Home dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.
A KDIGO Controversies Conference concluded that home dialysis is underused worldwide despite largely similar clinical outcomes across modalities, and that expanding its use requires shared decision-making plus aligned policy, financing, and clinician incentives so that everyone facing dialysis has access to home therapy.
Background
Home dialysis modalities, home hemodialysis and peritoneal dialysis, are associated with greater patient autonomy and treatment satisfaction than in-center care, yet worldwide uptake remains low. Barriers are context-dependent and shaped by local resources, dialysis costs, healthcare access, health-system policies, provider bias, cultural beliefs, lifestyle concerns, care-partner time, and financial burdens.
Key recommendations
Convened by KDIGO in May 2021, the conference concluded that clinical outcomes across dialysis modalities are largely similar, though for specific measures one modality may have advantages, making modality choice preference-sensitive. Decisions should weigh quality of life, life goals, clinical characteristics, family or care-partner support, and living environment, ideally through shared decision-making among patients, care-partners, and healthcare teams. The participants affirmed that everyone who faces dialysis should have access to home therapy.
Clinical implications
Expanding home dialysis within a health system requires alignment of policy, fiscal resources, organizational structure, provider incentives, and accountability, together with clear leadership from informed clinical teams. High-quality, iterative education and support for clinicians, patients, and care-partners were identified as priorities for facilitating universal access and increasing utilization.
Category
KDIGO
Source
Kidney Int
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