Perspective of Home Hemodialysis in Japan

HHD is one of the ESRD therapies that has been established after more than 35 year's experience in Japan. However, only 279 patients were treated with HHD in 2010, which accounts for 0.1% of 297,000 dialysis patients. Long-term HD has been popular in Japanese dialysis units because of the education and enlightment by some enthusiastic nephrologists who understand the advantage of slow and long dialyses. Following excellent clinical outcomes from Tassin County in France and the DOPPS study has revealed that long and frequent hemodialysis result in good clinical outcomes. These findings have encouraged Japanese nephrologist to promote intensive hemodialysis treatment in their HD units, and HHD has become the focus of dialysis methods. This review describes the training and practical procedures of HHD in Japan. The barriers of HHD use are discussed from patient-related and medical system-related viewpoints.