Vascular Access for Home Hemodialysis: A Perspective on Tunneled Central Venous Catheters at Home

Expansion of home hemodialysis (HHD) provides an opportunity to improve clinical outcomes, reduce cost of care, and address the staffing challenges currently faced in caring for patients with kidney failure on replacement therapy. To increase HHD expansion, current practices and barriers to home dialysis must be examined and addressed. One such barrier is vascular access for HHD; although tunneled hemodialysis central venous catheters (CVCs) have been used for decades, physicians still hesitate to send patients home without a mature, functional arteriovenous access. An expert panel of clinicians was convened by Outset Medical, a manufacturer of hemodialysis systems, to review the literature and generate consensus recommendations regarding the use of CVCs for HHD. Consistent with the most recent Kidney Disease Outcomes vascular access guidelines, the end-stage kidney disease life plan should be created via shared decision making for modality choices, with the corresponding dialysis access individualized for the patient, and for whom a CVC may represent the most appropriate vascular access to provide HHD.