title: How to overcome barriers and establish a successful home HD program.
abstract: Home hemodialysis (HD) is an underused dialysis modality in the United States, even though it provides an efficient and probably cost-effective way to provide more frequent or longer dialysis. With the advent of newer home HD systems that are easier for patients to learn, use, and maintain, patient and provider interest in home HD is increasing. Although barriers for providers are similar to those for peritoneal dialysis, home HD requires more extensive patient training, nursing education, and infrastructure support in order to maintain a successful program. In addition, because many physicians and patients do not have experience with home HD, reluctance to start home HD programs is widespread. This in-depth review describes barriers to home HD, focusing on patients, individual physicians and practices, and dialysis facilities, and offers suggestions for how to overcome these barriers and establish a successful home HD program.
authors.affiliation: Veterans Affairs Puget Sound Health Care System, Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington 98108, USA. youngb@u.washington.edu
authors.forename: Bessie A
authors.initials: BA
authors.lastname: Young
authors.forename: Christopher
authors.initials: C
authors.lastname: Chan
authors.forename: Christopher
authors.initials: C
authors.lastname: Blagg
authors.forename: Robert
authors.initials: R
authors.lastname: Lockridge
authors.forename: Thomas
authors.initials: T
authors.lastname: Golper
authors.forename: Fred
authors.initials: F
authors.lastname: Finkelstein
authors.forename: Rachel
authors.initials: R
authors.lastname: Shaffer
authors.forename: Rajnish
authors.initials: R
authors.lastname: Mehrotra
mesh_terms: D004501:Education, Medical; D004506:Education, Nursing; D006437:Hemodialysis, Home / Q000191:economics / Q000193:education* / Q000451:nursing / Q000639:trends; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010353:Patient Education as Topic; D016730:Program Development / Q000379:methods*; D011788:Quality of Life