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Home Hemodialysis in the United States

Get insights into the state of home hemodialysis and how to help your patients overcome common roadblocks

Home Hemodialysis Stats


of hemodialysis patients receive treatment in-center.


The number of hemodialysis patients receiving HHD in 2016 in the US.


The number of patients in the US unaware that HHD is a treatment option for ESRD


HHD can cost 20-50% less than in-center HD


The amount of nephrologists who said they would want to receive thrice weekly in-center hemodialysis if they needed treatment

Common Roadblocks & Solutions for Home Hemodialysis Acceptance

Researchers Rachael Walker, Kirsten Howard and Rachael Morton outlined the following perceived roadblocks to acceptance and implementation of Home Hemodialysis (HHD) programs and suggested solutions for each.

Lack of exposure and education to Home HD possibilities when patients are exploring their treatment options before beginning dialysis.


Create formalized training programs for pre-dialysis patients that contain non biased information on all treatment options so that patients can pick the best option for their lifestyle and situation.

Lack of patient confidence to perform HHD


Peer support from established HHD patients

Worry about unexpected problems in the early stages of Home HD


Increased support and clinician assisted in-home training while the patient is transitioning to Home HD to allay patient concerns.

Concern about increasing the burden for family caregivers


Encourage patients to independently handle their own care with enhanced support & training; include family members in training and education so they can support their loved ones in reaching independence. Explore assisted HD options. 

Inability to attend training sessions due to time constraints


Units provide flexible and individualized training programs (after hours, five days a week, from home).

Housing issues such as storage space and water quality


Newer machines with compact footprints that create their own dialysate on demand

Belief that HHD is too complex and difficult


Train clinical staff to increase confidence in HHD utilization and further the development of simpler HHD machines

Fear of being solely responsible for performing a complex medical procedure without medical team support


Strong doctors recommendation for Home HD, extensive training and involved clinical support programs for Home HD patients

Fear of self cannulation


Peer support from established Home HD patients coupled with in-center cannulation training and technological support (eg. ultrasound guidance devices) to make sure patients are empowered and comfortable with self- cannulation.

Worry about increased cost to patient


Provide transparent information regarding costs for out-of-pocket costs for establishing Home HD. 

Common Patient Fears

Patients may be afraid to begin HHD due to fears of:

  • Operating the machine
  • Self-cannulation
  • A life-threatening disaster
hd patients img

Help patients overcome these fears by:

  • Teaching patients self-cannulation while in the dialysis center
  • Having the patient learn the One Minute Check for their access type
  • Providing opportunities to practice setting up the machine
  • Having patients talk to successful home HD patients
  • Utilizing nurses who have been specifically trained for HHD

Clinical Benefits to HHD

hd patients img1

Compared to in-center HD Patients, HHD Patients Saw:

  • Significantly higher survival rates after one year — 91% to 81%, respectively
  • A 23% decreased risk of death over one year
  • Improved quality of life

Additional Advantages to HHD Include:

  • Increased patient independence, responsibility and confidence
  • Greater possibility to maintain employment
  • Greater ability to travel

improvements in:

  • Blood pressure regulation
  • Regression of left ventricular hypertrophy
  • Restoration of left ventricular ejection fraction
  • Normalization of phosphate control
  • Improved sleep quality

The Importance of Patient Education

Adequate patient education on dialysis options can play an important
role in the growth of HHD.


Whether using home or in-center hemodialysis, empowered patients are more likely to take charge of their care, have better outcomes and reduce complications.

This guide gives you what you need to help empower your patients today.
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