What Are the Keys to Promoting Home Dialysis in a Country Where In-Center Hemodialysis Is Highly Developed?

Background: In the past decade, the promotion of home dialysis has been recognized as a pressing global issue for several view points; to reduce the medical costs for chronic dialysis, to improve the accessibility to dialysis therapy, and to avoid “dialysis-related pandemic” which was recognized during the COVID-19 pandemic. Another aspect of promoting home dialysis is to create a home care environment for chronic kidney disease patients in the highly aging society. However, Japan’s rate of home dialysis, peritoneal dialysis (PD) and home hemodialysis (HHD) remain the lowest of the countries listed in the USRDS annual reports. The aim of this study is to clarify the keys to promoting home dialysis in Japan where in-center HD has highly developed. Methods: The data about home dialysis was extracted from the Japanese Society for Dialysis Therapy Renal Data Registry. The data of reimbursement was referred to those of our facilities. The data was evaluated in relation to the social and reimbursement events. Results: As of the end of 2022, the total number of chronic dialysis patients was 347,474, and 10,531 (3.0%) patients were treated by PD including 2,138 patients, and 827 (0.2%) patients. The number of PD patients had increased until 1997, but plateaued until 2020. It seemed to be the result from the shock of the life-threatening complication of PD, encapsulating peritoneal sclerosis. After the installation of an additional payment for providing proper options of renal replacement therapy, the number of PD patients are gradually increased. The number of HHD patients had been around between 100 and 150 until 1997, but it suddenly dropped because of the penalty to the doctor and the facility for false billing suspicion. Since government reimbursement for HHD was installed in 1998, the HHD patients have gradually increasing, and it was accelerated by the two positive revisions of reimbursement for HHD. There are several regulations to limit the promotion of both PD and HHD. Conclusion: The government policy, proper reimbursement and deregulation of certain regulations are important key to promote home dialysis in countries where in-center HD was highly developed.