Despite potential advantages of increased patient autonomy and treatment satisfaction use of home dialysis therapies remain relatively low in most countries with some notable exceptions. In May 2021 Kidney Diseases Improving Global Outcomes (KDIGO) held a controversies conference that focused on home dialysis, including consideration of health care policies, facility characteristics, and patient factors that impact its uptake and contribute to expanding its use. The reasons for limited use of home dialysis therapies include the availability of local resources, therapy costs, access to healthcare, health system policies, cultural considerations, preferences of providers as well as individual lifestyle concerns.  Importantly outcomes between the hospital and home-based dialysis modalities are similar – influenced more by individual patient characteristics than the difference between the modalities.  Therefore, it is important that the dialysis modality choice is determined by preferences that consider aspects that most matter to the individual, including life goals, support mechanisms and the living environment.  Emphasis should be placed on shared decision making between the patient and their health care team for the modality choice and subsequent therapy transitions.  Central to supporting this decision is high quality education of patients, their care partners and for health care professionals and this requires to be prioritised. In this talk I will review existing barriers to home dialysis and talk through potential solutions, couching the discussion in the context of the conclusions of the KDIGO conference.