The United States' perspectives on home dialysis

Home dialysis in the United States, both home hemodialysis and peritoneal dialysis, peaked in the early 1990s. Since then, there has been a striking increase in the numbers and proportion of patients on in-center home hemodialysis (HD). As of 2008, there were approximately 27,000 patients on peritoneal dialysis (PD) and 2,455 on home HD with over 300,000 on in-center HD. There are multiple barriers to home dialysis in the United States, including lack of adequate patient education on modalities prior to starting dialysis, physician competence with home dialysis, lack of infrastructure in many programs for home dialysis, and a misinterpretation of literature and research with selection bias that suggests higher mortality on PD versus in-center HD. These barriers to home dialysis can be overcome.