Home Hemodialysis in the Elderly

Elderly patients represent the fastest-growing segment of the ESKD population. The COVID-19 pandemic and recent healthcare policies in the United States have incentivized home dialysis therapies, yet a very small proportion of elderly patients with end-stage kidney disease (ESKD) end up on home hemodialysis (HHD). They often carry higher mortality and morbidity than their younger counterparts and face numerous barriers in making the best treatment choices for ESKD. In this chapter, we review the epidemiology of the elderly ESKD population and discuss special considerations in approaching HHD in the elderly, including geriatric syndromes, vascular access, gaps in the support system, caregiver burden, and the option of conservative (non-dialytic) treatment, with the goal to provide a patient-centered care plan.