Patient-Centered Self-Cannulation Training Simulator to Promote Self-Care and Home Hemodialysis among African American Patients with Kidney Failure

Disparities in the treatment of kidney failure remain for 800,000 patients with end-stage renal disease (ESRD) in the United States. While these disparities are known for kidney transplantation, they also exist for other patient-preferred therapies such as home hemodialysis (HHD), offering improved flexibility and independence, improved patient engagement, and improved outcomes compared to conventional in-center hemodialysis. Overall, 14.8% of white patients versus 10.9% of black patients choose home therapies at initiation of kidney replacement therapy (KRT). One year after initiating dialysis, 2.5% of whites remain on HHD while only 1.6% of black patients continue HHD. Furthermore, once on home-based therapies, the frequency of conversion back to in-center hemodialysis is higher among black patients compared to white patients—23.4% versus 19.6%. To achieve the AAKHI goal of 80% of new ESRD patients receiving dialysis at home by 2025, particularly in the context of existing disparities in HHD, it is essential to develop tools and methods to create and maintain safe and effective home-based dialysis. One significant challenge to HHD for black patients is the reduced opportunity for self-cannulation and self-care. Cannulation of vascular access is a crucial step typically performed by healthcare providers such as nurses and patient care technicians. Yet, infiltrating the vascular access (a common error during cannulation) can have significant short- and long-term consequences putting patient’s very lives at risk. Increasing evidence suggests that self-cannulation for hemodialysis results in superior clinical and patient outcomes since self-cannulation empowers patients to take control of their treatment, rather than depending on a rotating PCT staff at in-center dialysis clinics. Furthermore, self-cannulation allows patients to consistently and skillfully cannulate themselves to initiate dialysis—which can be an advantage. Sojourn MedTech LLC is creating SelfCan, a patient-centered educational tool that empowers patients to begin and maintain home hemodialysis through learning to care for their vascular access (called their “lifeline"). Based on the promising results of our technology, we have partnered with several Dialysis Organizations and Clinical Institutions to create and test SelfCan specifically for facilitating the learning of patients to self-cannulate. In Phase 1, we will build on our core technology to create the SelfCan for the purpose of teaching patients (led by expert nurses) to self-cannulate by overcoming two primary developmental hurdles: (1) iteratively adapting the technology into a safe, easy-to-use, wearable SelfCan with the direct input of patients and cannulators. (2) Obtain preliminary feasibility and usability data from patients, and expert nurse-educators toward larger-scale validation testing. The following aims will be executed: Aim 1: Patient-centered and provider feedback to iterate and improve SelfCan simulator functionality; and Aim 2: Quantitative and qualitative testing the SelfCan for teaching self-cannulation to patients.