• 1.

    Tennankore K, Nadeau-Fredette AC, Chan CT. Intensified home hemodialysis: Clinical benefits, risks and target populations. Nephrol Dial Transplant 2014; 29:13421349.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Trinh E, Chan CT. Intensive home hemodialysis results in regression of left ventricular hypertrophy and better clinical outcomes. Am J Nephrol 2016; 44:300307.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Foley RN, et al.. Long interdialytic interval and mortality among patients receiving hemodialysis. N Engl J Med 2011; 365:10991107.

  • 4.

    Young BA, et al.. How to overcome barriers and establish a successful home HD program. Clin J Am Soc Nephrol 2012; 7:20232032.

  • 5.

    US Renal Data System. USRDS 2016 Annual Report. https://www.usrds.org/2016/view/v2_13.aspx.

  • 6.

    Trinh E, Chan CT. The rise, fall, and resurgence of home hemodialysis. Semin Dial 2017; 30:174180.

  • 7.

    Hurst H, Figueiredo AE. The needs of older patients for peritoneal dialysis: Training and support at home. Perit Dial Int 2015; 35:625629.

  • 8.

    Berns JS. A survey-based evaluation of self-perceived competency after nephrology fellowship training. Clin J Am Soc Nephrol 2010; 5:490496.

  • 9.

    Merighi JR, et al.. Insights into nephrologist training, clinical practice, and dialysis choice. Hemodial Int 2012; 16:242251.

  • 10.

    Pipkin M, et al.. Recruitment and training for home hemodialysis: Experience and lessons from the Nocturnal Dialysis Trial. Clin J Am Soc Nephrol 2010; 5:16141620.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Elizabeth JL, et al.. Pre-dialysis education and patient choice. J Ren Care 2006; 32:214220.

  • 12.

    Goovaerts T, Jadoul M, Goffin E. Influence of a pre-dialysis education programme (PDEP) on the mode of renal replacement therapy. Nephrol Dial Transplant 2005; 20:18421847.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Ledebo I. What limits the expansion of self-care dialysis at home? Hemodial Int 2008; 12[Suppl 1]:S55S60.

  • 14.

    McLaughlin K, et al.. Why patients with ESRD do not select self-care dialysis as a treatment option. Am J Kidney Dis 2003; 41:380385.

  • 15.

    Qamar M, et al.. The United States’ perspectives on home dialysis. Adv Chronic Kidney Dis 2009; 16:189197.

  • 16.

    Rioux JP, et al.. Patient selection and training for home hemodialysis. Hemodial Int 2015; 19[Suppl 1]:S71S79.

  • 17.

    Schachter ME, Tennankore KK, Chan CT. Determinants of training and technique failure in home hemodialysis. Hemodial Int 2013; 17:421426.

  • 18.

    Rocco MV, et al.. The effects of frequent nocturnal home hemodialysis: The Frequent Hemodialysis Network Nocturnal Trial. Kidney Int 2011; 80:10801091.

  • 19.

    Suri RS, et al.. Burden on caregivers as perceived by hemodialysis patients in the Frequent Hemodialysis Network (FHN) trials. Nephrol Dial Transplant 2011; 26:23162322.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Tennankore KK, Chan CT, Curran SP. Intensive home haemodialysis: Benefits and barriers. Nat Rev Nephrol 2012; 8:515522.

  • 21.

    Group FHNT, et al. In-center hemodialysis six times per week versus three times per week. N Engl J Med 2010; 363:22872300.

  • 22.

    Suri RS, et al.. Risk of vascular access complications with frequent hemodialysis. J Am Soc Nephrol 2013; 24:498505.

  • 23.

    Jun M, et al.. Outcomes of extended-hours hemodialysis performed predominantly at home. Am J Kidney Dis 2013; 61:247253.

  • 24.

    MacRae JM, et al.. A randomized trial comparing buttonhole with rope ladder needling in conventional hemodialysis patients. Clin J Am Soc Nephrol 2012; 7:16321638.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Mustafa RA, et al.. Vascular access for intensive maintenance hemodialysis: A systematic review for a Canadian Society of Nephrology clinical practice guideline. Am J Kidney Dis 2013; 62:112131.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Faratro R, et al.. The care and keeping of vascular access for home hemodialysis patients. Hemodial Int 2015; 19[Suppl 1]:S80S92.

  • 27.

    Jansen MA, et al.. Predictors of the rate of decline of residual renal function in incident dialysis patients. Kidney Int 2002; 62:10461053.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Daugirdas JT, et al.. Effect of frequent hemodialysis on residual kidney function. Kidney Int 2013; 83:949958.

Barriers, Shortfalls, and Dangers of Frequent Hemodialysis

  • 1 Nalinee Saiprasertkit, MD, and Christopher T. Chan, MD, are affiliated with the Division of Nephrology, Toronto General Hospital, University Health Network.
Restricted access

Intensive home hemodialysis (IHHD) has become an apparent alternate treatment option for ESRD patients with several clinical benefits. Several studies have shown that, compared with in-center hemodialysis (HD), IHHD provided survival advantage, improvements in BP regulation, regression of left ventricular hypertrophy, restoration of left ventricular ejection fraction, normalization of phosphate control, better quality of life related to kidney disease, decreased recovery time from dialysis treatments, and improved pregnancy outcomes. Quality of sleep and sleep apnea have also been improved, especially in the case of nocturnal home HD (1, 2). Moreover, with more frequent therapies, it also

Save