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The crude prevalence of end-stage kidney disease (ESKD) is 2160.7 per million in the United States, with only 2% of these patients utilizing home hemodialysis (HHD).1 The number of HHD patients has increased in recent years and is expected to increase further following the introduction of the United States Department of Health and Human Services Advancing American Kidney Health Initiative. While HHD has been associated with multiple benefits,2–7 it is not without complications. Nephrologists must be knowledgeable about these complications as HHD use increases in the United States. In this chapter, we discuss technical, medical, and psychosocial complications associated with HHD and their diagnosis, management, and prevention.


The HHD room setup is quite important. In order to minimize the risk of complications, all screens for devices should be in direct line of sight with adequate lighting. The space utilized for HHD should have low humidity, a comfortable temperature, telephone access, and restricted access to children and pets. Availability of easy-to-use sinks with hands-free elbow taps would be ideal. All surfaces and furnishings should be easy to clean.


The summary of technical complications is provided in Table 8-1.

Table 8-1Technical Complications


Bleeding is an uncommon but serious complication of HHD. In two studies evaluating adverse events in HHD programs in Canada, blood loss was ...

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