Perspectives on home hemodialysis in Japan

Home hemodialysis (HHD) started in Japan in 1969. It has been done in the largest number of patients with the purpose of better social reintegration, followed by patients for whom commuting to a hospital is geographically difficult. In a subanalysis of the JSDT patient registry, the survival rate at 9 years for male patients excluding those with diabetes was significantly better in HHD patients than in facility dialysis patients. This result was thought to indicate that HHD was superior treatment both medically and socially, but it has not increased greatly because of conditions that impede the implementation of HHD, such as finding a caregiver and the burden on the caregiver, as well as the burden of light, heat, and water costs. However, long-duration dialysis and frequent dialysis are done even in general dialysis treatment, and the number of HHD patients has increased recently because of some improvement in health insurance payments for HHD in 1998. The spread of HHD is essential also in the broad implementation of diversifying HD modalities, and maintaining an accurate registry of HHD patients, analyzing factors that affect survival rates with each modality, clarifying conditions for adequacy of dialysis, and clarifying which treatments are superior are important future issues for dialysis treatment.