Clinical, patient-related, and economic outcomes of home-based high-dose hemodialysis versus conventional in-center hemodialysis

Abstract

Despite technological advances in renal replacement therapy, the preservation of health and quality of life for individuals on dialysis still remains a challenge. The high morbidity and mortality in dialysis warrant further research and insight into the clinical domains of the technique and practice of this therapy. In the last 20 years, the focus of development in the field of hemodialysis (HD) has centered around adequate removal of urea and other associated toxins. High-dose HD offers an opportunity to improve mortality, morbidity, and quality of life of patients with end-stage kidney disease. However, the uptake of this modality is low, and the risk associated with the therapy is not fully understood. Recent studies have highlighted the evidence base and improved our understanding of this technique of dialysis. This article provides a review of high-dose and home HD, its clinical impact on patient outcome, and the controversies that exist.

Keywords: hemodialysis; high dose; home dialysis; outcomes.

Figure 1

Target populations for high-dose home HD. Abbreviations: HD, hemodialysis; HTN, hypertension; LVH, left ventricular hypertrophy; ECF, extracellular fluid; CV, cardiovascular; ESRD, end-stage renal disease; NRSOT, nonrenal solid organ transplantation; QoL, quality of life; PD, peritoneal dialysis; OSA, obstructive sleep apnea.

Figure 2

The Markov model. Note: The Markov model comprises a number of discrete health states through which patients can transition. Abbreviations: HD, hemodialysis; PD, peritoneal dialysis.