International Applications of Home Hemodialysis: Barriers and How They Can Be Overcome

Home hemodialysis (HHD) has long been an option for patients with kidney failure and prioritizes many provider and patient-important outcomes. While advantageous, HHD presents many challenges, especially as patients adapt to more independency for their care at home. Whether it is a lack of supportive legislation, geographical challenges, or insufficient patient and provider education, barriers to HHD program implementation persist globally and require both creativity and advocacy to overcome. Many programs are developing novel strategies to make HHD both financially and environmentally sustainable while empowering patients who choose HHD as the kidney replacement therapy of their choice. This chapter highlights current challenges in implementation and endeavors from across the world at addressing systemic barriers to HHD. A structured approach in overcoming barriers to HHD prioritizes formalized patient and provider educational programming, overcoming infrastructural and environmental concerns, and addressing cost inequities to ensure regions of varying financial resources and funding models are supported.