Avantages cliniques de l’hémodialyse à domicile et les obstacles à son développement: Clinical benefits of home hemodialysis and barriers to its development

Abstract

In 2023, home hemodialysis (HHD) is a dialysis modality used safely and performed independently at home by patients with chronic kidney disease (CKD). HHD requires adequate training and appropriate installation which includes the management of medical devices and consumables in the environment of each patient. According to each patient, HHD can be performed daily, every other day or overnight (nocturnal). The duration of the session varies from a few hours (less than three) during the day to several hours (six to ten) during the night. Over the past 10 years, we have been part of a revival in HHD with the availability of small machines better suited to homes and patients. Few controlled interventional studies and extensive registry data support the hypothesis that increase of frequency and duration of dialysis is associated with improved patient survival, cardiovascular risk profile, and quality of life. In addition to the physiological benefits of HDD, there are clear quality of life, social and economic benefits. There are, however, some disadvantages of HHD, including the application and time required for training, the risk of burnout, and the reluctance to "hospitalize" at home. Overall, these limits can be anticipated and overcome by appropriate training, multidisciplinary monitoring, and a dedicated organization. This review recalls the main clinical advantages of HDD related to both physiology and lifestyle as well as the main obstacles and proposes perspectives to guarantee its development. © 2022 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.