Extra-hospital dialysis: the patient is at risk, not the method

Since dialysis was introduced thirty years ago, nephrologists have sought to diversify treatment strategies with the double aim of offering patients better psychosocial rehabilitation and containing the cost of treatment; this latter aim has been the cornerstone of development in haemodialysis, which in western countries now offers access to treatment for all patients with chronic renal insufficiency. The risk to life during a dialysis session is currently very small indeed. Such fatalities as do occur reflect on the one hand on various medical complications, the incidence of which is largely predictable because of the field involved, and on the other hand on unforeseeable accidents which are highly exceptional. We consider that the risk is not significantly higher in the absence of a physician (as in extra-hospital dialysis procedures) or a nurse (as in home dialysis) than where treatment is given in a fully equipped dialysis centre, provided that there is a prior selection of patients both with respect to their age and their extra-renal pathology.