Trends in Home Dialysis Over the Last Decade in Europe: an ERA Registry Study

BACKGROUND: Home dialysis therapies could offer benefits to individuals undergoing dialysis. This study examines trends of home dialysis, including home haemodialysis (HHD) and peritoneal dialysis (PD) across European countries from 2012 to 2021, and evaluates transitions between home dialysis and other kidney replacement therapies (KRT).

METHODS: Data from adult patients undergoing KRT in 13 European countries were obtained from the European Renal Association (ERA) Registry. Trends in home dialysis initiation, the number of patients receiving home dialysis by December 31st of each year, and transitions before and after home dialysis were analysed.

RESULTS: Between 2012 and 2021, 65 246 adults initiated PD and 7 878 HHD. Over the last decade, HHD initiation rates and prevalence increased, while those for PD declined, resulting in a stable overall home dialysis initiation rate and prevalence. Home dialysis accounted for 5.8% of the total KRT prevalence. Most HHD patients transitioned from in-centre HD (ICHD, 76.6%), whereas 86.9% of PD patients had no prior KRT. Two years after initiation, 53.2% of HHD patients remained on HHD, 20.9% received a kidney transplant (KT), 16.6% transitioned to ICHD, 8.1% died while on HHD, and 0.6% switched to PD. Among PD patients, 39.6% remained on PD, 22.6% transitioned to ICHD, 18.3% received a KT, 17.4% died while on PD and 0.3% switched to HHD.

CONCLUSIONS: While the use of HHD over the past decade increased in some European countries, the use of PD has declined. The prevalence of both HHD and PD remains low, with limited transitions from other KRT options to home dialysis and between home dialysis modalities. These findings highlight the need for more effective, region-specific strategies to improve access to these modalities for patients who may benefit from it.