A Medical Clinical Affairs White Paper | July 2021
Authors: Gopa B. Green MD, Graham Abra MD, and Brigitte Schiller MD FACP FASN
Home hemodialysis (HHD) has distinct clinical advantages and affords patients greater flexibility and control of their dialysis care. The prevalence of HHD in the United States is currently less than 2% of all patients undergoing maintenance dialysis for treatment of end-stage kidney disease (ESKD) which is significantly lower than other developed nations such as Australia and New Zealand where penetrance of HHD reaches up to 14%. Prior to the availability of federal coverage of dialysis costs, HHD was used much more commonly in the US. This allowed patients in desperate need of care to benefit from dialysis outside the hospital by outsourcing space and the actual performing of dialysis to patients and their families. In 1973, prior to the Medicare Act and the subsequent emergence of in-center hemodialysis, 40% of US patients were treated with HHD. In a canonical Satellite Healthcare reference, > 90% of nephrology professionals chose a home modality as their own personal preference for renal replacement therapy if they developed hypothetical kidney failure. Of these, nearly half chose HHD.