Home Haemodialysis in Children

Home haemodialysis (HHD) is not a novel concept but one that has resurfaced over the past two decades with a new profile that complements our paradigm shift in how we define ‘dialysis adequacy’ in paediatrics. The dialysis dose delivered by PD and standard in-centre HD is adequate to reduce mortality. In contrast an increase in dialysis hours per week at home delivers gentler dialysis prescriptions that result in more holistic, multifaceted treatment outcomes that are trending towards ‘optimising’ health and well-being, with the added benefit of a reduced delivery cost. Despite the positive narrative around HHD programs, uptake is still slow worldwide, and the evidence base in children is scarce. Individual departments struggle to secure the investment and commitment required to deliver a safe and effective HHD program which for many patients is a bridging therapy to transplantation. We present practical insights, experiences and outcomes from paediatric experts internationally which demonstrate the benefits for individual children and the possibility of paediatric HHD at service or population level. The description is inspiring and creates a vision for delivering more optimal dialysis with a pragmatic consideration of the ‘value added’ for a local service.