Data from: Self-cannulation for haemodialysis: patient attributes, clinical correlates and self-cannulation predilection models

Background and objectives: With emerging evidence in support of home
haemodialysis (HHD), patient factors which determine uptake of the
modality need to be better understood. Self-cannulation (SC) is a major
step towards enabling self-care ‘in-centre’ and home HD and remains the
foremost barrier to its uptake. Human factors governing this aspect of HD
practice are poorly understood. The aim of this study is to better
understand self-cannulation preferences and factors which define them in
end stage renal disease (ESRD). Design: In this multicentre study, 508 of
535 patients from predialysis (Group A: n=222), in-centre (Group B: n=
213), and home HD (Group C: n= 100) responded to a questionnaire with 3
self-cannulation questions. Simultaneously, data on clinical, cognitive
and psychosocial variables were ascertained. The primary outcome measure
was ‘perceived ability to self-cannulate AV access’. Predictive models
were developed using logistic regression analysis. Results: 36.6% of
predialysis patients (A) and 29.1% of the ‘in-centre’ haemodialysis
patients (B) felt able to consider SC for HD. Technical-skills related
apprehension was highest in Group B (14.4%) patients. Response to routine
venepuncture and the types of SC concerns were significant predictors of
perceived ability to self-cannulate. There was no significant difference
in concern for pain across the groups. In multivariable regression
analysis, age, education level, 3MS score, hypoalbuminemia in Groups B
& C and additionally, attitude to routine phlebotomy and the
nature of specific concern for self-cannulation in Groups A, B and C, are
significant predictors of SC preference. The unadjusted c-statistics of
models 1 (derived from Group A and validated on A) and 2 (derived from B+C
and validated on B), are 0.76(95% CI 0.69, 0.83) and 0.80 (95% CI 0.74,
0.87) respectively. Conclusions: There is high prevalence of perceived
ability to self-cannulate. Modifiable SC concerns exist in ESRD. The use
of predictive models to objectively define and target education and
training strategies could potentially impact on HD self-management and
future uptake of home HD.