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DEBATE: Should Dialysis at Home be Mandatory for All Suitable ESRD Patients?

Since their inception in the 1960s, home‐based dialysis therapies have been viable alternatives to conventional thrice weekly in center hemodialysis. In spite of this, uptake of these therapies has been steadily declining over past decades with utilization varying globally; dependent on training support, funding models, and prevailing Nephrologist beliefs. In the Australian context, home dialysis (predominantly peritoneal dialysis and extended hours nocturnal hemodialysis) is now again increasing in popularity—with enthusiasm driven not only by evidence of an array of physiological and psychological patient benefit but also significant economic advantage: critical in the current climate where dialysis therapies in Australia take approximately $1 billion dollars per year from the healthcare budget. When assessing the significant advantages of home‐based therapies, it is important to consider not only the increasing body of evidence around improved survival but also that for dramatically better health‐related quality of life, decreased economic burden and the overall benefits of undertaking treatment in the home. With patient‐centered care an increasingly important aspect of our decision making paradigm, home‐based dialysis should be considered as the default option in all patients transitioning to renal replacement therapy.