Home haemodialysis in the 1990s.

Abstract

Home haemodialysis has been utilized successfully in mencing long-term dialysis, but the number of low risk the treatment of end-stage renal failure (ESRF ) since patients beginning dialysis, who would have been 1961. After an initial expansion in home haemodialysis assessed previously as suited to training for home during the 1970s and early 1980s, the number of haemodialysis, remains unchanged. Such low risk patients receiving this mode of dialysis has decreased patients must now be opting for either peritoneal progressively over the past decade despite a major dialysis or hospital-based haemodialysis. This trend expansion in the total number of patients on chronic may be due to an increase in the number of regional renal replacement therapy [1]. In the US, the percent- renal units resulting in the provision of hospital haemoage of dialysis patients on home haemodialysis was dialysis nearer patients’ homes, the expansion of con39.2% in 1972, 23.7% in 1976 and 1.3% in 1992 [1,2]. tinuous ambulatory peritoneal dialysis (CAPD) and This international trend was also apparent in Scotland, automated peritoneal dialysis (APD) in the 1980s and where the number of patients receiving home haemo- socio-demographic changes in the family unit and in dialysis decreased from 160 in 1987 to 75 in 1995 while the workplace which may have led to fewer unpaid the total number of dialysis patients increased from helpers being able to assist with home haemodialysis. 760 to 1180 over the same time period [3]. In During the past 10 years in the West of Scotland Lombardy, Italy, which, like Scotland, also has a (population ~2.8 million), the number of renal units complete registry of patients on renal replacement has risen from three to six, the median age and number therapy, the percentage of dialysis patients on home of patients receiving chronic dialysis have increased, haemodialysis decreased from 15.7 to 5.3% over the the proportion of single person households has decade from 1983 in spite of a major increase in the increased, and peritoneal dialysis patient numbers have acceptance rate for dialysis and only a minor increase remained stable while the number of home haemodiain renal transplantation rates [4]. In our centre, the lysis patients has halved. Other factors may also have number of home haemodialysis patients at the end of influenced the decline of home haemodialysis over the each consecutive year from 1990 to 1997 was 60, 56, past decade: the perceived complexity of the technique, 48, 44, 41, 43, 39 and 42, indicating that home haemo- the low risk of air embolism, the additional time before dialysis patient numbers have remained stable over the and after every treatment required for setting up and past 4 years. clearing the haemodialysis system, and doubts about the cost-eVectiveness of the technique when patient numbers in each unit are small. Why has home haemodialysis declined in recent years?