Home hemodialysis technique survival: insights and challenges

Abstract

Home hemodialysis (HHD) offers several clinical, quality of life and cost-saving benefits for patients with end-stage kidney disease. While uptake of this modality has increased in recent years, its prevalence remains low and high rates of discontinuation remain a challenge. This comprehensive narrative review aims to better understand what is currently known about technique survival in HHD patients, elucidate the clinical factors that contribute to attrition and expand on possible strategies to prevent discontinuation. With increasing efforts to encourage home modalities, it is imperative to better understand technique survival and find strategies to help maintain patients on the home therapy of their choosing. It is crucial to better target high-risk patients, examine ideal training practices and identify practices that are potentially modifiable to improve technique survival.

Keywords: Discontinuation; Home hemodialysis; Technique failure; Technique survival; Training failure.

Fig. 1

Risk Factors for HHD TF. HHD, home hemodialysis; TF, technique failure; DM, diabetes mellitus; CVD, cardiovascular disease; CVC, central venous catheter; AV, arteriovenous

Fig. 2

Comparison between the main reasons for technique failure in HHD versus in PD. TF, technique failure; HHD, home hemodialysis; PD, peritoneal dialysis