Home hemodialysis: survival, quality of life, and rehabilitation.

Choice of treatment modality for patients with end-stage renal disease ideally should not only increase the chances of survival but also improve quality of life and facilitate rehabilitation goals. These goals include employment, enhanced physical functioning, improved understanding of dialysis, increased control, and resumption of activities enjoyed before dialysis. Home hemodialysis has been consistently associated with improved long-term patient survival and quality of life compared with patients treated with in-center hemodialysis or peritoneal dialysis. Home hemodialysis is also well suited to rehabilitation. Home hemodialysis training programs educate patients and partners to become responsible for dialysis treatments, thus encouraging independence and permitting flexible scheduling, which promotes greater participation in exercise and employment. Further information about modality choice and rehabilitation outcomes could be obtained by systematic data collection to enable comparisons between modalities. Patients should have the opportunity to choose from among all modalities, including home hemodialysis.