Comparative Effectiveness of Home-Based Kidney Dialysis Versus In-Center or Other Outpatient Kidney Dialysis Locations – A Systematic Review [Internet]

Excerpt

Home-based dialysis (defined for this review as in-home hemodialysis [HHD] or peritoneal dialysis [PD] outside of a dialysis facility) may offer advantages over in-center hemodialysis (HD), including patient convenience, expanded capacity for VA to deliver fully integrated care to Veterans with end-stage renal disease (ESRD), a reduction in fee-basis costs associated with dialysis, and potentially improved patient quality of life and blood pressure control with greater survival and fewer hospitalizations. As the number of patients requiring renal replacement therapy (RRT) increases, there is need for a current review of the benefits and harms of home-based dialysis (HHD or PD) versus in-center HD, the benefits and harms of different home-based dialysis modalities, and the predictors of successful home-based dialysis to allow VA to better serve patient needs. We reviewed the evidence from studies of adults with chronic kidney disease requiring dialysis and comparing home-based and in-center HD. Due to between-country differences in health care systems, we focused our review on studies most relevant to the VA, ie, those from North America, Europe, or Australia/New Zealand.