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Not all home dialysis therapy is alike, concludes a new article published in the Clinical Journal of the American Society of Nephrology that reviews the benefits of dialyzing at home and the barriers that dialysis clinics face when trying to set up a home hemodialysis program. The paper is authored by a number of notable home hemodialysis advocates and researchers, including nephrologists Bessie A. Young (lead author), Christopher Chan, Christopher Blagg, Robert Lockridge, and Thomas Golper, who co-authored a paper earlier this year in the American Journal of Kidney Diseases on barriers to expanding the peritoneal dialysis population.
The authors wrote the CJASN paper on behalf of the Dialysis Advisory Group of the American Society of Nephrology.
According to the report, benefits of home hemodialysis include:
- Potential for greater dialysis delivery (more frequent or overnight treatments)
- Improved quality of life
- Patient independence and employment potential
- Greater ability to travel
- 20%-50% less costly than in-center hemodialysis depending on the machine.
And the barriers to home hemodialysis include:
- Lack of patient awareness and education about home hemodialysis
- Patients' perceptions, including fear of change and lack of self-confidence
- Physicians' education about home hemodialysis
- Machine complexity, which is now minimal with newer, easier-to-use systems
- Inadequate payment to providers for home hemodialysis training.
"Home hemodialysis is an underused dialysis modality in the United States, even though it provides an efficient and probably cost-effective way to provide more frequent or longer dialysis,” the authors wrote. “…Although barriers for providers are similar to those for peritoneal dialysis, home HD requires more extensive patient training, nursing education, and infrastructure support in order to maintain a successful program. In addition, because many physicians and patients do not have experience with home HD, reluctance to start home HD programs is widespread."