Why home dialysis is not popular?


#1

Hello,

Is there a reason why home dialysis is not popular?

Theoretically every patient would like to have treatments at home, but why that doesn’t happen?

Do I miss something?

Thanks!


#2

There are many reasons why fewer patients do home dialysis than could do it. Some things that may contribute include:

  • Nephrologists typically only have patient care experience during training with in-center patients so their lack of experience with home dialysis patients may lead them to have conscious or unconscious biases leading them to recommend in-center dialysis.

  • Some patients who could be good candidates for home dialysis are excluded from consideration due to preconceived ideas about whether they could do it successfully, e.g., the elderly, those with less education, without support, racial minorities, people who are blind or deaf, people with pets, people who live in apartments with landlords who refuse to allow it, people who are viewed as potentially noncompliant, etc.

  • Patients who have not received fact-based education about treatment options prior to the need to start dialysis may be advised by their doctor to do in-center dialysis. Once on in-center dialysis, they may be comfortable in that setting and afraid to switch to a home option or they may be getting messages from in-center staff who no nothing about home dialysis that in-center dialysis is less burdensome and safer.

  • Patients who don’t have family or friends or enough money to hire someone to help them do home HD may not know that solo home HD is possible but only if their nephrologist approves it. [The FDA approved the NxStage cycler for solo home HD.]

These are just a few off the top of my head. I’m sure there are others. On the other hand, most patients who choose home dialysis love it and would be unhappy if they had to do in-center dialysis.