The renewed interest in home dialysis therapies makes it pertinent to address the essentials of establishing and running a successful home dialysis program. The success of a home program depends on a clear understanding of the structure of the home program team, the physical plant, educational tool requirements, reimbursement sources and a business plan. A good command of the technical and economic aspects is important, but the primary drivers for the creation and growth of a home dialysis program are the confidence and commitment of the nephrological team.

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Aim: To identify the major difficulties nephrologists in the US face in providing adequate dialysis. Methods: To identify the perceived obstacles to achieving adequate dialysis in the US, 30 clinical support specialists responsible for nursing education and training were polled. Their responses together with those found in the recent literature were summarized and analyzed. Results: The obstacles identified fell into the following major categories: (1) economic; (2) personnel shortage; (3) education, and (4) cultural. The principal specific difficulties identified in providing adequate dialysis were the provision of sufficient time and frequency of dialysis, adequate volume control and vascular and peritoneal access. Conclusions: The obstacles we currently face are serious but can be conquered through better understanding of the problems and education of professionals, patients and payers. The simple improvement in two specific areas, the creation of more native arteriovenous fistulae and growth of home dialysis, are identified as the highest priorities to overcome these obstacles.

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