Benefits of Home Hemodialysis

Intensified hemodialysis may be more physiologically tolerable for patients with many reported benefits. Patients can extend their cumulative treatment time per week to improve treatment outcomes by performing HD therapy more frequently, or for longer session durations by performing their treatment overnight. The most convenient treatment location to easily increase cumulative treatment time per week is at home.

The next sections will review the clinical and quality of life outcomes associated with intensified hemodialysis regimens, schedules which are easier to adhere to when the patient performs treatment in the home setting:

 

  • Improved fluid management and blood pressure control1–3
  • Significant cardiovascular improvement3–7
  • Reduced risk of hospitalization8–10 and mortality11–14
  • Improved nutritional status15,16 and anemia management17,18
  • Improved phosphate control3,19
  • Reduced reliance on medication6,19,20
  • Shorter post-dialysis recovery time21–23
  • Improve sleep and reduced symptoms of restless leg syndrome24,25
  • Improved health-related quality of life21,26–29

References:

  1. Pierratos A, Ouwendyk M, Francoeur R, et al. Nocturnal hemodialysis: three-year experience. J Am Soc Nephrol. 1998;9(5):859-868. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9596084.
  2. Fagugli RM, Reboldi G, Quintaliani G, et al. Short daily hemodialysis: blood pressure control and left ventricular mass reduction in hypertensive hemodialysis patients. Am J Kidney Dis. 2001;38(2):371-376. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11479164.
  3. Chertow GMG, Levin NNW, Beck GGJ, et al. In-center hemodialysis six times per week versus three times per week. N Engl J Med. 2010;363(24):2287-2300. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21091062.
  4. Sarnak MJ, Auguste BL, Brown E, et al. Cardiovascular Effects of Home Dialysis Therapies: A Scientific Statement From the American Heart Association. Circulation. 2022;146(11):E146-E164. Available from: https://pubmed.ncbi.nlm.nih.gov/35968722/.
  5. Reaves AC, Weiner DE, Sarnak MJ. Home Dialysis in Patients with Cardiovascular Diseases. Clinical Journal of the American Society of Nephrology. Published online February 6, 2024.
  6. Kotanko P, Garg AX, Depner T, et al. Effects of frequent hemodialysis on blood pressure: Results from the randomized frequent hemodialysis network trials. Hemodialysis International. 2015;19(3):386-401. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25560227.
  7. Rocco M V., Lockridge RS, Beck GJ, et al. The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial. Kidney Int. 2011;80(10):1080-1091. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21775973.
  8. Bergman A, Fenton SSA, Richardson RMA, Chan CT. Reduction in cardiovascular related hospitalization with nocturnal home hemodialysis. Clin Nephrol. 2008;69(1):33-39. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18218314.
  9. Suri RS, Li L, Nesrallah GE. The risk of hospitalization and modality failure with home dialysis. Kidney Int. 2015;88(2):360-368.
  10. Weinhandl ED, Nieman KM, Gilbertson DT, Collins AJ. Hospitalization in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. American Journal of Kidney Diseases. 2015;65(1):98-108.
  11. Nesrallah GE, Lindsay RM, Cuerden MS, et al. Intensive hemodialysis associates with improved survival compared with conventional hemodialysis. J Am Soc Nephrol. 2012;23(4):696-705. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22362910.
  12. Weinhandl ED, Liu J, Gilbertson DT, Arneson TJ, Collins AJ. Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. Journal of the American Society of Nephrology. 2012;23(5):895-904.
  13. Yeung EK, Polkinghorne KR, Kerr PG. Home and facility haemodialysis patients: a comparison of outcomes in a matched cohort. Nephrology Dialysis Transplantation. 2021;36(6):1070-1077.
  14. Ok E, Demirci C, Asci G, et al. Patient Survival With Extended Home Hemodialysis Compared to In-Center Conventional Hemodialysis. Kidney Int Rep. 2023;8(12):2603-2615. Available from: https://pubmed.ncbi.nlm.nih.gov/38106580/.
  15. Sikkes ME, Kooistra MP, Weijs PJM. Improved nutrition after conversion to nocturnal home hemodialysis. J Ren Nutr. 2009;19(6):494-499. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19616453.
  16. Spanner E, Suri R, Heidenheim APP, Lindsay RM. The impact of quotidian hemodialysis on nutrition. American Journal of Kidney Diseases. 2003;42(1 Suppl):30-35. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12830441.
  17. Poon CKY, Tang H-L, Wong JHS, et al. Effect of alternate night nocturnal home hemodialysis on anemia control in patients with end-stage renal disease. Hemodial Int. 2015;19(2):235-241. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25251291.
  18. Rioux J-P, Chan CT. Nocturnal home hemodialysis and its impact on erythropoietin responsiveness. Clin Nephrol. 2010;74(3):167-172. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20860900.
  19. Mucsi I, Hercz G, Uldall R, Ouwendyk M, Francoeur R, Pierratos A. Control of serum phosphate without any phosphate binders in patients treated with nocturnal hemodialysis. Kidney Int. 1998;53(5):1399-1404. Available from: https://www.sciencedirect.com/science/article/pii/S0085253815305524.
  20. Cherukuri S, Bajo M, Colussi G, et al. Home hemodialysis treatment and outcomes: Retrospective analysis of the Knowledge to Improve Home Dialysis Network in Europe (KIHDNEy) cohort 11 Medical and Health Sciences 1103 Clinical Sciences. BMC Nephrol. 2018;19(1):262. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30314451.
  21. Jaber BL, Lee Y, Collins AJ, et al. Effect of daily hemodialysis on depressive symptoms and postdialysis recovery time: Interim report from the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study. American Journal of Kidney Diseases. 2010;56(3):531-539. Available from: https://pubmed.ncbi.nlm.nih.gov/20673601/.
  22. Heidenheim AP, Muirhead N, Moist L, Lindsay RM. Patient quality of life on quotidian hemodialysis. Am J Kidney Dis. 2003;42(1 Suppl):36-41. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12830442.
  23. Rayner HC, Zepel L, Fuller DS, et al. Recovery time, quality of life, and mortality in hemodialysis patients: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2014;64(1):86-94. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0272638614000316.
  24. Jaber BL, Schiller B, Burkart JM, et al. Impact of Short Daily Hemodialysis on Restless Legs Symptoms and Sleep Disturbances. Clinical Journal of the American Society of Nephrology. 2011;6(5):1049-1056. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21415315.
  25. Walker S, Fine A, Kryger MH. Sleep complaints are common in a dialysis unit. American Journal of Kidney Diseases. 1995;26(5):751-756.
  26. Finkelstein FO, Schiller B, Daoui R, et al. At-home short daily hemodialysis improves the long-term health-related quality of life. Kidney Int. 2012;82(5):561-569. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22622497.
  27. Valderrábano F, Jofre R, López-Gómez JM. Quality of life in end-stage renal disease patients. American Journal of Kidney Diseases. 2001;38(3):443-464. Available from: https://www.sciencedirect.com/science/article/pii/S0272638601973688.
  28. Wong CKH, Chen JY, Fung SKS, et al. Health‐related quality of life and health utility of Chinese patients undergoing nocturnal home haemodialysis in comparison with other modes of dialysis. Nephrology. 2019;24(6):630-637.
  29. Tennankore KK, Chan CT, Curran SP. Intensive home haemodialysis: benefits and barriers. Nat Rev Nephrol. 2012;8(9):515-522.

GMO-001396  Rev A  11/2024