Home Hemodialysis in Saudi Arabia: Early Steps, Significant Progress in an Industry-Funded Practice

Background: Home hemodialysis (HHD) remains a relatively novel modality in the Middle East, often adopted not as a first-line therapy but as a transition from in-center hemodialysis (ICHD) when continued in-center care becomes unfeasible due to debilitating conditions such as stroke, fractures, or dementia. In such cases, the need for home nursing support may offset the cost advantages associated with HHD observed in other settings. This study describes patient- and service-level characteristics and clinical outcomes during the first two years of the DaVita-JHAH Saudi HHD program. Methods: We conducted a retrospective analysis of patients with kidney failure who initiated HHD between June 2022 and March 2025 in the DaVita-JHAH program. Variables assessed included demographic data, comorbidity burden, vascular access type, hospitalization frequency, and one-year all-cause mortality. Results: A total of 118 patients were included (mean age 70.8 ± 11.6 years; 46.6% female). Of these, 72.0% used conventional HHD machines, and 28.0% used NxStage systems. Arteriovenous fistula or graft was used in 54.2% of cases. The median dialysis vintage before HHD initiation was 14.8 months (IQR: 3.0–48.1). Diabetes (71.2%), hypertension (10.2%), and chronic glomerulonephritis (4.2%) were the most common causes of kidney failure. A Charlson Comorbidity Index ≥2 was present in 93.2% of patients, with notable rates of heart failure (31.4%), myocardial infarction (30.5%), stroke (13.6%), and peripheral vascular disease (10.2%). The one-year all-cause mortality rate was 14.7% (95% CI: 6.7%–22.7%), corresponding to approximately 7.0 deaths per 100 patient-years. The hospitalization rate was 4.3 events per 1000 patient-days of follow-up. Conclusion: All-cause mortality among HHD patients in this cohort was relatively high, likely reflecting the substantial burden of comorbid conditions within this population.