Home dialysis: A Dutch perspective

For patients with end-stage renal disease who are not (yet) eligible for renal transplantation, treatment with dialy-sis is mandatory for survival. Home dialysis modalities (home hemodialysis or peritoneal dialysis) offer patients more flexibility compared with in-center treatment and have been advocated as the first choice in clinically stable patients. However, despite encouraging developments in dialysis systems that make the procedure easier, in many countries the proportion of patients using home dialysis, especially peritoneal dialysis, is decreasing. In Europe this decrease is most pronounced in the Netherlands and the United Kingdom. This evolution cannot be motivated by an inferiority of home dialysis modalities compared with in-center treatment, as all these modalities have been shown to generate similar results. Other, often non-medical, factors (such as reimbursement, social and logistic issues, and the experience of physicians and nurses with home dialysis) seem to be responsible for this development.