Choices and considerations for in-centre versus home-based renal replacement therapy

There has been a renewed global interest in expanding home dialysis (both peritoneal dialysis (PD) and home haemodialysis (HHD)), but the majority of patients are maintained on in-centre haemodialysis (HD). While the importance of in-centre haemodialysis cannot be overlooked, home dialysis has many advantages. If so, why are so few patients maintained on home dialysis therapies? From the perspective of the patient, both inadequate modality education and self-perceived barriers limit selection of home dialysis. Physicians are less likely to consider elderly frail patients as candidates for home therapies. In addition, inadequate training and poor reimbursement for home dialysis are important physician barriers. From the facility perspective, the limited availability of personnel and physical resources to maintain a home unit are important barriers. However, while there are many obstacles to home dialysis, they can be overcome. Improved patient education, home support for elderly dialysis patients, and financial incentives may be effective measures. In addition, at the facility level, an emphasis needs to be placed on infrastructure development. Overall, while the appropriate balance of in-centre versus home-based renal replacement therapy has not been determined, maximizing the number of patients on home therapies is a reasonable target.