History of Home Hemodialysis

Home hemodialysis (HHD) emerged from a critical need to provide dialysis in the face of limited hospital resources and funding. This led in both the United States and the United Kingdom to the active development of programs to train patients and their lay caregivers to perform long-term hemodialysis in the home. The implementation of the 1973 Medicare End-Stage Renal Disease (ESRD) program shifted the focus to in-center dialysis due to enhanced funding. However, many technological advancements over the subsequent decades and, more recently, the Advancing American Kidney Health Initiative have spurred a resurgence in HHD, recognizing its clinical and economic benefits. This chapter examines the fluctuating trends in dialysis modality utilization, the impact of policy changes, and the ongoing challenges, providing essential historical context to inform future strategies in kidney health care.