Home hemodialysis

Home hemodialysis (HHD), is the provision of hemodialysis in the home of people with stage 5 chronic kidney disease.

In the United States, home hemodialysis was the most common method of renal replacement therapy in the early 1970s before the introduction of the federal End Stage Renal Disease Program under Medicare. With routine payment for dialysis secured through Medicare incenter hemodialysis quickly became the most common form of renal replacement therapy. In the late 1970s with the advent of peritoneal dialysis, another form of home dialysis, HHD went into further decline. In 2002 HHD began a resurgence in the United States with the introduction of machines designed solely for home use.

People on home hemodialysis are followed by a nephrologist who writes the dialysis prescription and they rely on the support of a dialysis unit for back-up treatments and case management. Studies show that HHD improves patients' sense of well-being; the more they know about and control their own treatment the better they are likely to do on dialysis.

There are three basic schedules of HHD and these are differentiated by the length and frequency of dialysis and the time of day the dialysis is carried out. They are as follows:

Thus an NHHD schedule results in a larger dose of hemodialysis per week, as do some SDHHD. More total time dialyzing, shorter periods between treatments and the fact that fluid removal speeds can be lower (thus reducing the symptoms resulting from rapid ultrafiltration), accounts for the advantages of these schedules over conventional ones.

A frequent NHHD schedule has been shown to have better clinical outcomes than a conventional schedule and evidence is mounting that clinical outcomes are improved with each increase in treatment frequency. and.

Home hemodialysis started in the early 1960s. Who started it is in dispute. Groups in Boston, London, Seattle and Hokkaidō all have a claim.

The Hokkaidō group was slightly ahead of the others, with Nosé's publication of his PhD thesis (in 1962), which described treating patients outside of the hospital for acute renal failure due to drug overdoses. In 1963, he attempted to publish these cases in the ASAIO Journal but was unsuccessful, which was latter described in the ASAIO Journal when people were invited to write about unconventional/crazy rejected papers. That these treatments took place in people's homes is hotly disputed by Shaldon and he has accused Nosé of a faulty memory and not being completely honest, as allegendly revealed by some shared Polish Vodka, many years earlier.

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