Exploring the reasons for the tiny percentage of patients on home hemodialysis

The number of patients requiring renal replacement therapy continues to grow. When patients are told they need a life-sustaining treatment, it is a profound experience that impacts all aspects of their lives and the lives of their families. In the United States, the stark reality is the majority of patients are treated with in-center hemodialysis, and only a very small percentage with a home dialysis therapy, such as peritoneal dialysis or home hemodialysis. Why is this? Do patients not factor in preference, independence, or quality and maintenance of a normal life? Or is it that as a renal community, nephrology nurses do not expose patients to the knowledge they need and promote involvement in this decision-making? Is patient autonomy being fostered? This article explores the reasons for the tiny percentage of patients on home dialysis and suggests strategies to address the education needed, the dynamics of why patients decide on a therapy, patient selection characteristics, and myths of who is and is not a candidate.