Home Hemodialysis: Benefits, Risks, and Barriers

Home hemodialysis (HHD) has been available as a modality of renal replacement therapy since the 1960s. HHD allows intensive dialysis such as nocturnal hemodialysis or short daily hemodialysis. Previous studies have shown that patients receiving HHD have an increased survival and better quality of life compared with those receiving in-center conventional HD. However, HHD may increase the risk for specific complications such as vascular access complications, infection, loss of residual kidney function and patient and caregiver burden. In Japan, only 529 patients (0.2% of the total dialysis patients) were on maintenance HHD at the end of 2014. The most commonly perceived barriers to intensive HHD included lack of patient motivation, unwillingness to change from in-center modality, and fear of self-cannulation. However, these barriers can often be overcome by adequate predialysis education, motivational training of patient and caregiver, nurse-assisted cannulation, nurse-led home visits, a well-defined nursing/technical support system for patients, and provision of respite care.