The resurgence of home dialysis therapies.

A recent resurgence of interest in home dialysis treatment is being driven by several factors, including (1) improved clinical outcomes associated with more frequent hemodialysis possible with home therapy; (2) patient preference for and greater convenience of home treatments; (3) lower treatment cost; (4) reduced staffing requirements; and (5) the availability of equipment specifically designed for self-care/home therapy. An important factor has been the recognition that the outcomes of peritoneal dialysis are similar to those of conventional in-center hemodialysis, and the advantages to the patient of utilizing different modalities during their dialysis "lifetime." Additionally, regional home-dialysis programs that offer the full continuum of home therapies and provide comprehensive patient education and clinical support have been developed as a model for reinvigorating home therapies. A shift away from the current model with all too frequent late referral of patients for in-center treatment to a new model characterized by early intervention and home-based dialysis therapies will improve outcomes, while more effectively handling the growing population of patients requiring maintenance renal replacement therapy.