Daily home hemodialysis: a hybrid of hemodialysis and peritoneal dialysis

Abstract

Despite that routine home hemodialysis, performed with thrice weekly frequency, had provided the best clinical results of any dialysis modality, it has been losing competition to center hemodialysis and home peritoneal dialysis. The main reason for this paradox is a lack of suitable equipment for home hemodialysis. Contrary to peritoneal dialysis, which is easy to learn and perform without need for a helper, home hemodialysis is difficult because the kidney machines are not designed for home therapy. Daily hemodialysis provides even better results than routine home hemodialysis. Several studies showed excellent intradialytic and interdialytic tolerance. In spite of these results the method is used only in a few centers. There are two major reasons for this incongruity: time requirement for the patient and the cost for the provider. With more frequent dialysis, more time is spent on machine setup, tear down, and cleaning. If supplies are not reused, the cost of dialysis increases substantially with increased frequency of dialysis. Daily home hemodialysis may become practical with a new machine. Three components seem crucial for this device: a built-in water treatment system; a simple, small, positive pressure, single pass, batch dialysate system; and a reusable extracorporeal circuit, automatically cleaned and disinfected daily. Daily home hemodialysis performed with the new artificial kidney system may be considered as a hybrid of hemodialysis and peritoneal dialysis. High efficiency is taken from hemodialysis; simplicity is taken from peritoneal dialysis.