Perceptions of Home Dialysis Training and Experience Among US Nephrology Fellows.

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Prior research suggests a lack of confidence amongst graduating US nephrology trainees in implementing both peritoneal dialysis (PD) and home hemodialysis (HHD). Gaps in fellowship training may represent an obstacle to achieving the Advancing American Kidney Health Initiative’s goal of increasing use of home dialysis. We sought to identify the strengths of and limitations in home dialysis training.A cross-sectional study surveying nephrology trainees regarding their confidence with home dialysis management and perceptions of home dialysis educational resources provided by their training program.A paper survey was distributed to 110 nephrology trainees with at least one year of nephrology fellowship training who attended any one of three home dialysis conferences.Data were summarized as percentages. Chi square, Fisher’s exact and the Kruskal-Wallis rank sum tests were used for statistical analysis.Self-perception of readiness to manage PD and HHD patients.76/110 (66%) of the attendees completed the survey. The majority of the respondents were moderately confident regarding principles of PD. However, only 3% had initiated patients on ‘urgent-start PD’ and 11% observed a PD catheter insertion. The level of confidence for HHD was low. Most of the trainees attended a home dialysis continuity clinic with mentorship from faculty.A small number of participants and the inability to verify respondent-provided data on the number of PD and HHD patients seen and clinics attended. Potential lack of generalizability owing to inclusion of only trainees who attended a home dialysis conference.Nephrology trainees perceive low and moderate levels of preparedness for managing HHD and PD, respectively. Educational innovation and optimization of resources at both the institutional and national level may improve confidence and promote public policy goals regarding home dialysis therapies.

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