Current International Status of Home Hemodialysis

Abstract

Three times weekly home hemodialysis (HHD) was introduced shortly after the initiation of chronic hemodialysis (HD) treatment in 1960. HHD eliminates the need of transportation to and from the dialysis unit and by allowing patients to set their own dialysis schedule, decreases the burden of treatment on their personal and professional lives. HHD has been found more economical and more highly associated with better patient survival than in-center dialysis. Nevertheless, the global prevalence of HHD decreased between 1980 and 2000 due to the increased availability of dialysis units and continuous ambulatory peritoneal dialysis, advances in cadaveric kidney transplantation, and several other factors. However, the availability of HHD at a frequency of more than 3 times/week, the typical frequency of conventional HD (CHD), in such forms as brief HD sessions of 2-3 h 5-6 days/week and nocturnal HD (NHD) has led to reversals in this trend. Frequent HHD, such as short daily HD (SDHD) and NHD instead of 3 times/week CHD, has been found to significantly improve hypertension, left ventricular mass, renal anemia, quality of life and mortality. On the other hand, NHD has been found to significantly improve hypertension, left ventricular mass, renal anemia, quality of life, malnutrition, mortality and phosphate clearance. Many observational clinical studies and one randomized controlled trial of SDHD and/or NHD have been conducted, and compact and convenient dialysis machines have been developed and used for HHD. The most recent data reported in the national and local registries of selected countries indicate that the prevalence of HHD among all dialysis patients from 2008 to 2010 varied from 0 to 3.3% except in New Zealand and Australia, where it was 16.3 and 9.3%, respectively. As HHD appears to be a more effective and economical dialysis modality than in-center CHD, its prevalence is likely to increase in the future.

Home hemodialysis and conventional in‐center hemodialysis in Japan: A comparison of health‐related quality of life

“…There is evidence that HHD is associated with better outcomes than conventional in‐center HD . Indeed, recent retrospective analyses have found that patients who undergo nocturnal or short daily HHD have a survival rate similar to that of patients who receive cadaveric renal transplantation . Other incentives include flexible scheduling, flexible prescriptions, less travel to HD units, a more liberal diet, and more privacy …”

DEBATE: Should Dialysis at Home be Mandatory for All Suitable ESRD Patients?

“…). Furthermore, 9% of all dialysis patients undertake home hemodialysis; these rates are significantly higher than the 0–3.3% reported internationally . Given the comparative strength of the Australian and New Zealand experience, it is the benefit and risk of this form of home dialysis that we will predominantly explore.…”

Wearable and implantable artificial kidney devices for end‐stage kidney disease treatment: Current status and review

“…As an alternative to treatments in dialysis centers, various (trans)portable devices have been developed which topic has been reviewed recently 49–51 …”

“…As an alternative to treatments in dialysis centers, various (trans)portable devices have been developed which topic has been reviewed recently. [49][50][51] In order to distinguish various degrees of (trans) portability, it is good to know the official terms as used within the international standards for medical devices, see Figure 2.…”