Home Hemodialysis: A Brief History

In the early 1960s, the demand for dialysis outweighed its availability, which meant many patients with end-stage renal disease (ESRD) or chronic kidney disease were turned away from treatment.

After the 15-year-old daughter of a friend of Les Babb’s was denied dialysis treatment, Babb, a professor of nuclear engineering at the University of Washington and Belding Schriber set to work developing a small home dialysis system. A few months later in London, Stanley Shaldon began using a similar machine to treat dialysis patients at home.

Since there was no government funding to pay for treatment in the ’60s, home hemodialysis became an affordable treatment option for patients.

That changed with the 1973 passage of Section 2991 of the Social Security Amendments, or the Medicare End-Stage Renal Disease Program, which made affordable dialysis treatment available to 90 percent of ESRD patients and affected home hemodialysis use.

Home hemodialysis use decreased after the passage of the Medicare End-Stage Renal Disease Program because:

• The program entitled all ERSD patients to treatment, which spawned a rapid increase in elderly and diabetic patients who are not good candidates for home hemodialysis.
• Federal funding caused the proliferation of dialysis units
• Most for-profit dialysis units were uninterested in home hemodialysis
• Patients preferring satellite or hospital dialysis increased

In the early 1970s, 40 percent of patients were using home hemodialysis compared to just 0.7 percent of patients in 2003.

The Evolution of Home Hemodialysis Technology

During its initial use in the ’60s, the technology needed for dialysis at home was cumbersome and usually required major alterations to the home. Since then, home hemodialysis technology has evolved to more patient- and home-friendly options. When a group of home hemodialysis patients and nephrologists were asked what changes they’d like to see in the technology, many had the same responses:

• Machines that had reduced clean up and set up times
• The ability to transport a machine outside of the home
• A machine that could sanitize itself
• Improved reliability

Benefits of Home Hemodialysis

Some observational studies suggest home hemodialysis can provide clinical benefits thanks to its flexible treatment schedule. These benefits include better blood pressure control, improved phosphate levels, a decrease in sleep apnea, and improved cardiac function among others.

A randomized controlled trial comparing thrice weekly in-center hemodialysis to daily nocturnal home hemodialysis published in the Journal of the American Medical Association found patients who underwent home hemodialysis had a significant reduction in left ventricular mass and an improved quality of life. The reduction of left ventricular mass can indicate potential improvement in cardiac function, study authors note.

Which Patients are Good Candidates for Home Hemodialysis?

According to the American Nephrology Nurses Association, these patients make good candidates for home hemodialysis:

• Patients who desire self-care and independence
• Need self-scheduling or increased treatment flexibility
• Are transplant candidates