Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2014 Nov 20;2014(11):CD009535.
doi: 10.1002/14651858.CD009535.pub2.

Home versus in-centre haemodialysis for end-stage kidney disease

Suetonia C Palmer  1 , Andrew R Palmer, Jonathan C Craig, David W Johnson, Paul Stroumza, Luc Frantzen, Miguel Leal, Susanne Hoischen, Jorgen Hegbrant, Giovanni F M Strippoli
Affiliations
Review

Home versus in-centre haemodialysis for end-stage kidney disease

Suetonia C Palmer et al. Cochrane Database Syst Rev. .

Update in

  • Home versus in-centre haemodialysis for people with kidney failure.
    Cheetham MS, Ethier I, Krishnasamy R, Cho Y, Palmer SC, Johnson DW, Craig JC, Stroumza P, Frantzen L, Hegbrant J, Strippoli GF. Cheetham MS, et al. Cochrane Database Syst Rev. 2024 Apr 8;4(4):CD009535. doi: 10.1002/14651858.CD009535.pub3. Cochrane Database Syst Rev. 2024. PMID: 38588450 Review.

Abstract

Background: Home haemodialysis is associated with improved survival and quality of life in uncontrolled studies. However, relative benefits and harms of home versus in-centre haemodialysis in randomised controlled trials (RCTs) are uncertain.

Objectives: To evaluate the benefits and harms of home haemodialysis versus in-centre haemodialysis in adults with end-stage kidney disease (ESKD).

Search methods: The Cochrane Renal Group's Specialised Register was searched up to 31 October 2014.

Selection criteria: RCTs of home versus in-centre haemodialysis in adults with ESKD were included.

Data collection and analysis: Data were extracted by two investigators independently. Study risk of bias and other patient-centred outcomes were extracted. Insufficient data were available to conduct meta-analyses.

Main results: We identified a single cross-over RCT (enrolling 9 participants) that compared home haemodialysis (long hours: 6 to 8 hours, 3 times/week) with in-centre haemodialysis (short hours: 3.5 to 4.5 hours, 3 times/weeks) for 8 weeks in prevalent home haemodialysis patients. Outcome data were limited and not available for the end of the first phase of treatment in this cross-over study which was at risk of bias due to differences in dialysate composition between the two treatment comparisons.Overall, home haemodialysis reduced 24 hour ambulatory blood pressure and improved uraemic symptoms, but increased treatment-related burden of disease and interference in social activities. Insufficient data were available for mortality, hospitalisation or dialysis vascular access complications or treatment durability.

Authors' conclusions: Insufficient randomised data were available to determine the effects of home haemodialysis on survival, hospitalisation, and quality of life compared with in-centre haemodialysis. Given the consistently observed benefits of home haemodialysis on quality of life and survival in uncontrolled studies, and the low prevalence of home haemodialysis globally, randomised studies evaluating home haemodialysis would help inform clinical practice and policy.

PubMed Disclaimer

Conflict of interest statement

  1. Jonathan C Craig: none known

  2. Luc Frantzen: fees for consulting from Fresenius Medical Care

  3. Jorgen Hegbrant: paid an honorarium as a member of the Gambro Safety Board

  4. Susanne Hoischen: None known

  5. David W Johnson: consultant for Baxter Healthcare Pty Ltd and has previously received research funds from this company. He has also received speaker's honoraria and research grants from Fresenius Medical Care and is a current recipient of a Queensland Government Health Research Fellowship

  6. Miguel Leal: none known

  7. Andrew R Palmer: none known

  8. Suetonia C Palmer: none known

  9. Giovanni FM Strippoli: none known

  10. Paul Stroumza: none known

Figures

1
1
Flow diagram showing study selection process
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

McGregor 2001 {published data only}
    1. McGregor DO, Buttimore AL, Lynn KL, Nicholls MG, Jardine DL. A comparative study of blood pressure control with short In‐center versus long home hemodialysis. Blood Purification 2001;19(3):293‐300. [MEDLINE: ] - PubMed

References to studies excluded from this review

Cargill 2002 {published data only}
    1. Cargill A, Watson AR. An evaluation of telecare to support patients receiving chronic peritoneal dialysis at home [abstract]. Peritoneal Dialysis International 2002;22(1):136. [CENTRAL: CN‐00594560] - PubMed
Castro 1971 {published data only}
    1. Castro L, Gahl G, Froese P, Kessel M. Comparison of effectiveness and frequency of complications in clinical continuous dialysis and home dialysis. Die Medizinische Welt 1971;22(24):1031. [CENTRAL: CN‐00305035]
Chauveau 1999 {published data only}
    1. Chauveau P, Larroumet N, Desvergenes C, Montoriol J, Combe C, Aparicio M. A 3‐year prospective study of the outcome of patients dialyzed at home or in self‐care units [abstract]. Nephrology Dialysis Transplantation 1999;14(9):A184. [CENTRAL: CN‐00483479]
De Smet 2007 {published data only}
    1. Smet R, Dhondt A, Eloot S, Claus S, Vanholder R. Nocturnal hemodialysis with the Genius® dialysis system [abstract no: FP327]. Nephrology Dialysis Transplantation 2007;22(Suppl 6):vi128.
Fagugli 2001a {published data only}
    1. Fagugli RM, Reboldi G, Quintaliani G, Pasini P, Ciao G, Cicconi B, et al. Short daily hemodialysis: blood pressure control and left ventricular mass reduction in hypertensive hemodialysis patients. American Journal of Kidney Diseases 2001;38(2):371‐6. [MEDLINE: ] - PubMed
FHN DAILY Trial 2007 {published data only}
    1. Chan CT, Chertow GM, Daugirdas JT, Greene TH, Kotanko P, Larive B, et al. Effects of daily hemodialysis on heart rate variability: results from the frequent hemodialysis network (FHN) daily trial. Nephrology Dialysis Transplantation 2014;29(1):168‐78. [MEDLINE: ] - PMC - PubMed
    1. Chan CT, Greene T, Chertow GM, Kliger AS, Stokes JB, Beck GJ, et al. Determinants of left ventricular mass in patients on hemodialysis: Frequent Hemodialysis Network (FHN) Trials. Circulation. Cardiovascular Imaging 2012;5(2):251‐61. [MEDLINE: ] - PMC - PubMed
    1. Chan CT, Greene T, Chertow GM, Kliger AS, Stokes JB, Beck GJ, et al. Effects of frequent hemodialysis on ventricular volumes and left ventricular remodeling. Clinical Journal of the American Society of Nephrology: CJASN 2013;8(12):2106‐16. [MEDLINE: ] - PMC - PubMed
    1. Chan CT, Levin NW, Chertow GM, Larive B, Schulman G, Kotanko P, et al. Determinants of cardiac autonomic dysfunction in ESRD. Clinical Journal of the American Society of Nephrology: CJASN 2010;5(10):1821‐7. [MEDLINE: ] - PMC - PubMed
    1. Daugirdas JT, Chertow GM, Larive B, Pierratos A, Greene T, Ayus JC, et al. Effects of frequent hemodialysis on measures of CKD mineral and bone disorder. Journal of the American Society of Nephrology 2012;23(4):727‐38. [MEDLINE: ] - PMC - PubMed
FHN NOCTURNAL Trial 2007 {published data only}
    1. Chan CT, Greene T, Chertow GM, Kliger AS, Stokes JB, Beck GJ, et al. Determinants of left ventricular mass in patients on hemodialysis: Frequent Hemodialysis Network (FHN) Trials. Circulation. Cardiovascular Imaging 2012;5(2):251‐61. [MEDLINE: ] - PMC - PubMed
    1. Chan CT, Levin NW, Chertow GM, Larive B, Schulman G, Kotanko P, et al. Determinants of cardiac autonomic dysfunction in ESRD. Clinical Journal of the American Society of Nephrology: CJASN 2010;5(10):1821‐7. [MEDLINE: ] - PMC - PubMed
    1. Daugirdas JT, Chertow GM, Larive B, Pierratos A, Greene T, Ayus JC, et al. Effects of frequent hemodialysis on measures of CKD mineral and bone disorder. Journal of the American Society of Nephrology 2012;23(4):727‐38. [MEDLINE: ] - PMC - PubMed
    1. Daugirdas JT, Greene T, Rocco MV, Kaysen GA, Depner TA, Levin NW, et al. Effect of frequent hemodialysis on residual kidney function. Kidney International 2013;83(5):949‐58. [MEDLINE: ] - PMC - PubMed
    1. FHN Trial Group, Chertow GM, Levin NW, Beck GJ, Depner TA, Eggers PW, et al. In‐center hemodialysis six times per week versus three times per week. New England Journal of Medicine 2010;363(24):2287‐300. [MEDLINE: ] - PMC - PubMed
Gutman 1984 {published data only}
    1. Gutman RA, Blumenkrantz MJ, Chan YK, Barbour GL, Gandhi VC, Shen FH, et al. Controlled comparison of hemodialysis and peritoneal dialysis: Veterans Administration multicenter study. Kidney International 1984;26(4):459‐70. [MEDLINE: ] - PubMed
Kraus 2007 {published data only}
    1. Kraus M, Burkart J, Hegeman R, Solomon R, Coplon N, Moran J. A comparison of center‐based vs. home‐based daily hemodialysis for patients with end‐stage renal disease. Hemodialysis International 2007;11(4):468‐77. [MEDLINE: ] - PubMed
Raj 2000 {published data only}
    1. Raj DS, Ouwendyk M, Francoeur R, Pierratos A. beta(2)‐microglobulin kinetics in nocturnal haemodialysis. Nephrology Dialysis Transplantation 2000;15(1):58‐64. [MEDLINE: ] - PubMed
Shand 1993 {published data only}
    1. Lynn KL, Buttimore AL, Inkster JA, Divakar D, Mylius AL, Ikram H, et al. Echocardiographic assessment of cardiac effects of erythropoietin in haemodialysis patients [abstract]. 9th Asian Colloquium in Nephrology; 1992 May 17‐21; Seoul, Korea. 1992:183.
    1. Lynn KL, Richards AM, Buttimore AL, Inkster JA, Bailey RR, Robson RA, et al. Placebo‐controlled study of blood pressure and vasoactive hormones in haemodialysis patients on erythropoietin [abstract]. 9th Asian Colloquium in Nephrology; 1992 May 17‐21; Seoul, Korea. 1992:183.
    1. Shand BI, Buttimore AL, Hurrell MA, Wells JE, Inkster JA, Bailey RR, et al. Hemorheology and fistula function in home hemodialysis patients following erythropoietin treatment: a prospective placebo‐controlled study. Nephron 1993;64(1):53‐7. [MEDLINE: ] - PubMed
Walsh 2006 {published data only}
    1. Bass A, Ahmed SB, Klarenbach S, Culleton B, Hemmelgarn BR, Manns B. The impact of nocturnal hemodialysis on sexual function. BMC Nephrology 2012;13:67. [MEDLINE: ] - PMC - PubMed
    1. Culleton BF, Walsh M, Klarenbach SW, Mortis G, Scott‐Douglas N, Quinn RR, et al. Effect of frequent nocturnal hemodialysis vs conventional hemodialysis on left ventricular mass and quality of life: a randomized controlled trial. JAMA 2007;298(11):1291‐9. [MEDLINE: ] - PubMed
    1. Culleton BF, Walsh M, Klarenbach SW, Mortis G, Scott‐Douglas N, Quinn RR, et al. Nocturnal hemodialysis lowers blood pressure and reduces left ventricular mass: results of a randomized controlled trial [abstract no: SU‐FC002]. Journal of the American Society of Nephrology 2007;18(Abstracts):67A‐8A. [CENTRAL: CN‐00783714]
    1. Khangura J, Culleton BF, Manns BJ, Zhang J, Barnieh L, Walsh M, et al. Association between routine and standardized blood pressure measurements and left ventricular hypertrophy among patients on hemodialysis. BMC Nephrology 2010;11:13. [MEDLINE: ] - PMC - PubMed
    1. Klarenbach S, Tonelli M, Pauly R, Walsh M, Culleton B, So H, et al. Economic evaluation of frequent home nocturnal hemodialysis based on a randomized controlled trial. Journal of the American Society of Nephrology 2014;25(3):587‐94. [MEDLINE: ] - PMC - PubMed
Zellweger 2004 {published data only}
    1. Deziel C, Zellweger M, Comeau R, Kerangueven M, Raymond‐Carrier S, Madore F. Hemodynamic stability during hemodialysis and quality of life with automated blood volume regulation: a prospective, randomized controlled trial.[abstract no: SU‐FC014]. Journal of the American Society of Nephrology 2004;15(Oct):47A. [CENTRAL: CN‐00583226]
    1. Deziel C, Zellweger M, Comeau R, Valleau A, Raymond‐Carrier S, Madore F. Home blood pressure management with automated blood volume regulation in hemodialysis patients: a prospective randomized controlled trial. [abstract no: SU‐PO279]. Journal of the American Society of Nephrology 2004;15(Oct):594A. [CENTRAL: CN‐00583224]
    1. Zellweger M, Deziel C, Bui TN, Madore F. Hemodialysis tolerance is significantly improved with blood volume control (hemocontrol®) when aiming at a better blood pressure control by reducing dry weight [abstract]. 41st Congress. European Renal Association. European Dialysis and Transplantation Association; 2004 May 15‐18; Lisbon, Portugal. 2004:334. [CENTRAL: CN‐00509576]

Additional references

Agar 2009
    1. Agar JW. International variations and trends in home hemodialysis. Advances in Chronic Kidney Disease 2009;16(3):205‐14. [MEDLINE: ] - PubMed
ANZDATA 2009
    1. McDonald S, Excell L. Method and location of dialysis. In: Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) Registry 2009 report. http://www.anzdata.org.au/anzdata/AnzdataReport/32ndReport/Ch04.pdf (accessed 30 October 2014).
Bremer 1989
    1. Bremer BA, McCauley CR, Wrona RM, Johnson JP. Quality of life in end‐stage renal disease: a reexamination. American Journal of Kidney Diseases 1989;13(3):200‐9. [MEDLINE: ] - PubMed
Cases 2011
    1. Cases A, Dempster M, Davies M, Gamble G. The experience of individuals with renal failure participating in home haemodialysis: An interpretative phenomenological analysis. Journal of Health Psychology 2011;16(6):884‐94. [MEDLINE: ] - PubMed
Charra 1992
    1. Charra B, Calemard E, Ruffet M, Chazot C, Terrat JC, Vanel T, et al. Survival as an index of adequacy of dialysis. Kidney International 1992; Vol. 41, issue 5:1286‐91. [MEDLINE: ] - PubMed
Davison 2006
    1. Davison SN, Jhangri GS, Johnson JA. Cross‐sectional validity of a modified Edmonton symptom assessment system in dialysis patients: a simple assessment of symptom burden. Kidney International 2006;69(9):1621‐5. [MEDLINE: ] - PubMed
Davison 2010
    1. Davison SN, Jhangri GS. Impact of pain and symptom burden on the health‐related quality of life of hemodialysis patients. Journal of Pain & Symptom Management 2010;39(3):477‐85. [MEDLINE: ] - PubMed
de Jager 2009
    1. Jager DJ, Grootendorst DC, Jager KJ, Dijk PC, Tomas LM, Ansell D, et al. Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA 2009; Vol. 302, issue 16:1782‐9. [MEDLINE: ] - PubMed
Evans 1985
    1. Evans RW, Manninen DL, Garrison LP Jr, Hart LG, Blagg CR, Gutman RA, et al. The quality of life of patients with end‐stage renal disease. New England Journal of Medicine 1985; Vol. 312, issue 9:553‐9. [MEDLINE: ] - PubMed
FHN Trial Group 2010
    1. FHN Trial Group, Chertow GM, Levin NW, Beck GJ, Depner TA, Eggers PW, et al. In‐center hemodialysis six times per week versus three times per week. New England Journal of Medicine 2010; Vol. 363, issue 24:2287‐300. [MEDLINE: ] - PMC - PubMed
Hedayati 2006
    1. Hedayati SS, Bosworth HB, Kuchibhatla M, Kimmel PL, Szczech LA. The predictive value of self‐report scales compared with physician diagnosis of depression in hemodialysis patients. Kidney International 2006; Vol. 69, issue 9:1662‐8. [MEDLINE: ] - PubMed
Held 1991
    1. Held PJ, Levin NW, Bovbjerg RR, Pauly MV, Diamond LH. Mortality and duration of hemodialysis treatment. JAMA 1991; Vol. 265, issue 7:871‐5. [MEDLINE: ] - PubMed
Higgins 2011
    1. Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated February 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Jhamb 2009
    1. Jhamb M, Argyropoulos C, Steel JL, Plantinga L, Wu AW, Fink NE, et al. Correlates and outcomes of fatigue among incident dialysis patients. Clinical Journal of the American Society of Nephrology: CJASN 2009; Vol. 4, issue 11:1779‐86. [MEDLINE: ] - PMC - PubMed
Kutner 1991
    1. Kutner NG, Brogan D, Fielding B. Employment status and ability to work among working‐age chronic dialysis patients. American Journal of Nephrology 1991;11(4):334‐40. [MEDLINE: ] - PubMed
Mailloux 1988
    1. Mailloux LU, Bellucci AG, Mossey RT, Napolitano B, Moore T, Wilkes BM, et al. Predictors of survival in patients undergoing dialysis. American Journal of Medicine 1988;84(5):855‐62. [MEDLINE: ] - PubMed
Marshall 2006
    1. Marshall MR, Byrne BG, Kerr PG, McDonald SP. Associations of hemodialysis dose and session length with mortality risk in Australian and New Zealand patients. Kidney International 2006;69(7):1229‐36. [MEDLINE: ] - PubMed
McGregor 2000
    1. McGregor D, Buttimore A, Robson R, Little P, Morton J, Lynn K. Thirty years of universal home dialysis in Christchurch. New Zealand Medical Journal 2000; Vol. 113, issue 1103:27‐9. [MEDLINE: ] - PubMed
Mowatt 2003
    1. Mowatt G, Vale L, Perez J, Wyness L, Fraser C, MacLeod A, et al. Systematic review of the effectiveness and cost‐effectiveness, and economic evaluation, of home versus hospital or satellite unit haemodialysis for people with end‐stage renal failure. Health Technology Assessment (Winchester, England) 2003;7(2):1‐174. [MEDLINE: ] - PubMed
Navaneethan 2010
    1. Navaneethan SD, Vecchio M, Johnson DW, Saglimbene V, Graziano G, Pellegrini F, et al. Prevalence and correlates of self‐reported sexual dysfunction in CKD: a meta‐analysis of observational studies. American Journal of Kidney Diseases 2010; Vol. 56, issue 4:670‐85. [MEDLINE: ] - PubMed
Nitsch 2010
    1. Nitsch D, Steenkamp R, Tomson CR, Roderick P, Ansell D, MacGregor MS. Outcomes in patients on home haemodialysis in England and Wales, 1997‐2005: a comparative cohort analysis. Nephrology Dialysis Transplantation 2010; Vol. 26, issue 5:1670‐7. [MEDLINE: ] - PubMed
Roberts 2011
    1. Roberts MA, Polkinghorne KR, McDonald SP, Ierino FL. Secular trends in cardiovascular mortality rates of patients receiving dialysis compared with the general population. American Journal of Kidney Diseases 2011;58(1):64‐72. [MEDLINE: ] - PubMed
Saner 2005
    1. Saner E, Nitsch D, Descoeudres C, Frey FJ, Uehlinger DE. Outcome of home haemodialysis patients: a case‐cohort study. Nephrology Dialysis Transplantation 2005; Vol. 20, issue 3:604‐10. [MEDLINE: ] - PubMed
Saran 2006
    1. Saran R, Bragg‐Gresham JL, Levin NW, Twardowski ZJ, Wizemann V, Saito A, et al. Longer treatment time and slower ultrafiltration in hemodialysis: associations with reduced mortality in the DOPPS. Kidney International 2006; Vol. 69, issue 7:1222‐8. [MEDLINE: ] - PubMed
Suri 2006a
    1. Suri RS, Garg AX, Chertow GM, Levin NW, Rocco MV, Greene T, et al. Frequent Hemodialysis Network (FHN) randomized trials: study design. Kidney International 2006; Vol. 71, issue 4:349‐59. [MEDLINE: ] - PubMed
Suri 2006b
    1. Suri RS, Nesrallah GE, Mainra R, Garg AX, Lindsay RM, Greene T, et al. Daily hemodialysis: a systematic review. Clinical Journal of The American Society of Nephrology: CJASN 2006;1(1):33‐42. [MEDLINE: ] - PubMed
Unruh 2008
    1. Unruh ML, Sanders MH, Redline S, Piraino BM, Umans JG, Chami H, et al. Subjective and objective sleep quality in patients on conventional thrice‐weekly hemodialysis: comparison with matched controls from the sleep heart health study. American Journal of Kidney Diseases 2008; Vol. 52, issue 2:305‐13. [MEDLINE: ] - PMC - PubMed
USRDS 2010
    1. US Renal Data System. USRDS 2010 Annual Data Report: Atlas of Chronic Kidney Disease and End‐Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2010. http://www.usrds.org/atlas10.aspx (accessed 30 October 2014).
van Manen 2001
    1. Manen JG, Korevaar JC, Dekker FW, Reuselaars MC, Boeschoten EW, Krediet RT, et al. Changes in employment status in end‐stage renal disease patients during their first year of dialysis. Peritoneal Dialysis International 2001; Vol. 21, issue 6:595‐601. [MEDLINE: ] - PubMed
Vecchio 2010
    1. Vecchio M, Navaneethan SD, Johnson DW, Lucisano G, Graziano G, Saglimbene V, et al. Interventions for treating sexual dysfunction in patients with chronic kidney disease. Cochrane Database of Systematic Reviews 2010, Issue 12. [DOI: 10.1002/14651858.CD007747.pub2] - DOI - PubMed
Walsh 2005
    1. Walsh M, Culleton B, Tonelli M, Manns B. A systematic review of the effect of nocturnal hemodialysis on blood pressure, left ventricular hypertrophy, anemia, mineral metabolism, and health‐related quality of life. Kidney International 2005;67(4):1500‐8. [MEDLINE: ] - PubMed
Walsh 2010
    1. Walsh M, Manns BJ, Klarenbach S, Tonelli M, Hemmelgarn B, Culleton B. The effects of nocturnal compared with conventional hemodialysis on mineral metabolism: A randomized‐controlled trial. Hemodialysis International 2010; Vol. 14, issue 2:174‐81. [MEDLINE: ] - PubMed
Woods 1996
    1. Woods JD, Port FK, Stannard D, Blagg CR, Held PJ. Comparison of mortality with home hemodialysis and center hemodialysis: a national study. Kidney International 1996; Vol. 49, issue 5:1464‐70. [MEDLINE: ] - PubMed

References to other published versions of this review

Palmer 2012
    1. Palmer SC, Palmer AR, Craig JC, Johnson DW, Stroumza P, Frantzen L, et al. Home versus in‐centre haemodialysis for end‐stage kidney disease. Cochrane Database of Systematic Reviews 2012, Issue 1. [DOI: 10.1002/14651858.CD009535] - DOI - PMC - PubMed