before declaring that they are not candidates but I think it should be evaluated on a case by case basis.
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This is a very difficult issue for which there is no clear objective answer, just subjective/ experiential ones. A history of non-compliance with medications and clinic visits obviously bodes poorly for successful self-care dialysis, as established behavior patterns are unlikely to change. Some people advocate for the use of so-called "behavioral contracts" in which the patient agrees that if s/he does not comply with expectations, home dialysis will be terminated. Easier said than done - by far...
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