Stage V Chronic Kidney Disease: A plea for Home Dialysis

Summary Overall, home dialysis remains underutilized in much of the world. It is only in some parts of the world, such as Hong Kong, Mexico, Thailand, the Netherlands, Finland, Denmark, Iceland, Australia, Canada and New Zealand, that home dialysis is used for more than 20% of the dialysis population. It is observed that in most high- and middle-income countries, home dialysis is generally more economical than center-based dialysis. According to the results of the REIN 2020 registry, the share of out-of-center dialysis in France has been increasing since 2012. This is mainly due to the increase in the number of patients treated in low medicalized dialysis units (LMDUs) (+7.3% per year between 2012 and 2016, then +3.8% between 2016 and 2020). In contrast, the proportion of patients treated at home has changed little. The percentage of patients on peritoneal dialysis is decreasing (-1.8% per year). Home hemodiaysis is increasing (+10.3% per year) but remains very marginal (1% of dialysis patients). Finally, the advanced age of dialysis patients, which is constantly increasing, cannot be ignored. The proportion of these very old patients has increased from 10.5% in 2012 to 12.5% in 2020. However, during the COVID-19 epidemic, several articles in the literature have demonstrated the protective effect of home dialysis in all its forms (peritoneal dialysis and home hemodialysis) against SARS-CoV-2 infection. We report on the status of home dialysis in France, its advantages and proposals for its development, as presented at the Home Dialysis Day (DIADOM) of University Seminars of Nephrology (SUN) in Paris in January 2022.