Data from: Is lack of suitable housing a barrier to home-based dialysis therapy for patients with end-stage renal disease? A cohort study

Objective: To determine whether inadequate housing is the main barrier to the provision of home dialysis treatment. Design: Prospective observational study. Participants: All patients attending a predialysis clinic between 2006 and 2009 deemed medically suitable for home dialysis and not active on the preemptive transplant list. Setting: A predialysis clinic in a London teaching hospital. Main outcome measure: Assessment of patient's accommodation for suitability for home-based dialysis using departmental guidelines and the Government's Housing Health and Safety Rating System regulations 2005. Results: A lack of adequate housing prohibited the provision of home haemodialysis to all but one of these patients. Moreover, only 29% of homes assessed were suitable for peritoneal dialysis, despite the lower spatial demands of this form of renal replacement therapy. In addition to the specific requirements of dialysis, we also found that only 33% of the homes visited fulfilled the minimum standard of housing as defined in the Government's Decent Homes Standard, with multiple specific hazards identified across the properties. Conclusions: This study illustrates that the lack of suitable housing is a major barrier to the provision of home-based dialysis and underscores the need for this to be addressed urgently at both the central government and local authority levels. We suggest that it should be considered as a major priority to rehouse medically suitable patients with a view to enabling home-based therapy.

研究目标：明确住房不足是否为居家透析（home dialysis）治疗开展的主要阻碍因素。
研究设计：前瞻性观察性研究。
研究对象：2006年至2009年间于透析前门诊就诊的所有患者，这些患者经评估符合居家透析的医学指征，且未列入优先移植等候名单。
研究场景：伦敦某教学医院的透析前门诊。
主要结局评估指标：依据科室指南与英国政府2005年版《住房健康与安全评级系统（Housing Health and Safety Rating System）》条例，对患者住所是否适配居家透析治疗进行评估。
研究结果：除1名患者外，其余所有符合条件的患者均因住房不达标无法开展居家血液透析（home haemodialysis）。此外，尽管腹膜透析（peritoneal dialysis）对空间的要求更低，但经评估的住所中仅29%适配该疗法。除透析治疗的特定要求外，本研究还发现，仅33%的受访住所达到英国政府《体面住房标准（Decent Homes Standard）》规定的最低住房标准，且各住所均存在多项明确的安全隐患。
研究结论：本研究表明，住房适配性不足是开展居家透析治疗的主要阻碍因素，凸显了中央政府与地方政府层面亟需尽快解决该问题的必要性。我们建议应将为符合医学指征的患者重新安置住房作为核心优先事项，以推动居家透析治疗的开展。