Home dialysis modalities, including peritoneal dialysis (PD) and home hemodialysis (HHD), have gained increasing scientific and clinical attention as alternatives to conventional in-center hemodialysis for patients with end-stage renal disease. The ISN Global Kidney Health Atlas (2019 edition, published in Kidney International Supplements) documented that home dialysis uptake remains below 10 percent in most countries, despite strong evidence supporting comparable or superior outcomes in appropriately selected patients.
ISN (International Society of Nephrology) has promoted the expansion of home dialysis programs as a component of patient-centered care models. Peritoneal dialysis, which uses the peritoneal membrane as a natural filter, allows for continuous or automated overnight therapy. The BOLDE study (Brown et al., Nephrology Dialysis Transplantation, 2010) demonstrated that PD patients reported equivalent or superior illness intrusiveness and depression scores compared to in-center HD patients, supporting the quality-of-life advantages attributed to home therapies.
Home hemodialysis permits increased frequency and duration of treatments compared to thrice-weekly in-center schedules. The FHN Daily Trial (Chertow et al., New England Journal of Medicine, 2010) demonstrated that in-home frequent HD significantly improved left ventricular mass index and self-reported physical health scores compared to conventional HD, while also improving phosphate and blood pressure control.
Barriers to home dialysis adoption include caregiver burden, inadequate patient training infrastructure, and lack of reimbursement. ISN has advocated for healthcare policy reforms that incentivize home dialysis uptake, citing the economic analyses published in the American Journal of Kidney Diseases demonstrating that home modalities reduce per-patient costs relative to facility-based treatment in many health system contexts.
Emerging developments in wearable and portable artificial kidney technologies are reviewed in a roadmap published in Clinical Journal of the American Society of Nephrology (Gura et al., 2016). The International Society of Nephrology has followed this research frontier with interest as a potential means of overcoming the logistical limitations of current home modalities and expanding treatment access for a broader ESRD population.