“HOME HEMODIALYSIS has received little attention in the past 15 years,” the U.S. Renal Data System wrote in its 2008 annual data report. Today, however, the renal community has dusted off the idea and is looking for ways to make it a viable—and popular—treatment option for the growing dialysis population.
New technology and a concerted effort to study its clinical and economic benefits is reviving interest in home hemodialysis, but will the momentum behind home hemo continue?
More than 30 years ago, when Congress mandated dialysis to be provided to anyone with end-stage renal disease, dialysis in the home was one of the few options patients had in their care. The major decline in home hemo came in the 1970s when peritoneal dialysis became popular. But since the 1980s there has been a general decline in both home hemo and PD. The main reason: It has just been so economically feasible and profitable to do in-center dialysis.
Another reason was the technology. “In the 1980s and on, home hemodialysis was dependent on technology that looked the same as it did in-center with, probably, inferior water delivery,” said Michael Kraus, MD, associate professor of clinical medicine and clinical chief-Division of Nephrology, Indiana University Medical School, Indianapolis. “It was difficult for patients to set up. It was not portable. And the water treatment was costly and difficult as well.”
Growing Numbers
The number of patients on home hemo peaked in 1985 at 5,817, but that number’s decline had been precipitous as, according to the USRDS, “a number of government programs, paying home aid to deliver the therapy, ended soon afterwards.” The number of home hemo patients dropped to a low of 1,756 in 2002.
