Home Dialysis: is patient autonomy for an artificial organ possible?
Résumé
The best way to make a dialysis patient autonomous is to have his dialysis done himself at home, either by "home" hemodialysis (HD) or by peritoneal dialysis (PD). Home HD has been performed since the 1970s. Its maximum was reached in the 1980s with 20% of dialysis patients in some facilities. Then the percentage decreased in France probably because of renal transplantation and self-dialysis units. Currently there is renewed interest in this method due to the arrival of new simplified machines and due to new short daily dialysis programs. PD began in the 1980s. It developed in an inhomogeneous way in France, for questions of medical care traditions. Currently it is a mature treatment and the survivals in PD and HD are equivalent. France is among the European countries where home HD and PD have the lowest prevalence. The levers of action to try to develop home dialysis in France are reviewed. Professional incentives have shown their limits and it is likely that regulatory or financial incentives are now needed alongside a proactive policy.