Home dialysis first: a new paradigm for new ESRD patients.

Patients with end-stage renal disease (ESRD) were treated with either in-center hemodialysis (ICH) or one of the modes of home-based dialysis (HBD)-- peritoneal dialysis (PD) or home hemodialysis (HHD). Home-based dialysis modes showed better outcomes than ICH (PD for the first 2-3 years and HHD for the long-term). Home PD has become more attractive with overnight cyclers for PD and the use of home helpers. Home dialysis (PD or HHD) offers a high quality of life and a high degree of independence and is financially attractive. This review will propose a paradigm shift in the initial form of dialysis offered to new patients with ESRD: instead of selecting between in-center dialysis and PD, patients after they are advised of the advantages of dialysis at home (either PD or HHD) should be offered a choice between dialysis at home (PD or HHD) or in hospital. We will review the advantages of home-based dialysis and the arguments for this simple but vital change in the process by which new patients requiring dialysis choose their treatment option.