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Home hemodialysis

Authors
Christopher R Blagg, MD, FRCP
Lionel U Mailloux, MD, FACP
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD

INTRODUCTION

Home hemodialysis began in the early 1960s in Boston, Seattle, and London [1-5]. Studies since then have shown that patients using conventional, three times weekly home hemodialysis have an increased survival [6-13] and better quality of life [14-16] compared with those who use other dialysis modalities. This modality also costs significantly less than conventional in-center hemodialysis [17-21].

These findings led some investigators to believe that home hemodialysis is the best renal replacement therapy, other than renal transplantation. Despite these apparent benefits, the proportion of prevalent dialysis patients with end-stage renal disease (ESRD) treated by home hemodialysis in the United States declined steadily from the start of the Medicare ESRD program in 1973 until 2002, when it was 0.57 percent [22]. Similar changes occurred in other countries (figure 1 and figure 2) [23-25].

Since 2002, there has been a gradual increase in the number and percent of all United States dialysis patients treated by home hemodialysis; by 2008, there were 3826 patients (1.09 percent) on home hemodialysis [22], and preliminary estimates for 2010 suggested that the number of patients was between 5000 and 6000. This reflects the increasing interest in more frequent home hemodialysis [26]. Based on United States Renal Data System (USRDS) 2013 data for incident 2011 patients, total home dialysis patients have risen but mainly due to a significant increase in the number of patients utilizing continuous cycler peritoneal dialysis [27]. There are multiple barriers to patients choosing a home modality [28]. (See 'Barriers to increased use of home hemodialysis modalities' below.)

Issues relating to patient survival and other benefits derived from home hemodialysis, the declining incidence of this modality in the United States, and developments with more frequent daily and nightly hemodialysis (which are generally performed at home at night) are discussed here and elsewhere [29]. How home, short daily, and nocturnal hemodialysis are performed is discussed separately. (See "Organization and elements of a home hemodialysis program" and "Technical aspects of nocturnal hemodialysis" and "Short daily hemodialysis".)

INCIDENCE AND PREVALENCE

The number of patients using any home dialysis modality (hemodialysis or peritoneal dialysis) decreased for over 10 years from 1996 to 2008, when the trend began to change. By 2010, there was a large increase in all home dialysis, with most new patients choosing peritoneal dialysis. There was also a clear increase in home hemodialysis by 2011 to 2013, though less than 1500 patients out of the nearly 13,000 patients chose a home modality [30]. The overall use of home hemodialysis remains low. Among incident end-stage renal disease (ESRD) patients, only 9.1 percent of home dialysis patients were treated with home hemodialysis in 2013 (figure 3).

         

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