Chronic kidney disease (CKD) is a prevalent condition associated with significant morbidity and mortality as well as considerable economic burden. A percentage of patients with CKD will eventually progress to end-stage kidney disease (ESKD) and require some form of dialysis. There are three dialysis options available; the large majority of patients opt for in-center hemodialysis (HD), with only a small proportion of patients performing peritoneal dialysis at home, and even fewer doing home hemodialysis (HHD). The predominance of in-center HD and underutilization of home dialysis modalities is likely related to what is offered to the patient, that is, healthcare providers have much more experience with in-center HD than with home modalities, and are much more comfortable referring patients for in-center HD.
When dialysis first became available, HHD was actually more prevalent than it is now. The proliferation of in-center HD units, which began in the 1970s, led to the decline in HHD. Due to the small size of the HHD population, nephrologists have limited exposure to HHD during training. Once they enter practice, nephrologists may not discuss HHD with patients due to a lack of knowledge about the modality. These days, healthcare providers frequently turn to online material or pocket guides to help them manage these gaps in knowledge. Through our research, we felt that there was a lack of texts about HHD. When it was discussed within a much larger context, the few pages devoted to HHD lacked the in-depth discussion necessary to truly manage a patient on HHD. We recognized this paucity of information as an opportunity to educate healthcare providers on this modality and to help build the HHD population.
The use of HHD in the United States has increased over the past 10 years. With new legislation, the Advancing American Kidney Health Initiative, introduced in the United States by the Department of Health and Human Services in July 2019, the number of HHD patients is expected to increase further. Home dialysis modalities provide more flexibility for patients. HHD is associated with benefits such as improved cardiovascular parameters and better quality of life. We need to provide patients with the chance to pursue these benefits if HHD fits with their lifestyle.
Our vision for the Handbook of Home Hemodialysis was to develop a resource that educates healthcare providers about HHD, provides in-depth instructions for implementing an HHD program, and ultimately gives more patients with ESKD the opportunity to select HHD. This book is not intended to be an all-encompassing text about HHD, but should provide healthcare providers a stepping off point to pursue further education through seminars, journals, and other resources. We hope that both nephrology trainees and established nephrologists can benefit from the Handbook of Home Hemodialysis.
Daphne H. Knicely, MD, MEHP, FASN
Emaad M. Abdel-Rahman, MD, PhD
Keiko I. Greenberg, MD, MHS