The introduction of home haemodialysis in the Maltese islands : a needs analysis

Abstract

Chronic kidney disease is a major public health issue, with end-stage kidney disease patients requiring renal replacement therapy. In Malta, haemodialysis is exclusively hospital-based, creating pressures on bed capacity, accessibility and staffing. Home haemodialysis (HHD) may offer improved health outcomes and quality of life while relieving strain on the healthcare system, however, its feasibility and desirability in small island states remain largely unexplored. This study seeks to answer the question: To what extent is home haemodialysis feasible and desirable in a small island state within the European Union? The research, guided by an interpretivist approach, employed a qualitative case-study design. Semi-structured interviews and focus groups with stakeholders were conducted, and the findings were analysed using established frameworks, to provide a multidimensional, person-centred understanding of feasibility and desirability. The analysis revealed five key themes: quality of life and independence, safety and support, training and education, infrastructure and logistics, and sustainability and strategy. Data triangulation across stakeholder groups revealed perceived benefits and concerns, identifying barriers and facilitators. The results indicate that stakeholders perceive home haemodialysis as both feasible and desirable, particularly for its potential to improve quality of life, autonomy, and system efficiency. However, concerns were raised regarding training requirements, psychosocial support, and infrastructural capacity. The study concludes that successful implementation in Malta will depend on careful planning, sustained investment, and supportive policy frameworks. This dissertation contributes to the knowledge base on the introduction of person-centred dialysis care in small island states within the European Union, and its findings may serve as a basis for similar settings.