The changing landscape of home dialysis in the United States

Curr Opin Nephrol Hypertens. 2014 Nov;23(6):586-91. doi: 10.1097/MNH.0000000000000066.


Purpose of review: To discuss the changing landscape of home dialysis in the United States over the past decade, including recent research on clinical outcomes in patient undergoing peritoneal dialysis and home hemodialysis, and to describe the impact of recent payment reforms for patients with end-stage renal disease.

Recent findings: Accumulating evidence supports the conclusion that clinical outcomes for patients treated with peritoneal dialysis or home hemodialysis are as good as or better than for patients treated with conventional in-center hemodialysis. The recent implementation of the Medicare-expanded prospective payment system for the care of end-stage renal disease patients has resulted in substantial growth in the utilization of peritoneal dialysis in the United States. Utilization of home hemodialysis has also grown, but the contribution of the expanded prospective payment system to this growth is less certain.

Summary: Home dialysis, including peritoneal dialysis and home hemodialysis, represents an important alternative to in-center hemodialysis that is effective and patient-centered. Over the coming decade, the growth in the number of end-stage renal disease patient treated with home dialysis modalities should prompt further comparative and cost-effectiveness research, increased attention to racial and ethnic disparities, and investments in home dialysis education for both patients and providers.

Video abstract:

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Hemodialysis, Home / economics
  • Hemodialysis, Home / statistics & numerical data
  • Hemodialysis, Home / trends*
  • Humans
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / economics
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / therapy*
  • Medicare / trends
  • Peritoneal Dialysis / economics
  • Peritoneal Dialysis / statistics & numerical data
  • Peritoneal Dialysis / trends*
  • Practice Patterns, Physicians' / economics
  • Practice Patterns, Physicians' / trends*
  • Prospective Payment System / trends
  • Treatment Outcome
  • United States / epidemiology