Home-based dialysis treatment includes peritoneal dialysis (PD) and home hemodialysis (HD). There are two forms of PD, namely continuous ambulatory peritoneal dialysis (CAPD), performing PD exchanges manually, and automated peritoneal dialysis (APD), using a dialysis machine to perform PD exchanges typically at night while the patient sleeps. CAPD was first started in Hong Kong in 1980, which proved to be more cost-effective than in-center HD. The Government adopted the PD first policy in 1985 to cope with the increasing number of end stage renal disease patients requiring dialysis treatment. APD became available in Hong Kong in 1995. PD has become the predominant mode of dialysis in the Hospital Authority with two third of the dialysis patients being treated with PD (76% on CAPD and 24% on APD). The proportion of PD patients in our locality is the highest in the world. HD is usually performed in a dialysis center but can be performed at home in suitable patients. Nocturnal home HD, introduced in 2006, provides another home-based dialysis option for patients who have treatment failure in PD since 2010. With training, and plumbing and home modification if needed, patients and their caregivers can perform the treatment at home, typically every other night while sleeping. Nursing support is available 24/7 by phone and regular machine maintenance is provided by the supplier. The program offers more customizable patient-centered care with flexible, longer and more frequent dialysis than the in-center HD, allowing patients more freedom to work, fewer dietary and fluid restrictions, better clinical outcomes, and, for the healthcare system, lower treatment cost. In this talk, current status of the PD and home HD programs will be outlined, barriers to home HD utilization and potential solutions will be discussed, and cost analysis and benefits of the programs will be presented.
