Survival for patients on dialysis is poor. Earlier reports have indicated that home-hemodialysis is associated with improved survival but most of the studies are old and report only short-time survival. The characteristics of patient populations are often incompletely described. In this study, we report long-term survival for patients starting home-hemodialysis as first treatment and estimate the impact on survival of age, comorbidity, decade of start of home-hemodialysis, sex, primary renal disease and subsequent renal transplantation. One hundred twenty-eight patients starting home-hemodialysis as first renal replacement therapy 1971-1998 in Lund were included. Data were collected from patient files, the Swedish Renal Registry and Swedish census. Survival analysis was made as intention-to-treat analysis (including survival after transplantation) and on-dialysis-treatment analysis with patients censored at the day of transplantation. Ten-, twenty- and thirty-year survival were 68%, 36% and 18%. Survival was significantly affected by comorbidity, age and what decade the patients started home-hemodialysis. For patients younger than 60 years and with no comorbidities, the corresponding figures were 75%, 47% and 23% and a subsequent renal transplantation did not significantly influence survival. Long-term survival for patients starting home-hemodialysis is good, and improves decade by decade. Survival is significantly affected by patient age and comorbidity, but the contribution of subsequent renal transplantation was not significant for younger patients without comorbidities.

When you are working with home HD education you often meet patients who are very afraid of the moment when they are going to puncture the fistula themselves. Our experience is that the patient sometimes can’t concentrate on anything but this moment. For this reason we let the patient try to puncture as soon as possible. We also get many questions from colleges, doctors, and nurses on how to do it. Most of the patients are very successful and prefer to puncture themselves after having tried it. They say that it is less painful if you puncture yourself and we also have a feeling that it is very rare that they are unsuccessful. To get proof for these feelings we made a small inquiry among our patients, asking about how it is to puncture yourself. We sent the inquiry to 30 patients. We also decided to make a film showing how to puncture yourself. We asked some of our home HD patients if they wanted to contribute. The result of this is a video, which is 9 min long, showing how to puncture in different types of fistulas, underarm, overarm, and grafts.