The Way Home: A Scoping Review of Public Health Strategies to Increase the Utilization of Home Dialysis in Chronic Kidney Disease Patients

IntroductionHome dialysis (HoD) remains underutilized, despite evidence showing it provides comparable mortality rates to in-center hemodialysis (ICHD) while offering advantages such as improved quality of life and lower overall costs. This scoping review comprehensively evaluates the impact of public health interventions on increasing the use of HoD, including both Peritoneal Dialysis (PD) and Home Hemodialysis (HHD). MethodsRelevant studies were searched in the Web of Science, Medline, Embase, Scopus, EBSCOhost, and EconLit databases from their inception through May 2024. Studies were eligible for review if they assessed the effectiveness of public health interventions in terms of utilization and retention rates for general HoD, PD, and HHD. ResultsForty-three studies were included, with interventions categorized into three main types: educational programs, service provision improvements, and modifications to payment structures. Our findings indicate that educational interventions--aimed at enhancing knowledge about dialysis options and promoting shared decision-making among patients, families, and healthcare providers--and service provision improvements, such as assisted PD and nephrologist-performed catheter insertions, could significantly increase the initiation, utilization, and retention rates of HoD. However, the impact of payment interventions on HoD outcomes differed across different contexts. ConclusionEducation and service provision enhancements may represent the most effective public health interventions for increasing initiation, utilization, and retention rates of HoD in dialysis requiring patients. However, these findings are predominantly based on evidence from observational studies; further experimental studies with rigorous methodology are warranted to validate the effectiveness of these interventions in promoting HoD utilization. PLAIN TEXT SUMMARYKidney dialysis is a life-sustaining therapy that can be offered both at home and in medical centres, however, home dialysis is underutilised globally. This scoping review gathers evidence from around the world to identify and assess the effectiveness of public health interventions to improve home dialysis utilization. The interventions we found were mainly related to improving patient knowledge, redesigning service provision, or adjusting payment/reimbursement conditions. Our results suggest that educating patients about their dialysis options to support shared decision-making before they require dialysis and offering assisted peritoneal dialysis at home can help increase the number of patients starting and staying on home dialysis. However, adjusting payment and reimbursement policies showed mixed results.