How to choice of the suitable renal replacement therapy? -The impact of home hemodialysis

The annual statement from “Japanese society of Dialysis therapy” reports the number of patients on blood purification therapy, hemodialysis and peritoneal dialysis, was 309,946 and that of these induction was 38,165 in 2012. Renal replacement therapy (RRT) is composed of hemodialysis (HD), peritoneal dialysis and renal transplantation (RT). Patient under CKD stage 5, below eGFR 15ml/min/1.74m2, needs to prepare blood access in case of induction of blood purification therapy. It is well known the best modality of RRT is RT among the others, but the number of RT in Japan is very low compared in Europe and the United States. There is no clinical evidence, but most widely HD therapy is 4.5 hour thrice-weekly in Japan. Recently it has been reported that frequent and long HD therapy improved the life prognosis of renal-failure patients as well as the deceased-donor RT. The frequent and long HD therapy means short-term home HD, long-term home HD and overnight HD. Increment of HD amount according hemodialysis product (HDP) probably leads to make activity of daily life on HD patients better. Here I want introduce the new modality of home HD.