This lecture aims to: · Describe hidden cost of dialysis · Explore why we should consider home dialysis and how to increase its uptake Hidden cost of dialysis · Dialysis is ‘challenging’ and burdensome. · Most patients experience dialysis as incompatible with an active lifestyle. · Depression and anxiety affect patients receiving dialysis ~4X that of general population. · Untreated emotional problems are associated with poor outcomes. Home dialysis can potentially alleviate these challenges by delivering individualised person-centred care. · Home dialysis (e.g., peritoneal dialysis, home haemodialysis) has been associated with better quality of life and higher patient satisfaction compared to in-centre haemodialysis possibly from greater treatment flexibility. · Identifying patients for home dialysis can be met with potential barriers, which may be at clinician, patient, and service levels. Many of these can be overcome by using a systematic approach to assessment and providing support. · There is a great variation in home dialysis penetration between and within countries, demonstrating opportunities to enhance uptake. · To enhance home dialysis uptake, we need to: o Actively develop and implement pathway to home dialysis o Set up appropriate infrastructure § Dedicated unit – physical and personnel § Multi-disciplinary resources Summary · Home dialysis enables delivery of individualised, patient-centred care offering greater autonomy and flexibility · Variable uptake in home dialysis is not due to patient factors, but rather originates from culture/philosophy of unit · Strategies need to address personnel, resources and infrastructure