HOME HEMODIALYSIS AND PATIENT OUTCOMES

As the national focus on the costs of medical care intensifies, it is important to review ESRD modality, choices in light of their ability to facilitate positive patient outcomes, including rehabilitation. Home hemodialysis has been associated with longer survival and better quality of life than other dialysis modalities. Higher rates of employment, near-normal levels of physical activity, and enhanced independence have also been reported for home hemodialysis patients. These benefits remain even when patient selection factors are controlled for in case-mix studies. Cost comparisons indicate that home hemodialysis is both less costly and more cost effective than other dialysis modalities. Lack of physician experience with home hemodialysis may be the deciding factor in the decline of home hemodialysis numbers. Further research to identify additional reasons for the favorable outcomes seen with home hemodialysis may be helpful. Three case histories are presented in this article to illustrate the benefits of home hemodialysis to patients.