Patient Training and Preparation of the Home for Dialysis

Performing both types of home dialysis, peritoneal dialysis and home hemodialysis, requires a significant investment in initial training and subsequent management of the therapy by the patient in close collaboration with the healthcare team. This is in stark contrast to center-based outpatient hemodialysis which is largely a passive enterprise for most patients. Because of this, home hemodialysis has a measurable incidence of initial training failure followed by subsequent technique failure within the first year of approximately 2% per month notably due to nonmedical factors. This contrasts with peritoneal dialysis which still lists peritonitis and catheter-related complications as the most common forms of early and late technique failures (Trinh et al., Nephrol Dial Transplant:34(11):1941–9. https://doi.org/10.1093/ndt/gfz075 , 2019). This chapter will review best practices for patient preparation, training, and longitudinal care for success with home hemodialysis.